Skip to main content
. 2011 Apr;16(4):241–242. doi: 10.1093/pch/16.4.241

TABLE 1.

Summary of general principles from the American Academy of Pediatrics clinical report on forgoing medically provided nutrition and hydration in children

  1. Children capable of safely eating and drinking who show signs of wanting to eat or drink should be provided food and fluids.

  2. Medically provided fluids and nutrition constitute a medical intervention that may be withheld or withdrawn for the same types of reasons that justify the medical withholding or withdrawing of other medical treatments.

  3. Decisions about whether medical interventions should be provided to a child, including medically provided fluids and nutrition, should be based on whether the intervention provides net benefit to the child.

  4. The primary focus in decision-making should be the interests of the child.

  5. Although withholding or withdrawing medically provided fluids and nutrition may be morally permissible, it is not morally required.

  6. Medically provided fluids and nutrition may be withdrawn from a child who permanently lacks awareness and the ability to interact with the environment. Examples of such children include children in a persistent vegetative state or children with anencephaly. The diagnosis and prognosis should be confirmed by a qualified neurologist or other specialist with expertise in the evaluation of children with these conditions.

  7. Medically provided fluids and nutrition can be withdrawn from children when such measures only prolong and add morbidity to the process of dying. In these situations, continued fluids and nutrition often provide very limited, if any, benefit and may cause substantial discomfort. Some examples of children in this group include those with terminal illnesses in the final stages of dying, infants born with heart defects that are ultimately incompatible with survival beyond a few months and for which transplant is the only therapeutic option, infants with renal agenesis, or infants with a severe gastrointestinal malformation or a disease that is destructive to a large portion of the gastrointestinal tract, leading to total intestinal failure, and whose parents have opted for palliative care rather than intestinal transplant.

  8. Parents or guardians should be fully involved in shared decision-making with the physician and health care team and should support the decision to withhold or withdraw medically provided fluids and nutrition. Parents should be reassured that their child will be kept comfortable and should be informed about the likely course of events, including broad estimates of when the child’s death is anticipated. Comprehensive palliative care measures for the child, including appropriate sedation and oral hygiene, should be provided in this situation.

  9. Ethics consultation is strongly recommended when particularly difficult or controversial decisions are being considered.

Reproduced with permission from reference 5