Symptom management in palliative care of the child or young person (CYP) with cancer

This section is designed to give a brief insight into the medical management of the main symptoms experienced in the child or young person (CYP) with advanced cancer and a brief insight into the main issues families face. 

This should be read alongside the section 'Palliative care in the child and young person (CYP) with cancer - background informationduction to palliative care' which includes discussion on regional variations of palliative care services.

If you are reading this as a member of the community multi-disciplinary team, please be reassured that you should never be left to palliate a child or young person with cancer without input and advice from the patient’s specialist cancer centre team. The following booklets are also useful:

The main symptoms experienced in the children and young people age group are similar to adults:

  • Pain
  • Anxiety
  • Agitation and restlessness
  • Seizures (convulsions/fitting)
  • Nausea and vomiting
  • Excessive secretions
  • Breathing problems
  • Fatigue
  • Drowsiness
  • Constipation
  • Itching
  • Urinary problems
  • Nutrition

(Together for Short Lives, 2024)

The palliative care team will use recognised paediatric (0-16 years) or adult (16-24 years) palliative care drug formularies to manage pain and other symptoms (Together for Short Lives, 2024).  Some commonly used drugs are:

  • Analgesics including Non-Opioids e.g. paracetamol and Opioids such as Morphine, Oxycodone, and Fentanyl
  • Midazolam
  • Steroids
  • Laxatives

 Non-pharmacological interventions are also recommended within palliative care guidance.  

There are significant differences in the types of symptoms reported by professionals and families looking after children adolescents of cancer (Woofe, 2000). A symptom history should be actively sought and frequently updated.

Children differ from adults in their body composition, absorption, distribution, metabolism and elimination of drugs (Greenstein, 2006). Children also have a higher metabolic rate (BNF, 2025). In paediatrics, drugs are prescribed as per body weight or surface area. In some cases doses are capped and in most cases the maximum adult dose should not be exceeded, however, palliative or end of life analgesia can be an exception to this rule.

As advised in the BNFC (2025), wherever possible, medicines should be prescribed within the terms of the product licence. However, it is acknowledged that many children and young people may require medicines that are not licensed for the paediatric age group, or used “off label.”

To achieve optimal pain control, it may be necessary to use different routes to administer pain medication. The routes of administration may vary depending on your area of work as this can differ between a paediatric setting and TYA/adult setting. In children’s services, one way that pain relief may be administered is via a continuous infusion of pain medication through patient-controlled analgesia (PCA) or nurse-controlled analgesia (NCA). Having a continuous background rate running and being able to self-administer a bolus, a PCA can give a sense of control back to the CYP.

Syringe drivers or CADD pumps are widely accepted in delivering of drugs in palliative care (Together for Short Lives, 2024). These are easy to use via the subcutaneous route and their universal use aids the staff involved in the cross-boundary and regional care of the palliative children and young people.

Paediatric Palliative Care Formularies and manuals have been developed that are used throughout the UK; the most commonly used are listed below:

References

British National Formulary. (2025).  Prescribing in children. London: Royal Pharmaceutical Society. Available at: https://bnf.nice.org.uk/medicines-guidance/prescribing-in-children/ (Accessed: 15 August 2025)

Greenstein B. (2006). Trounce’s Clinical Pharmacology for Nurses 17th edn. London: Churchill Livingstone

National Institute for Health and Care Excellence (2016) End of life care for infants, children and young people with life-limiting conditions: planning and management (NG61). Last updated 2019. Available from: https://www.nice.org.uk/guidance/ng61 (Accessed 15th August 2025).

Wolfe, J., Grier, H.E., Klar, N., Levin, S.B., Ellenbogen, J.M., Salem-Schatz, S., Emanuel, E.J. and Weeks J,C. (2000) ‘Symptoms and suffering at the end of life in children with cancer’. The New England Journal of Medicine, 342(5), pp. 326-333.

Page last updated: March 2026