• Rutger R G Knops, Leontien C M Kremer, A A Eduard Verhagen, and Dutch Paediatric Palliative Care Guideline Group for Symptoms.
• Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. r.r.knops@amc.uva.nl.
• BMC Palliat Care. 2015 Nov 5; 14: 57.

BackgroundChildren dying of a life threatening disease suffer a great deal at the end of life. Symptom control is often unsatisfactory, partly because many caregivers are simply not familiar with paediatric palliative care. To ensure that a child with a life-threatening condition receives high quality palliative care, clinical practice guidelines are needed. The aim of this study is to improve palliative care for children by making high quality care recommendations to recognize and relieve symptoms in paediatric palliative care.MethodsAn extensive search was performed for guidelines and systematic reviews on paediatric palliative care up to year 2011. An expert panel combined the evidence with consensus to form recommendations on the treatment of symptoms in paediatric palliative care.ResultsWe appraised 21 guidelines and identified 693 potentially eligible articles of which four met our inclusion criteria. None gave recommendations on the treatment of symptoms in paediatric palliative care. Two textbooks and an adult palliative care website were eventually our main sources of evidence.ConclusionHardly any evidence is available for the treatment of symptoms in paediatric palliative care. By combining evidence for adult palliative care and the sparse evidence for paediatric palliative care with expert opinion we defined a unique set of high quality care recommendations to relieve symptoms and lessen the suffering of children in palliative care. These results are an important tool to educate caregivers on how to relieve symptoms in children in paediatric palliative care.

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