Which statement best describes decisions about goals of care during a pediatric arrest?

• A. Proceed with full escalation regardless of directives.
• B. Respect advance directives and family wishes; discuss goals of care and consider stopping resuscitation per orders when appropriate.
• C. Never discuss goals during arrest.
• D. Only medical staff decide without family input.

Answer: (B)

During a pediatric arrest, decisions about goals of care should center on respecting any advance directives or existing orders and actively involving the family to determine what level of treatment aligns with the child’s values and prognosis. If there are valid do-not-resuscitate or other limits in place, those orders guide the course of action and resuscitation should be stopped or adjusted accordingly when appropriate. If no directives exist, clinicians should engage the family as soon as feasible to discuss goals of care, weighing the benefits and burdens of continued resuscitation and considering a shift toward comfort-focused care if that reflects the family's wishes and the child’s best interests. This approach honors autonomy, strengthens family-centered decision-making, and aligns medical actions with the child’s overall goals of care. Other approaches that ignore directives, avoid essential conversations, or leave the family out of decisions do not fit this framework.