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Artificial nutrition and hydration for children and young people towards end of life: consensus guidelines across four specialist paediatric palliative care centres
  1. Anna-Karenia Anderson1,
  2. Kimberley Burke1,
  3. Lizzie Bendle2,
  4. Michelle Koh3,
  5. Renee McCulloch4 and
  6. Maggie Breen1
  1. 1 Paediatrics, Royal Marsden Hospital, Sutton, UK
  2. 2 Paediatric Palliative Medicine, Evelina London Children's Hospital, London, UK
  3. 3 Paediatrics, Southampton University Hospitals NHS Trust, Southampton, UK
  4. 4 Paediatric Palliative Medicine, Gt Ormond St Hospital, London, UK
  1. Correspondence to Dr Anna-Karenia Anderson, Paediatrics, Royal Marsden Hospital, Sutton SM25PT, UK; annakarenia.anderson{at}


There is a paucity of evidence on the role, use, benefit and challenges of artificial nutrition and hydration (ANH) in children at end of life. Parents express the difficulty they face with making the decision to withdraw ANH. Decision-making on the role of ANH in an individual child requires careful multidisciplinary team deliberation and clear goals of care with children and families. Four paediatric palliative care specialist centres reviewed the current literature and developed consensus guidelines on ANH at end of life. These guidelines seek to provide a practical approach to clinical decision-making on the role of ANH in a child or young person entering the end-of-life phase.

  • artificial nutrition
  • hydration
  • end of life care
  • palliative care
  • children
  • young people

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  • Contributors A-KA: concept, design, analysis, consensus review, draft, revision. KB: literature review, draft, revision. LB: analysis, interpretation, consensus review, draft, revision. MK and RM: concept and design, consensus review, draft, revision. MB: concept and design, literature review, analysis, consensus review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.