A New Holistic-Evolutive Approach to Pediatric Palliative Care

Carlo Bellieni is currently the Director of the Pediatric Pain Prevention Unit at University of Siena, with a 20-year experience in general pediatrics, neonatal intensive care, infant care and neonatal electroencephalography. His clinical experience covers several fields among which: neonatal resuscitation, intubation, infection therapy and pain management, bioethics. Since 2004 he has a relevant story of teaching in pain treatment and pediatrics. Dr. Bellieni has obtained the license as Associated Professor of Pediatrics by the Italian Ministry of Instruction in 2014 and of Full Professor in Pediatrics in 2018. He has been invited speaker in many national and international congresses on pediatric pain, palliative care and environmental hazards in pediatric settings. He teaches in a Master of Pediatric Palliative Care in the University of Aguas Calientes (Mexico). Prof. Bellieni owns 2 Italian and 1 European patents of medical tools; he is member of 14 international and national scientific associations and serves as a reviewer or member of the editorial board of 50 international scientific journals. He has written more than 300 scientific papers with a high total impact factor and Hirsh score, mainly in the field of pediatric analgesic treatment. He also wrote several books, chapters of books and encyclopedias. He has performed scientific research in the field of pediatric analgesia, and environmental hazards, producing new analgesic treatments and pain assessment tools.

His researches on pain have been reported by several international mass media, e.g. BBC, CNN, Time (US), Times (London), Le Figaro, Le Monde (Paris), El Mundo, La Vanguardia (Madrid). In the field of pediatric pain Prof. Bellieni developed, validated and published a new pain scale (ABC scale); developed, validated and published a new method of non-pharmacological analgesia (Sensorial Saturation, also known as "Multisensory Stimulation"); edited books and published more than 300 papers and chapters of books and encyclopedias; gave many lectures in hospitals and universities and interviews to the main international newspapers and mass-media and taught pediatric and neonatal pharmacology, with special regard to pain treatment.

Part I. Communication Throughout Palliative Care.- Crucial Importance Of The Dialogue.- Certain news is indelible.- The importance of silence.- Informed Consent: Ethical And Practical Peculiarities.- Understanding The Phase Of Grief To Speak Properly To The Patient.- Phases or stages of grief.- The pathological or unresolved grief.- When should I ask for help?.- What are postponed griefs?.- It Is Difficult To Use The Word Death.- Dealing with death and babies.- Piaget's Theory: How Children Change Their Mode To Understand Throughout Their Growth.- How The Piaget Models Are Applied To The Dialogue With The Children About Death.- Special children.- Obstacles To Communication.- Desire to protect the child from distress.- Parents' emotional well-being.- Factors that influence the communication of health professionals.- Learning To Communicate According To The Patient's Character And Mood.- Bringing Your Patients Mentally Close: The Briggs Indicator.- Part II. Ethics And Palliative Care.- What Is "Ethical".- Not principles but virtues.- The drama of imitation and of being mere "copies of the human".- The conditions for ethics: Reason, Realism, Empathy.- Does The Child Have Ethical Responsibilities?.- The role of coherence and imitation.- Children are not small adults.- Suicide.- Children are not allowed to choose something against their health.- Parents Cannot Choose But Children's Health And Wellbeing.- The Words Of Health Show That Healthcare Is "Alliance" And Not Mere Procedures.- Origin of the words "medicine", "health", "care".- What Is Health.- Health is socially helped satisfaction.- Health is possible even for the sick.- Health and loneliness are false friends.- Pain and environment limit real health.- Part III. Perinatal Care.- Treating As Human Those Who Do Not Seem Human: The Philosophical Dilemma.- Fetal Palliative Care.- Newborns: To Heal Them All, And At Any Price?.- Criteria.- The probabilistic criterion.- Best interest principle.- The least harm criterion.- The least pain criterion.- Measuring Pain And Stress.- Scales.- Other tools to measure pain.- Part IV. Therapies.- Analgesic Therapies.- Drugs.- Adjuvant analgesics.- Non-pharmacological therapies.- Distraction: Physiological Basis.- Sedation.- Drugs.- Scales.- Self-sedation.- Refractory symptoms.- Sedation is not always necessary.- Opioids In Pediatrics.- Main opioids used in pediatrics.- Recommendations.- Most common objections.- Opioid withdrawal.- When to start or continue opioids for chronic pain.- Selection, dosage, duration, monitoring and suspension of opioids.- Special Needs.- Part V. Landmarks For A Holistic-Evolutive Approach.- The Three Paradoxes Of Caring For Terminal Children.- The baby scares us.- Paradox of the contemporary flowering and death.- Paradox of inverted reason.- Paradox of the spectator's shadow (Plato's myth).- Wrong Cases Of Pediatric Palliative Care.- Use of a smoky principle.- Therapeutic obstinacy.- Contagious Pain.- Caregivers' burnout.- The pain ofthe parents.- A vicious circle.