This study examines the current trends of spiritual care provided by hospital chaplains in pediatric end of life care settings in Japan. Semi-structured interviews were conducted with three hospital chaplains who currently work in a Japanese healthcare setting. The participants of this study included one Buddhist chaplain and two Christian chaplains who each has experience in providing spiritual care to children, adolescents, and young adults facing imminent death and their families in end of life care settings. The results revealed the chaplain's understanding of spiritual care, spirituality, and the spiritual needs of children and their families, the ways that chaplains provide care and support to these children and families, and the limitations and challenges in current Japanese hospital settings. Through the analysis of the results, two significant findings emerged: (1) Due to their expertise in spiritual care and their religious presence, chaplains can cultivate meaningful relationships and improve the well being of patients and families, (2) Japanese culture plays a vital role and influences the way chaplains provide spiritual care. The results of this study also suggested the need to consider the unique religiosity and psychological characteristics of the Japanese people in order to deliver more applicable and effective spiritual care in the Japanese cultural context.