Outcomes: 1. Utilizing a case-based approach, participants will self-report the ability to describe logistical, clinical, and ethical challenges faced by multidisciplinary medical teams providing pediatric palliative sedation 2. Utilizing a case-based approach, participants will self-report the ability to list the benefits associated with the development of a national society guideline for pediatric palliative sedation Palliative sedation (PS) is an uncommon but crucial intervention for pediatric patients at the end of life. For patients experiencing refractory symptoms causing intolerable suffering, PS reduces level of awareness with comfort as the paramount goal. This presentation will use two case-based examples to highlight challenges regarding pediatric PS across clinical contexts. Both patients had underlying neurologic diagnoses, which differs from most patients described in pediatric PS literature, who predominately have oncologic diagnoses. Little guidance exists regarding PS for children who have delayed developmental milestones, pre-existing agitative behaviors prior to end of life, and differences in communication. The first case explores PS on a pediatric general care inpatient unit, overseen by pediatric hospitalists. Multidisciplinary team members in this setting are comfortable with pediatric patients, but rarely care for children at end of life and do not manage sedative infusions. Logistical and clinical challenges developed regarding dosing PS medications and with institutional policies that generally do not permit administration or escalation of such medications outside of an intensive care unit. Ethical questions, specifically around euthanasia, arose from team members unfamiliar with PS. In contrast, the second case reviews PS administered in the home with hospice. Team members in this setting are comfortable with adult patients at end of life, but rarely care for children, particularly with neurologic impairment. Discrepancies were noted regarding dose escalation in children compared to adults. Team members struggled with moral distress related to refractory symptoms for a child at end of life. Dilemmas encountered during these cases demonstrate the need for greater support for all providers who care for children at end of life. The presenters will review just-in-time education strategies, team-based bedside support, and debriefing techniques. Finally, building on these experiences, the presenters will call for the development of a national society guideline for pediatric PS. [ABSTRACT FROM AUTHOR]