Brainstem tumors make up only 10% of all childhood brain tumors and they carry with them a bleak prognosis. The majority of children are dead within 2 years of diagnosis from a malignant histology in a malignant location within the brain. A small group of brainstem tumors which by clinical and magnetic resonance imaging diagnosis are slow growing may be amenable to surgical debulking prior to adjunctive therapy. The morbidity associated with this treatment is high but long-term survival in this category of brainstem tumors is possible. Regardless of histopathologies, the medical, physical and emotional care of children and their families is complex and challenging. Effective patient/family education and support for children diagnosed with brainstem tumors is essential to providing medical care aimed at the cure or terminal care which allows the child to die in comfort with dignity.