Over the past 50 years, nursing has undergone a profound transformation. What was once a profession defined by medical routines and hierarchical hospital structures has evolved into a profession grounded in evidence, partnership, and compassion. In children's nursing, advances in research, education, policy, and technology have redefined care, placing children and families at the centre. The shift from a biomedical model to one that recognises the psychological, social, and relational dimensions of children's lives represents one of the most significant paradigm changes in healthcare. Contemporary children's nursing is underpinned by respect for the rights, voices, and lived experiences of children and their parents. Milestones such as the establishment of family-centred care, the embedding of evidence-based practice, and the expansion of higher education and research have strengthened the profession's visibility and influence within increasingly complex healthcare systems. These advances have evolved through continual negotiation between professional ideals, organisational pressures, and societal expectations of children's care. This commentary examines the key developments, innovations, and turning points that have shaped children's nursing over the past half-century and considers what lies ahead. It critically reflects on how these changes have enhanced both practice and professional identity, while also highlighting persistent challenges in equity, sustainability, and workforce wellbeing. As demographic, technological, and environmental changes accelerate, children's nursing must remain adaptive, embracing innovation while safeguarding its humanistic core. By reflecting critically on where we have come from and envisioning what lies ahead, the profession can continue to unite evidence, advocacy, and compassion to deliver equitable, child and family-centred care. Against this backdrop of social and professional transformation, several milestones stand out as defining moments in the evolution of children's nursing that have reshaped not only how care is delivered but also the profession's purpose and identity. This section highlights three areas that have been particularly transformative: the evolution of family-centred care, major advances in neonatal care, and significant shifts in nursing education and practice. Not so long ago, children in hospital were routinely separated from their parents. Visiting hours were restricted, and many endured illnesses surrounded by strangers rather than family. This practice began to change when researchers and advocates drew attention to the emotional harm caused by separation. Research by Bowlby and Robertson first exposed the emotional harm caused by such separations, influencing the landmark Platt Report (Ministry of Health 1959), which called for unrestricted visiting and greater parental involvement in care. Although progress was slow, continued advocacy by parents, professionals, and advocacy groups such as Action for Sick Children and the Association for the Care of Children's Health led to acceptance of parents in that they were no longer viewed as visitors but essential for their children's welfare. As a result, family-centred care (FCC) emerged as the philosophical foundation of modern children's nursing, reframing parents not as visitors but as partners in the care team. Over time, family-centred care has moved families' position from exclusion to collaboration, and now to shared expertise, recognising families as essential partners in achieving the best outcomes for children. Today, family-centred care continues to evolve in response to shorter hospital stays, increased ambulatory and home-based care, and the growing complexity of chronic conditions. Families now act as constant caregivers and coordinators across fragmented systems, a shift that has strengthened parental agency but also introduced new burdens of responsibility. Nurses increasingly must balance empowerment with ensuring adequate support and equity, particularly for families with fewer resources. As more care has moved into the home, hospital practice has necessarily adapted. This evolution in family roles has also prompted a parallel re-examination of children's roles within healthcare. In the past, care reflected the old saying that ‘children should be seen and not heard’: children were expected to comply, not contribute or participate in their care. The United Nations Convention on the Rights of the Child (United Nations 1989) fundamentally challenged this view by recognising children's right to be informed, consulted, and involved in all matters affecting them, including healthcare. Consequently, children's participation has become an integral extension of family-centred care. Today, nurses work alongside play therapists and child life specialists, listening to children, giving information, easing fears, and preparing them for procedures. It is broadly accepted that when children are supported to participate, they feel valued, more prepared, less anxious, and overall, more satisfied with their care. Family-centred care has been reframed to ‘child- and family-centred care’ as this change in terminology reflects recognition of children as active central contributors to decisions about their health. It is about seeing each child as an individual with developmental needs, values, preferences, and making care more responsive to those needs and preferences. This shift from primarily parental participation to supporting children's active participation represents a significant cultural and ethical transformation in the focus of children's nursing. However, translating these rights-based principles and personalised care into clinical practice remains inconsistent and suboptimal. To achieve meaningful participation for children and families requires sustained investment in staff training, supportive organisational cultures, and alignment of policy with practice. While family-centred care has reshaped paediatrics, its future development now hinges on whether healthcare systems can truly empower both families and children to participate in healthcare decisions to the extent that they wish. Building on these shifts in child and family participation, neonatal nursing has evolved profoundly over the past five decades. Advances in technology, evidence-based interventions, and multidisciplinary collaboration have reshaped care for the most vulnerable infants. The rapid expansion of neonatal and paediatric intensive care units (NICUs and PICUs), alongside innovations such as surfactant therapy, therapeutic hypothermia, and continuous physiological monitoring, has dramatically reduced neonatal mortality. Nurses have been central to these developments, pioneering bedside monitoring, supporting families, and leading innovations in developmental care. Their technical expertise and ethical sensitivity were evident in delivering complex interventions such as extracorporeal membrane oxygenation (ECMO), which demands precision when caring for neonates on life-sustaining support. Other breakthroughs, such as improved oxygen titration, pulse oximetry, and the introduction of surfactant therapy, revolutionised the management of respiratory distress and reduced retinopathy. Equally transformative was the promotion of kangaroo care, demonstrating that skin-to-skin contact strengthens parent–infant bonding and improves survival. A growing understanding of infant physiology and pain also changed practice. Once thought to be insensitive to pain, neonates are now recognised as highly sensitive, leading to the development of pain assessment tools and routine use of pre-emptive analgesia and sedation, initiatives often driven by nurses. Similarly, the introduction of Paediatric Early Warning Scores (PEWS) has standardised the early detection of clinical deterioration, reducing preventable arrests and positioning nurses at the centre of patient safety and rapid-response systems. Yet, despite major technological advances, infants and parents were often separated. Strict visiting policies excluded parents from NICUs, undermining bonding and emotional wellbeing. Contemporary neonatal care now recognises parents as essential partners, reflecting a profound shift toward family-centred and developmentally supportive practice. Increasing attention has also turned to the psychosocial dimensions of neonatal care, highlighting the importance of emotional support and shared decision-making with parents. This renewed emphasis on relationships and equity mirrors broader global priorities. The Lancet Child and Adolescent Health Commission on the Future of Neonatology acknowledges the extraordinary progress made while noting that neonatal mortality remains unacceptably high in many regions. To address these persistent disparities, the Commission calls for inclusive partnerships between professionals, families, and advocacy groups to advance both scientific excellence and health equity for newborns worldwide. Overall, the story of neonatal care is one of evolution from survival-focused, technology-driven medicine to holistic, family-centred, and ethically grounded care. Nursing leadership, research, and education have been pivotal in driving this transformation and continue to shape the future of neonatal care worldwide. Over the past five decades, children's nurse education has evolved from a marginal and task-based vocation into a dynamic, research-informed, and academically grounded profession. Its origins, however, stretch back much further. As early as the 19th century, hospitals such as Great Ormond Street recognised that sick children had distinct needs and pioneered specialist paediatric nursing, laying the foundation for dedicated training and professional identity in children's care. A major turning point came with Project 2000 which integrated nurse education into higher education institutions and formally established children's nursing as a distinct branch of pre-registration training. This reform shifted nursing from an apprenticeship model to a university-based discipline, granting academic legitimacy and embedding research and critical thinking at its core. The introduction of diploma and degree pathways, followed by the move to an all-graduate nursing profession, marked far-reaching change. Student nurses were no longer hospital employees whose learning needs were secondary to service demands; instead, they became supernumerary learners, combining theory with structured clinical placements throughout their degree programmes. Graduate nurses were prepared to be reflective practitioners, educated to think critically, lead teams, and contribute to evidence-based decision-making. This transition to graduate-level education was important as international evidence shows that care delivered by degree-educated nurses is associated with improved patient outcomes and reduced morbidity (Aiken et al. 2017). Today, children's nurse education continues to expand in scope and sophistication. Simulation technologies, virtual reality, and digital learning platforms now complement traditional clinical training, allowing students to develop decision-making and technical skills in a realistic, risk-free environment. Children's nurses are increasingly leading the translation of research into practice, shaping guidelines and standards for high-quality care. At the same time, doctoral-level education has become integral to advancing nursing science and health equity, enabling nurses to influence research agendas and policy for children's care. Collectively, these advances have positioned children's nursing as a scholarly field underpinned by evidence, ethics, and advocacy. Parallel to educational reform has been the rise of advanced and specialist nursing roles, reflecting both the growing complexity of healthcare and the expanding expertise of nurses. Advanced nurse practitioners (ANP's) and clinical nurse specialists (CNSs) now lead outpatient clinics, manage complex cases, conduct assessments, prescribe medications, and coordinate multidisciplinary care. These roles are particularly prominent in childhood cancer care, emergency, acute and community settings, where nurses provide continuity, accessibility, and holistic support. Research consistently demonstrates that advanced practice roles improve patient outcomes, enhance satisfaction, and reduce waiting times and hospital admissions. In many cases, care delivered by nurse practitioners (NPs) matches or exceeds that provided by medical staff. Their contribution extends beyond bedside care to encompass leadership, education, and system-level innovation. In community and home-care settings, advanced practice nurses have strengthened of care and reduced hospital In the expansion of for nurses has been essential in to address medical workforce allowing advanced practice nurses to prescribe has improved the of care and made to more these over the past 50 a from a to a highly profession. Children's nursing as a recognised that compassion with clinical Its practitioners are and advocates to delivering child and family-centred care across and from this of the past, now to the 50 years, the key challenges that children's nurses are to This section examines how technological and global health influence children's health and nursing practice. considers for these challenges and how nurses can and within an increasingly complex healthcare environment. children with complex and chronic that many now into sustained nursing support across the life that early life experiences can have on health outcomes, children's health requires a that and developmental care. At the same time, broader shifts in healthcare including shorter hospital stays, management of illnesses hospital settings, and increased ambulatory and home-based care have fundamentally changed where and how children care. 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