Children with life-threatening conditions may encounter significant spiritual suffering as they anticipate and prepare for their impending deaths. This pediatric palliative care case study illustrates symptom management challenges related to spiritual suffering of a dying adolescent. The nurse plays a critical role in identifying the pediatric patient’s verbal and nonverbal cues that may denote spiritual problems, as well as patient, family, and environmental factors. Evidence-based clinical practice guidelines are available to facilitate symptom management of spiritual suffering in pediatric patients across disciplines and within the community. This article highlights the nursing role in assessing and managing symptoms of spiritual suffering in children living with life-threatening conditions. The complexity of spiritual suffering in the pediatric palliative care population emphasizes the need for an interdisciplinary team approach and the integral role of the nurse in providing spiritual support at end of life.