Circumstances of dying in hospitalized children.

UNLABELLED: Conditions of dying in a tertiary children's hospital were assessed in a retrospective cohort study. Non-survivors, excluding newborns and emergency room patients, were allocated to four groups: brain death (BD), failed cardiopulmonary resuscitation (failed CPR), death following a do-not-resuscitate (DNR) order and death following withholding or withdrawal of therapy (W/W). In a 4-year period 190 (1.3%) of 14,903 admitted patients died. Of these 134 (71%) died on the paediatric intensive care unit, 42 (22%) on the ward and 14 (7%) in the operating room. W/W was found in 75 (39%), failed CPR in 57 (30%), BD in 32 (17%), and death following a DNR order in 26 (14%). Justifications for restrictions of treatment (W/W or DNR) were imminent death in 41 (41%), lack of future relational potential in 13 (13%) and excessive burden of disease in 47 (47%). In non-survivors analgesics and sedatives were frequently used to relieve suffering in the terminal phase. General principles for the approach of terminally ill children in whom death may become an option instead of a fate are discussed. CONCLUSION: In the majority of children dying in hospital, death occurred following restrictions of life-sustaining treatment, comprising do-not-resuscitate or other forms of withholding or withdrawal of therapy.

[Bedwetting by Dutch, Surinam, Moroccan and Turkish 3-4, 5-6, and 11-12-year-old children]. / Bedplassen bij Nederlandse, Surinaamse, Marokkaanse en Turkse kinderen van 3-4, 5-6 en 11-12 jaar.

OBJECTIVE: To investigate whether ethnic origin is related to the prevalence of bedwetting among children and how parents handle bedwetters. DESIGN: Descriptive study. SETTING: Department of Youth Health Care in Amsterdam, the Netherlands. METHOD: Parents of children who attended a child health centre in 1992/1993 were interviewed using a questionnaire. A total of 1506 children aged 3-4, 2422 aged 5-6 and 2081 aged 11-12 years participated in the study. RESULTS: The prevalences of bedwetting were 24.6%, 15.7% and 5.4% at 3-4, 5-6 and 11-12 years of age respectively. Moroccan and Turkish 3-4-year-olds wet their beds just as often as Dutch children, Surinamese 3-4-year-olds less often. However, Surinamese, Moroccan and Turkish school children wet their beds more often than their Dutch classmates. For Dutch children the prevalence of bedwetting at the age of 5-6 was clearly lower than at the age of 3-4, in contrast with Surinamese, Moroccan and Turkish children. Non-Dutch bedwetters were rewarded less often for a dry night and punished more often for a wet night than Dutch bedwetters, even at the age of 3-4. CONCLUSION: Bedwetting by school children still occurs often, and more often among non-Dutch than among Dutch children. Possibly, differences between Dutch and non-Dutch parents in the ways they deal with bedwetting plays a part. Appropriate information and support of (especially non-Dutch) parents of young children can perhaps reduce the prevalence of bedwetting at later ages.