Background: Advances in pediatric perioperative care have supported the safe provision of increasingly complex surgical care to patients with complicated diseases and abnormal physiology. This has led to the possible misalignment of the impact of potential surgical outcomes and goals of care. Methods / Objectives: We describe the development of a novel process that leverages the combination of longitudinal engagement of pediatric palliative care consultants and multidisciplinary care planning to ensure that perioperative care remains patient-centered and goal-directed for all children, especially children with complex baseline disease. Conclusions: Our novel process should be considered a solution to a crictial gap in pediatric perioperative care.