Palliative care professes to take a family-centred approach to patient care.¹ However, children under 18 may not feel included when a parent is being cared for in a hospice.² A systematic literature review of PsychINFO, Medline, Embase, Scopus and Web of Science was conducted, with no restriction on publication date. Nineteen studies met the inclusion criteria, all reporting primary data from children under 18, whose parent has a life-limiting illness.

Findings from the review reveal that:

• Children and young people often feel excluded when a parent is dying.

• Communication about prognosis does not routinely happen with children.

• For children, the terminal period is generally more stressful than after the death.

• There are discrepancies between the support children would like from professionals and

• The support they typically receive.

Recommendations highlighted by the review:

• Regular training for all hospice staff in relation to working with children – including recognition of how parental illness may affect children, the importance of communication, and children’s understanding of death at different ages.

• Consideration of how children can be more routinely involved, for example inclusion in family meetings.

• Encouraging staff to explore patients’ wishes and feelings in relation to their children.

• Consideration of whether the hospice environment is ‘child–friendly’.

• Flexibility around working hours – children are often ‘invisible’ and visit parents in the evening and at weekends.

• Consideration of creative methods of including children, perhaps by using technology.

Hospices are encouraged to consider these recommendations and promote a model of family-centred care which includes children under 18.