Although dying is a part of life, a child's death, in a very real sense, is unnatural and has a devastating and enduring impact. Over the past century such deaths have been significantly reduced by socioeconomic, public health, and medical advances in developed countries such as the United States. Nonetheless, over 50,000 children die each year.

This report builds on two earlier IOM reports - Approaching Death: Improving Care at the End of Life (1997) and Improving Palliative Care for Cancer (2001). It continues their arguments that medical and other support for people with fatal or potentially fatal conditions often falls short of what is reasonably if not simply attainable.

Key messages of this report include:

• Too often, children who die and their families fail to receive competent, compassionate, and consistent care that meets their physical, emotional, and spiritual needs.
• Current methods of organizing and financing palliative, end-of-life, and bereavement care compromise the provision and coordination of the best mix of services to help children and families and sometimes present families with cruel choices between curative or life-prolonging care and certain palliative services, in particular, hospice care.
• Better care is possible now, but we also need better data and scientific knowledge to guide efforts to deliver more effective care, educate professionals to provide such care, and design supportive public policies.
• Improving care for children who die and their families should help improve care for all children and families facing a child's life-threatening medical condition.