Mercedes Bernadá, MD – Associate Professor of Pediatrics, School of Medicine of the University of the Republic in Montevideo, Asociación Española, Uruguay
Dr. Bernadá’s is a leading specialist in pediatric palliative care (PPC) and served as Coordinator of thePPC Unit at the Centro Hospitalario Pereira Rossell, one of the country’s principal children’s hospitals. Her work focuses on improving quality of life for children with serious illnesses and supporting their families through comprehensive, interdisciplinary care. She has contributed to international research and collaborations in pediatric palliative medicine, including peer-reviewed publications on pain management and care delivery models, and participation in national and global initiatives to advance education in PPC.
Featured Article
Holland, C., Nohavicka, L., & Harrop, E. J. (2026). Symptom management: How can specialist paediatric palliative care teams help? Archives of Disease in Childhood: Education and Practice Edition. (2043136268).
Through a brief, simple and descriptive clinical case study, Holland and collaborators from the Helen and Douglas House (UK) point out the important role of Specialists in Pediatric Palliative Care (SPPC). These specialists’ roles include teaching the key principles of comprehensive symptom management among pediatric professionals outside the PPC community. This is a great need all over the world!
The authors illuminate the increasing “medical complexity” that pediatricians and other pediatric professionals are encountering in many settings. As a consequence, the generalized need for disseminated knowledge and competencies for comprehensive symptom management is expanding. This article highlights the importance that SPPC interface with local core providers and tertiary specialists to ensuring equitable access and support for patients and families.
With two simple vignettes, one with the case of a child with a severe neurological disease and another of an adolescent with advanced cancer, the authors describe the applicability of a comprehensive symptom management model, either for the diagnostic and analytical phase or for the multimodal treatment approach, for symptoms presented in children facing life limiting or threatening conditions (LLTC).
Authors highlight the importance of interdisciplinary approach to understand biological, psychosocial and spiritual determinants. This article considers exacerbating factors as well as multimodal treatment, both pharmacological and non-pharmacological management, using evidence-based and expert recommendations for symptom control and prescription.
Through the clinical examples, they show the applicability of this model to the following frequent problems: feed-related visceral symptoms, dystonia and neuropathic pain in children with severe neurological impairment in different stages of disease trajectory and to breathlessness in children with cancer.
The authors also draw attention to challenges typically present in pediatric settings: the frequent co-existence of 3 symptoms, on average, in children with LLTC, becoming more frequent close to end of life; the heterogeneity in access to SPPC according to health care setting, locality or country; and difficulties related to medication administration, including medication refusal. What is helpful is that the authors include some advice regarding these situations, and note the availability of liquid medications suitable for children as one example.
As for recommendations, the authors also encourage empowering patients and families to actively participate in the decisions regarding quality of life. In addition, they note the importance of including SPPC, particularly when symptoms are complex or additional support for healthcare professionals, children or families is needed when navigating complex decision-making or changing illness trajectory.
From my perspective in Latin America, what I found interesting about this article is that it offers practical and simple ideas for addressing a global problem. There is a growing need for a PPC approach for the increasing number of children living with LLTC, and to address the worldwide scarcity and heterogeneity in accessing quality PPC. This increases the need to democratize both knowledge and PPC competencies. The article comes from the Helen and Douglas house, the birthplace of PPC. It shows that even in high income countries, it is unlikely that all children in need of PPC will be able to access professionals with advanced specialist training. This is even more pronounced for those living in medium or low-income countries, where most of the children in need of PPC live.
In our experience in a small Latin American country such as Uruguay, we understand that training enough interdisciplinary SPPC professionals will take much longer than suffering children can wait, therefore other strategies are necessary in the meantime.
That is why I agree with the authors that SPPC should be available for direct complex symptom management and support for families and professionals navigating complex decision- making processes. Critically, disseminating guidance and principles of comprehensive symptom management to non-SPPC professionals is helpful for those in charge of the children at shifts and in all clinical settings. Although it is not easy, we are strongly convinced that clinical care, education, research, and advocacy must be simultaneous tasks for leaders and specialists in PPC.
In our opinion, this brief report is a nice example and hopefully a model for more literature by other colleagues from all over the world describing other specific clinical situations and challenges. As with this one, they might help to illuminate clinical management to many pediatric professionals who don’t have the possibility of advanced PPC training, but do have the need to comprehensively address children suffering all over the world.
TRENDS 2026; Issue #04
Click the links below to view this months full list in desired format.
Acuna-Caicedo, S. A., Gonzalez-Brossard, A. G., Perez-Gonzalez, L. E., Arcia-Galvez, M. E., & Sanchez-Cardenas, M. A. (2026). Community-based pediatric palliative care: A systematic review of structures, processes, and outcomes. Jornal de Pediatria, 102(2), 101510. (2043358938).
Adlung, C., Niehot, C., & van Capelle, C. (2026). Quality of care metrics contributing to the development, implementation, and evaluation processes of telehealth solutions in home-care settings for paediatric palliative care: Protocol for a systematic literature review. BMJ Open, 16(2), e112005. (650293627).
Alvarez-Perez, Y., Duarte-Diaz, A., Rivero-Santana, A., Abrante-Luis, A., Carreras, B., Infante-Ventura, D., Ramos-Garcia, V., Herrera-Ramos, E., Marrero Gomez, J. L., Torres-Castano, A., & Perestelo-Perez, L. (2026). Effectiveness of psychological interventions for children eligible for pediatric palliative care: Systematic review and meta-analysis. BMC Pediatrics. (650174063).
Burgess, A., Murray, C., & Clancy, A. (2025). Fathers’ relational experiences of stillbirth: Pre-natal attachment, loss and continuing bonds through use of objects. Omega: Journal of Death and Dying, 91(4), 1779–1806. (2026-42924-005).
Clancy, M., & Thomas, F. (2026). Fostering cultural humility in perinatal palliative care. An interpretative qualitative study from the United Kingdom. Mortality, 31(1), 55–75. (191375309).
da Rosa, R., Dos Santos, J. L. G., Ross, R., de Lima, M. M., Antunes Wilhelm, L., & Costa, R. (2026). Model of interprofessional care for the newborn and family during neonatal death and dying: A multistage evaluation mixed methods study. Journal of Interprofessional Care, 1–9.
Ekberg, S., Danby, S., Watts, J., Weinglass, L., Cooke, R., Nelson, M., Pitt, E., Ekberg, K., Bluebond-Langner, M., Langner, R., Bradford, N., Yates, P., Delaney, A., Duffield, J., Orr, A., Fleming, S., Scully, M., Ryan, S., & Herbert, A. (2026). Involving Nonspeaking and Speaking Children in Clinical Encounters: An Observational Study of Real-World Clinical Encounters. Journal of Paediatrics and Child Health, 62(2), 273–281.
Hanna, R., Hasson, F., Beck, E., & Keeney, S. (2026). The Use of Patient-controlled Analgesia for Children Requiring Symptom Management at End of Life: A Scoping Review. Pain Management Nursing.
Holland, C., Nohavicka, L., & Harrop, E. J. (2026). Symptom management: How can specialist paediatric palliative care teams help? Archives of Disease in Childhood: Education and Practice Edition. (2043136268).
Jackson, K., Marchetta, A., Nierenberg, B., & Valenzuela, J. M. (2026). Religion and spirituality in pediatric end-of-life: A systematic review. Journal of Pediatric Psychology. (650191159).
Kelly, J.-A. J., Griffin, K. A., Vemuri, S., Sacks, B., & Lee, S. (2026). Loading phenobarbital in paediatric home-based terminal care: A case series. Palliative Medicine, 40(2), 265–272. (191177803).
Kubek, L., Wager, J., Brzoska, P., Fraser, L., & Zernikow, B. (2026). Introducing the Descriptive Framework for Assessing Epidemiological Cross-National Transferability: Application to Extrapolating Pediatric Life-Limiting Condition Prevalence Between Two European Countries. Journal of Palliative Medicine, 29(1), 11–24. (190928920).
Lafrenaye, S., Dumas, M., Gosselin, E., Duhamel, A., & Bourgault, P. (2021). Parents living with a child afflicted by a life-limiting medical condition: Typology of their narrative identity. Qualitative Research in Medicine & Healthcare, 5(2), 9174.
Manrriquez, A., Chen, H. H. A., Klein, M. J., Rake, A., Greenman, J., Winter, M. C., & Arora, G. (2026). Mock No Code: A simulation curriculum for responding to patients with varying goals of care. Journal of Pain and Symptom Management. (650317675).
Pearson, T., Due, C., & Obst, K. (2025). Culturally and linguistically diverse men’s grief experiences following perinatal death in Australia. Omega: Journal of Death and Dying, 91(3), 1331–1347. (2026-34555-015).
Perenyi, C., Cambonie, G., Durand, S., Lahaye, F. V., Gaudaire, A., Milesi, C., & Gavotto, A. (2026). End-of-life circumstances and unanticipated deaths in a neonatal intensive care unit: A retrospective analysis. BMC Palliative Care.
Richner, G. J., Forbes, M. L., Aultman, J. M., Grossoehme, D. H., Oravec, M. J., Page-Goertz, C. K., & Friebert, S. (2026). Palliative Care and Decision for Terminal Cardiopulmonary Resuscitation in the PICU: Single-Center, Retrospective, Mixed-Methods Analysis, 2013-2022. Pediatric Critical Care Medicine: A Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Rissman, L., Collell, A., Lyons, K., Ashworth, R., Alladin, A., & Dickerman, M. (2026). Palliative Care Education for Pediatric Critical Care Trainees: A Scoping Review and a Call to Action. The American Journal of Hospice & Palliative Care, 10499091261424903. (650221065).
Safarifard, R., Molati, A., Kiernan, G., Corcoran, Y., Courtney, E., Mitchell, J., Akard, T. F., & Lambert, V. (2026). Feasibility and Acceptability of a Digital Storytelling Intervention in Paediatric Palliative Care: A Small-Scale Pilot Study in Ireland. SSRN. (2043217501).
Saringer-Siegl, S., Essl-Maurer, R., & Paal, P. (2026). Nurses’ perspectives on implementing pediatric palliative care: A qualitative participatory study on the emerging role of the advanced practice nurse. European Journal of Pediatrics, 185(3), 143. (2043376082).
Siddiqui, K., Al-Musa, A., Alsaedi, H., Ghemlas, I., AlAnazi, A., Al-Ahmari, A., Ramiz, S. W., Sadler, K., Virk, T., Ayas, M., & Khan, S. J. (2026). Retrieval-Augmented Generation (RAG) AI for End-of-Life Support in Pediatric HCT: Bridging Information Gaps for Patients and Caregivers on Palliative Care. Transplantation and Cellular Therapy, 32(2 Supplement), S557. (2043182171).
Singh, S., Buddington, S. S., & Huseynova, R. (2025). Ethical Challenges in Neonatal Life Support. Newborn: Official Journal of the Global Newborn Society, 4(4), 194–202. (191365625).
Superdock, A. K., Farner, H., Reeves, C., Mehler, S., Christianson, C., Gehle, S., Garrett-Thomas, D., Mack, J. W., & Kaye, E. C. (2026). Hope and Uncertainty in Prognostic Discussions. Pediatrics, 157(2), 1–10. (191273968).
Zengin, M., Yayan, E. H., & Kenc, I. (2026). The Experiences of Primary Caregivers of Children Receiving Palliative Care: A Qualitative Study. Journal of Hospice and Palliative Nursing : JHPN : The Official Journal of the Hospice and Palliative Nurses Association. (650287062).
Zhu, Y., Zhang, Q., Zhang, Y., Zhao, Q., & Zhang, A. (2026). Factors Influencing Bereavement Care Competence in Midwifery Students: Regression and QCA Analysis. Nursing Open, 13(1), 1–10. (191182318).