In addition, children and young families are disproportionately represented among immigrants and thus are especially vulnerable to misunderstandings related to differences in language, cultural experiences, and values about life, illness, death, and medical or nonmedical therapies. Millions of children, both immigrants and native born, live with their families in unsafe environments that put them at high risk of injury. Such environments can also make it a challenge to get a child to the doctor, pick up a prescription, or persuade a home care provider to come into the neighborhood. These broader problems are not the subject of this report, but their contribution to deficits in care for children and their families should be recognized in strategies to improve pediatric palliative, end-of-life, and bereavement care.
In general, the basic working principles and starting points set forth in the 1997 IOM report apply to children as well as adults. Some details differ, however, and certain additional values apply either uniquely or with special emphasis to children. Of the principles adopted by this committee (Box S.1), the first three are specific to children; the other four restate earlier principles from the 1997 report in terms of children.