FIGURE S.1 Percentage of total childhood deaths by age group (1999).

maturity, pregnancy, or childbirth. For older infants, sudden infant death syndrome (SIDS) is an important cause of death.

For older children and teenagers, unintentional and intentional injuries are the leading causes of death. Overall, injuries account for approximately 30 percent of child deaths (Figure S.2). Given the importance of sudden and unexpected deaths from injuries and SIDS, efforts to improve care for children and to provide support for bereaved families must extend to emergency first-response personnel, including police, emergency department staff, and staff of medical examiners’ offices. Among fatal chronic conditions, the most important are cancers, diseases of the heart, and lower respiratory conditions.

Common Problems Experienced by Both Children and Adults

Some deficits in palliative and end-of-life care for children parallel those experienced by adults. For example, frightened and upset patients and families may receive confusing or misleading explanations of diagnosis, prognosis, and treatment options. They may likewise be provided too little opportunity to absorb shocking information, ask questions, and reflect on goals and decisions, even when no immediate crisis drives decisionmaking. Patients at all ages suffer from inadequate assessment and management of pain and other distress, despite the ready availability of therapies known to help most patients. For both children and adults, physicians may advise and



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