BACKGROUND: More than 40% of childhood mortality occurs while children are hospitalized. End-of-life health care utilization patterns for children have not been well characterized at the national level. OBJECTIVE: To describe patterns of length of stay, total charges, and principal diagnoses for children who die while admitted to a hospital, versus those who survive to discharge. METHODS: We conducted a cross-sectional analysis of 3 years spanning a decade of the Nationwide Inpatient Sample (NIS), a nationally representative dataset of hospital discharges, to analyze sociodemographic characteristics and patterns of hospital resource use associated with in-hospital mortality. RESULTS: Inpatient mortality rate was significantly higher for non-newborn infants (<1 year old) than for all other age groups, and the overall number of deaths was greatest for newborns. Patients transferred between hospitals had significantly greater mortality rate, compared with patients admitted not on transfer. Insured children had lower mortality rates compared to uninsured, and decedents had significantly longer length of stay and higher charges compared with survivors. Uninsured decedents did not have longer lengths of stay than survivors, and hospital charges were significantly lower for uninsured children compared with insured children. CONCLUSION: As hospital staff strive to meet the needs of ill children and their families, they must be cognizant of the high burden of mortality among the youngest children and those transferred between hospitals, and the potential for less resource use and higher mortality risk for children without insurance, because these patients may require expanded services not readily available in most hospital settings.