Introduction: Paediatric Palliative care has been a relatively new specialty in Malaysia. It serves to cater hospital and community support for children with life-limiting illnesses (LLI). The aim of the study is to describe the clinical characteristic of Paediatric Palliative Care (PPC) cases in the North East of Peninsular Malaysia. Methods: Children with LLI were identified through 2 databases captured by the ‘Sayangku’ Homecare team and Paediatric Palliative Care (PPC) team. These databases include the details on clinical diagnosis, time of referral and outcome. Children included were those referred from November 2012 to March 2020 to PPC service. The number of new cases referred per annum (2019) was compared to the crude estimation of prevalence. Results: A total of 216 children were included. About half of the children with LLI (50.5%) were from group 4 and about a quarter from group 1 (27%) of the ACT/ RCPCH classification. Approximately one third of our cohort (31%) had died, majority from oncology causes. There were 116 neurology cases, 60 oncology cases and further 48 cases were the remaining cases in our databases. More than one third (37.5%) of the patients were in the age range of 11-18-year-old. The estimated cases under PPC was only 7.7% from the estimated annual prevalence of LLI. Conclusion: The current data showed that many of the LLI cases in our area have gone underreported. There is a need to disseminate information and awareness among the medical fraternity on the patient’s eligibility for the PPC service.