The author describes the development of pediatric palliative care (PPC) based on a journey through 45 years as a nursing student, clinician, educator, and researcher. He describes what inspired his involvement in this field, reflect on significant markers in the early development of PPC. The author identifies significant current work in the field, selected challenges, and a hope for the future. The earliest work in the field that has come to be known as PPC centered on the care of children who were dying children with leukemia. Significant developments in PPC during the 1970s and 1980s focused on the location of care for children with cancer and subsequently other life-threatening conditions (LTC). PPC includes management of symptoms, provision of respite, coordination of services, including transition services where needed, end-of-life care, and bereavement support. Uncertain prognosis and unpredictable disease trajectory are characteristic of children in PPC, particularly those with LTC.