Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting.Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had “Do Not Resuscitate” orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment.