The International Children’s Palliative Care Network (ICPCN) held its 4th international conference in Manila, Philippines (12th–15th November 2025), in partnership with The Ruth Foundation. The conference, ‘Milestones & Horizons,’ marked ICPCN’s 20th anniversary and convened 419 delegates from 49 countries across all World Health Organisation regions to celebrate the progress of children’s palliative care (CPC), while identifying priorities for equitable access for the 21 million children with life-threatening and life-limiting conditions. Hosted in the Philippines, it showcased local developments, including the National Children’s Hospital Pediatric Palliative Care Unit and community models, catalysing CPC’s formal recognition as a specialty by the Philippine Pediatric Society. The conference featured 155 accepted abstracts (63 oral, 26 rapid-fire and 46 posters), 10 keynotes, 5 plenary panels, 7 ‘Meet the Expert’ sessions and 9 workshops on leadership, research, advocacy, spiritual care, touch therapy and equity. Sessions highlighted milestones in system building, service integration, interdisciplinary collaboration and family-informed research, alongside horizons in digital innovation, humanitarian reach and children’s voices. Several sessions highlighted significant CPC ‘Milestones’, focusing on health system strengthening, service integration and diverse multidisciplinary research. Around the theme of ‘Horizons’, key conference sessions explored future directions such as digital innovation, care in humanitarian settings, interprofessional leadership and amplifying children’s voices through co-design and creative therapies. Conference evaluations emphasised the high value of the in-person event with the opportunity for increasing personal motivation, peer support and new collaborations. The 2025 ICPCN conference demonstrated CPC’s maturation through interdisciplinary collaboration while catalysing local progress in the Philippines. Critically, the conference demonstrated the irreplaceable value of in-person convening for relationship-building across diverse organisations, creating momentum toward shared goals of universal access and health system integration. Evaluations confirmed this collaborative energy as uniquely motivating, fostering cross-border partnerships and actionable commitments amid constrained resources, climate challenges and humanitarian needs.