WASHINGTON -- The U.S. health care system needs to improve the care it gives to dying and chronically ill children and the support it provides to their families, according to a report issued on Thursday by the Institute of Medicine. "It is hard to imagine a situation that has a greater imperative for humane care-giving, yet far too often today it is not provided," Dr. Richard Behrman, who headed the institute's committee that studied the subject, said in the report. "It is time to correct this situation."

The institute provides advice on health policy issues under a congressional charter.

The report focuses on palliative care, the practice of relieving or preventing a person's pain and other symptoms, and on end-of-life care, meant to prepare people for death by thinking through life-support decisions, last family visits and adjusting symptom management.

The institute's report called for health care professionals to provide a more focused care plan attuned to a grieving family's sensitivities.

"This report argues that we can and should do more than we currently are doing to prevent and relieve the physical and emotional suffering of dying children and the psychic pain of their families, to respect the personal dignity of the dying child and the grieving family, and to allow all who are affected by a child's death the opportunity to address their feelings and concerns," Behrman said.

---- Emotional, Spiritual and Cultural Needs ---- "We can and we must reduce the number of those who fail to receive consistent, competent care that meets not only their physical needs, but their emotional, spiritual and cultural ones as well," added Behrman, whose panel included doctors, nurses and professors from universities and hospitals.

While advances in medicine mean that fewer children are dying, about 55,000 children, from newborns up to age 19, died in 1999, according to the institute. The most common fatal chronic conditions in children are cancer, heart diseases and lower respiratory conditions.

Nearly half of those 19 and under who die do so before reaching their first birthday, often due to congenital abnormalities, complications related to pregnancy or sudden infant death syndrome.

Teens aged 15 to 19 make up the second-largest percentage of deaths, usually from injuries. Overall, injuries account for 30 percent of deaths in children.

Deborah Dokken, who testified before the committee while it was gathering facts for the report, described her experiences with a Washington hospital before her young daughter died.

She said the baby, Abigail, was born prematurely and was only 6 months old when she died. She said neither she nor her husband ever were told that Abigail's death was a possible outcome, and they were unprepared when she died after one in a series of medical procedures.

"We learned the hard way," Dokken said in an interview.

"To me, it's just critically important that health care professionals work with parents so that parents feel capable as parents making the decision they need to," Reuters quoted Dokken as saying.

A 1997 Institute of Medicine report focused on guidelines, but mainly for adults, and a need for specialized information for practitioners emerged for those under 20, who account for about 2 percent of deaths annually, according to the report.

Children are not usually able to understand what is happening to them in the hospital as well as adults do -- physically, emotionally or spiritually, the report said.

Some children die suddenly or unexpectedly from rare diseases, while others are chronically ill for years. This means doctors, nurses, social workers, religious staff and volunteers have to be flexible as they struggle to make life as normal as possible for families, the report said.

The report offered three new goals specific to children: designing appropriate care on an individual basis; involving and respecting the child and the family; and integrating families into the medical care team.

The report suggested preparation and conversation as essential themes for health care practitioners to keep in mind when communicating with child patients and families.