This article considers the response of children's nurses to contemporary change in the management of sick children and their families throughout the last decade. In recognizing the rich and diverse history of children's nursing the impact of those factors which have led to the development of operational strategies to manage children's services will be considered. The quest, not always successful, to coordinate care as a seamless web of services to children and their families will be investigated, as will the role dimensions encompassed by specialist children's nurses and their interface with interprofessional colleagues. A range of nurse-led services in a variety of contemporary child health settings will be explored.