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Objective: Global surgery programs have proliferated over the last decade, but 1) have been primarily composed of high-income country participants; and 2) no initiative has specifically focused on children. This is despite the burden and unique care requirements of children in low- and middle- income countries (LMICs), where over 50% of the population is <15 years old. Design: Interventional study Setting: London, England and Washington, DC Participants: Children’s surgery providers and organizations serving children in LMICs. Interventions: Two international meetings Main Outcome Measure(s): Development of optimal resources for children’s surgery Results: Two meetings to launch the Global Initiative for Children’s Surgery (GICS): a first (London, UK) to elicit highest priority action areas from children’s surgical providers in LMICs; and a second (Washington, DC) to prioritize action items and include a greater number of surgical organizations. To meet gaps in previous initiatives, a majority of the attendees were clinical providers from LMICs and representatives from several children’s surgical subspecialties. Thematic analysis of pre-meeting surveys and meeting discussions resulted in four primary focus areas including 1) training 2) infrastructure 3) service delivery and 4) research. A Delphi-based iterative priority-setting process at both meetings led to proposed action plans in all of these domains. An Optimal Resources for Children’s Surgery document has been drafted for consensus among specialties and possible ratification by the World Health Organization. Conclusions: GICS was created to meet an area not explicitly addressed in recent global surgery initiatives. Clinical providers in LMICs led priority-setting through email surveys and two international conferences. Development of optimal resources to meet children’s surgical needs emerged as a high priority and are currently being developed.