AUSTIN, TEXAS - Though Casey cannot walk, she wears ballet slippers purchased on Etsy to attend ballet classes. Casey, 8, has a number of primary issues including HIE (Hypoxic Ischemic Encephalopathy); Quadriplegia Cerebral Palsy; and a host of respiratory problems. In addition to CP, Casey is missing basic reflexes --- she is unable to suck, swallow, gag or blink. Without the ability to swallow, Casey's airway is in constant risk. Suction equipment is needed to remove secretions and anything else in her mouth/throat in order for her to breathe. Also, without the ability to swallow Casey cannot eat by mouth and is fed with a G-Tube. Pediatric palliative care has changed considerably in the past decade in the United States. It is no longer just about end-of-life care, but rather addresses the logistical, emotional, and spiritual needs of children and their families. The Dell Children's Hospital Palliative Care team in Austin, Tex., directs and manages the complex care of three children photographed here. The children are the beneficiaries of new technologies that have already allowed them to live beyond their expected life terms. All three families focus on their children living --- in the past, care for critically ill children like these was dictated by the idea that their lives would soon end. Palliative Care makes this new thinking possible. Whether by consult online or in person, palliative care physicians and social workers address issues that arise with these young patients' afflictions. Their conditions are so complex that an enormous amount of coordination must take place in order for numerous specialists to communicate and then address an issue. When Casey Barnes, five, for example, suffered from gastro-intestinal bleeding, her parents were not receiving the proper instructions or answers from her specialists. It was the palliative care team that brought the various doctors together in a room to solve her alarming problem. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Marty Barnes pushes her daughter Casey, 8, into the back of the family's minivan. Marty says the family bought a custom van to accommodate Casey's needs. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Tim Barnes holds his daughter's hand on Christmas day. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Dr. Craig Hurwitz (left) addresses Marty and Tim Barnes and social worker Rachel Carnahan (right) during a care conference, where five of Casey's doctors were present, whether in person or by conference call. Dr. Hurwitz organized the meeting to look at Casey's changing prognosis and to specifically find a way around a problem, which is that Casey's bone structure prevents her from safely getting imaging done-- imaging that one doctor had requested. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Casey Barnes' bedroom is decorated with things for Casey to look at. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Crystal Bedford looks at a CT scan of her daughter Marley's head on a screen in an imaging room at Dell Children's Medical Center. Marley, 5, was born with a rare form of terminal dwarfism called rhizomelic chondrodysplasia punctata, or RCDP. Fewer than 100 children worldwide suffer with this condition. Eighty percent of children born with this disease die within their first year of life. Marley, at five, has good days and bad, but moves around with ease and surprises her doctors every day. Her mother, Crystal, reports that Marley's doctors don't know what to make of her. She's breaking the mold for someone with her condition, Crystal says, and no one knows what she'll do next. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Marley Bedford has her head and neck scanned as a follow-up to surgery she had. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Casey Barnes' toe is illuminated by an oxygen monitor. Ilana Panich-Linsman for The New York Times.

AUSTIN, TEXAS - Rachel Carnahan, a social worker on the Palliative Care team, uses a doll with ports to talk to Marley Bedford about a medical procedure. All three families in this project praised Ms. Carnahan for helping them and supporting their family. Ilana Panich-Linsman for The New York Times.

FREDERICKSBURG, TEXAS - Marley Bedford, 5, walks with her family through a park in Fredericksburg, Texas. Ilana Panich-Linsman for The New York Times.

FREDERICKSBURG, TEXAS - Marley, 5, who was predicted never to walk with RCDP, swings on a play structure outside the family's home. Ilana Panich-Linsman for The New York Times.