The transformation in pediatric care settings has been driven by a combination of societal changes, medical advances, emphasis on patient- and family-centered care, and a growing understanding of children’s developmental needs. Pediatric facilities have transitioned from environments that mix children with adult patients to those that are engaging and secure, supporting a child's developmental journey from infancy through adolescence. This has included the integration of design elements that are comforting and familiar, yet stimulating and age-agnostic, such as interactive and multisensory experiences to reduce stress during medical procedures. Moreover, the evolution of design philosophies has embraced evidence-based and human-centered methodologies, focusing on creating spaces that support psychological, social, and physiological health. In pediatric healthcare settings, designs must cater to the distinct physiological, cognitive, and emotional needs of children compared to adults, while also accommodating the broad support system that surrounds pediatric patients. The iterative engagement of pediatrics, their families, staff, and other key stakeholders in the design process ensures that these environments are not only functional but also resonate with patients’ and families’ experiences and expectations. This holistic approach to pediatric healthcare design aims to foster environments that are not only healing but also nurturing, thereby enhancing the overall well-being and development of children in healthcare settings. The translation of diverse inputs—such as organizational culture, budget, patient demographics, and community characteristics—into a functional and holistic building design encompasses various phases: Programming, which defines the project’s vision and requirements; Schematic Design, focusing on site configuration and initial layouts; Design Development, where technical, functional, and aesthetic elements are integrated; and Construction Documentation, which finalizes the building instructions. Throughout these phases, designers create integrated “design layers,” a concept that synergizes multiple design aspects around operations and process considerations. These layers address numerous operational and physical challenges, offering solutions that prioritize patient and staff needs while aligning with organizational protocols. Site-specific factors, exterior design elements, department sizes, room sizes, adjacencies, interiors, and furniture and equipment configurations must be meticulously planned to enhance functionality and safety. By iteratively developing these layers in coordination with organizational processes, the design approach not only meets the immediate needs of healthcare delivery but also adaptably responds to the evolving demands of healthcare environments, care delivery models, and supporting technology. Descriptive and visual examples of these layers are included to demonstrate how design solutions can foster a patient-centered, family-friendly environment that supports both clinical efficiency and comfort. Despite the evolving landscape of healthcare demands, the overarching trend towards patient- and family-centered care remains paramount, driving the continual evolution of pediatric healthcare design to prioritize user experience and well-being.