Nearly all children worldwide who need palliative care live in low and middle-income countries, according to a new study led by researchers at the University of California Los Angeles (UCLA) and published in The Lancet Child & Adolescent Health. The report estimates that 10.6 million children experienced serious health-related suffering (SHS) in 2023, with 96%—about 10.2 million—residing in these regions.
The study defines SHS as pain and distress linked to life-threatening or life-limiting conditions, covering physical, psychological, social, or spiritual aspects. Researchers found that most children needing palliative care now live longer with chronic illness, shifting the demand for services from end-of-life care to long-term support.
The three leading causes of SHS among children were endocrine, metabolic, blood and immune disorders (51%), premature birth and birth trauma (18%), and injuries (7%). While these were common across income groups, the third leading cause differed: HIV was predominant in low-income countries; congenital malformations in lower-middle-income countries; leukaemia in upper-middle-income countries; and injury or poisoning in high-income countries.
Between 1990 and 2023, low-income countries saw a 34% increase in children needing palliative care, while high-income countries had a 36% decrease. This shift is attributed partly to reductions in pediatric HIV cases and broader health system improvements.
The research used updated methods specific to children’s needs and analyzed data from the Global Burden of Disease Study 2023. An international panel identified which conditions caused significant symptom burdens for young people. In total, the study covered 21 health conditions across different regions and income levels.
Researchers argue that unmet palliative care needs represent a major global health challenge due to limited resources. They note that previous estimates suggested $1 million per year could cover pain medication for all children aged 0-14 needing it in low-income countries. However, pediatric palliative care remains underfunded and overlooked.
“The suffering of children, especially those living in poverty, has been largely invisible in global health policy,” said co-lead author Dr. Felicia Marie Knaul of UCLA Health’s David Geffen School of Medicine. “Our findings underscore the urgent need to expand access to high-quality paediatric palliative care. As more children live longer with serious illness, health systems can and must respond with adequately funded, child-specific policies to reduce the avoidable burden of suffering.”
The authors recommend integrating palliative care into universal health coverage programs and ensuring access to essential medicines tailored for children. They also call for expanded training for healthcare professionals at all levels.
UCLA has been associated with notable achievements including Nobel laureates and MacArthur Fellows according to its official website. The university is recognized nationally and internationally for its excellence in scholarship, arts, athletics,diverse perspectives, inclusive environments,and academic programs supported by its 419-acre campus. UCLA operates within the University of California system.
The study was funded by the University of Miami. Disclosures related to research grants or advisory roles are available in the original publication.
