anxiety, brain tumors, hiccups, palliative care, pediatrics, seizures, vomiting



  1. Madden, Jennifer R. MSN, RN, CPNP
  2. Hendricks-Ferguson, Verna L. PhD, RN
  3. Foreman, Nicholas K. MD


Children dying of a brain tumor often experience unpredictable and poorly controlled symptoms (vomiting, seizures, anxiety, loss of function, and neurologic changes). Ineffective control of symptoms can cause physical and emotional discomfort for affected children. In this case study, we will describe (a) a palliative care (PC) intervention used to manage target symptoms experienced by a 6-year-old male pediatric patient with a progressive brain tumor, (b) the steps used by a neurooncology team to plan and administer a continuous infusion of midazolam to control the target symptoms for this patient in the home setting, and (c) the role of an advanced practice nurse during the home care management of this patient's symptoms. The PC intervention encompassed administration of continuous-infusion medications to manage commonly identified symptoms among children diagnosed with a progressive brain tumor. We propose that use of an effective symptom-control intervention has the potential to decrease suffering, to promote quality of life among children dying of a brain tumor, and to potentially foster a peaceful death in the affected child's home.