Ethical issues in pediatric mental health care have undergone little theoretical consideration and empirical study. In this exploratory ethnographic study, 20 Pediatric Mental Health Registered Nurses (PMHRNs) describe the ethical issues they believe arise from the care they deliver to children in school-age and adolescent age groups. Three major themes emerge from the interviews. These themes, the PMHRNs' relational roles, their role as advocate facilitator, and their view of the milieu as an extension of the family, are analyzed for ethical content using several ethical theories. These ethical theories are evaluated for adequacy, and an argument for the use of relational ethical theories in examining pediatric mental health ethical issues, as well as general pediatric nursing practice, is presented.