Over 21 million children globally require pediatric palliative care (PPC) services. This number will continue to grow as more children with serious illness survive infancy due to advances in medical treatments and technology. However, many children (and their families) with life limiting, life threatening, and or fatal conditions fail to receive “competent, compassionate, and consistent care that meets their physical, emotional, and spiritual needs." Research shows that early integration of PPC enhances quality of life and reduces suffering in these children, but many clinicians fail to refer early or even initiate conversations about referrals. With the growing number of children with medical complexities and life limiting or life-threatening illness, it is important for all pediatric PA's to know when to refer to pediatric palliative care, as well as the positive impact that it can have on children and families lives from diagnosis through end of life, or even survivorship.