Dyspnea in Children with Serious Illness.

Dyspnea is a common and distressing symptom in children living with serious illnesses, particularly near the end of life, and requires thoughtful, family-centered assessment and management. A stepwise nursing approach to pediatric dyspnea is explored, which includes clinical assessment, identification of potentially reversible causes, and shared decision-making grounded in the child's symptoms, goals of care, and family context. Using a case study of a child with metastatic osteosarcoma, practical strategies are highlighted for symptom management, including nonpharmacologic interventions, communication, anticipatory guidance, and pharmacologic treatment. It is paramount to balance evidence-based practice with value-based care to reduce suffering, support function and comfort, and respond adaptively to changing needs across the illness trajectory.