The management of pervasive refusal syndrome illustrates the practical application of hope promoting principles in clinical work. It involves a multidisciplinary team approach and a structured yet flexible management plan with a clear rationale employed over months to years. This article details the components of such a plan, including nursing management, physiotherapy, individual and family therapy. Pre-admission expectations, the necessary assessments on admission, and the establishment of management goals are also discussed. The issue of consent is elaborated, emphasizing the problematic role that refusal plays. Steps to ensure the child's survival and optimal development are outlined. Specific problem behaviours in the child and the family are described, and the need for adequate support within the treatment team to deal with these problems is considered. Attitudes that facilitate staff survival of the long haul of treating these children are described. Despite the difficulties, however, the typically favourable outcome of treatment is reported. The high cost, in terms of money and morale, means that more efficient management plans need to be developed.
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