Currently the provision of palliative care is patchy and inconsistent. What is needed is a systematic and comprehensive approach to all children with significant life-threatening diseases to ensure that their special needs are met. If timely palliative care is to be available to the terminally ill child, a shift in perspective is required as to how and when such support is introduced. Developing resources with the people who provide frontline care for these children and their families enables health professionals to assume this special aspect of care with more confidence and competence. Consultation with a palliative care service is still required for some difficult problems, but the focus of care should be based primarily where the child and family are cared for. By linking the primary care team with the palliative care program early on in the disease course, resources can be combined and bolstered to provide the best available support to the dying child and to those whose lives are committed to caring for that child.