Pediatric nephrology is at a pivotal moment. As treatment advances have improved survival and clinical outcomes, families and clinicians increasingly call for a more holistic view of what it means to care well for children with kidney disease. Professional society mission statements, which emphasize a commitment to “optimal care for children with kidney disease,” offer a foundation upon which to articulate that broader vision. In this perspective, we discuss what we think optimal care isn’t – an exclusive focus on cure, survival, and adult outcomes; and what optimal care is – promoting flourishing of children with kidney disease and their families.