Assisting families facing a death necessitates constant reevaluation of each family's adaptation to the illness. Protracted terminal illness is particularly difficult because the prolonged stress, suffering, and pain may be much more difficult to cope with than the death itself. Successful management requires acknowledging the families' emotions, assuring them that their responses are normal, and providing them a balanced perspective through supportive, honest, and open communication. In so doing, the pediatrician can help families predict reactions, manage problems, and avoid long-term psychological consequences.