Pediatric palliative care services are a challenge worldwide, particularly in developing countries such as Mexico. Substantial improvements in the care of neonates and children with life-threatening diseases have been made over the last decade, with centers established within pediatric tertiary facilities located in the main metropolitan areas of Mexico City, Guadalajara and Monterrey. Care is provided by pediatric subspecialists, primarily oncologists and anesthesiologists with an interest in pain management. A high percentage of children seen by palliative care providers in Mexico have underlying malignancies. A significant segment is represented by neurologic diseases. Active collaboration via personal communication aided by electronic media between these institutions has resulted in major shifts in health policy, education, and patient care. An improved understanding of the importance of appropriate symptom control has facilitated the use of strong opioids for cancer care in Mexico. Health care delivery remains problematic in more marginalized populations, especially indigenous populations residing in the southeastern parts of the country.