Ask yourself, ‘Would I be surprised if this child died within a year?’ If the answer is ‘no’ [I would not be surprised], consider progressing to steps 2 and 3.

Child or parents wish to progress advance care planning discussions. Life-limiting condition and any of the below:

• family or staff recognise deteriorating patient condition
• conflict between parents and clinical team regarding use of life-sustaining medical therapy
• three or more unplanned hospital admissions in the past 12 months
• prolonged unplanned hospital admission > 3 weeks
• intensive care unit stay ≥ 1 week
• multi-organ failure
• severe infectious disease
• initiation of palliative therapy
• palliative therapy and new/progressing symptoms
• participation in phase 1 trial
• increasing difficulty controlling symptoms
• prolonged or failed attempts to wean off invasive ventilation
• escalating non-invasive ventilation requirements
• under consideration for transplant (solid organ or bone marrow).