Objective: In pediatrics, patients that are susceptible to palliative care may have a long survival, but a life that is limited or threatened by their disease. Therefore, it is not only important to know the causes of death, but also the prevalence of such diseases. The aim of this research was to determine the epidemiological, clinical, and evolutionary characteristics of children with chronic and life-limiting diseases who received palliative care in a highly complex pediatric hospital during 2014 and 2015. Methodology: descriptive, retrospective study, carried out at Hospital Pablo Tobon Uribe in Medellin, Colombia, in which 3 226 patients with chronic and life-limiting diseases were included. There were no exclusion criteria. Data were tabulated and analyzed using SPSS version 21 statistical package. Data were obtained by the researchers’ review of the clinical records. Results: During the study period, 6 230 patients were admitted to the pediatric ward, 52% (3 226) of whom had chronic and life-limiting diseases that could receive palliative care. 58% of the patients were male, 17% were under one year, and only 2% were neonates. The majority (48%) were older than 5 years, with an average age of 8 years. 21% had cancer diagnosis, 20% had congenital malformations, and another 20% had hematological and immune system diseases (immunodeficiency). Another 22%, with similar distribution, had metabolic diseases, conditions originated in the neonatal period, and neurological diseases. Only 3.7% (n =119) received palliative care. Mortality was 3% (95) for the duration of the study (2 years). 75% (71) of the patients died in the PICU; 63% (60) had invasive mechanical ventilation. Conclusions: Palliative care should be developed and accessible to all children with lifethreatening illnesses to improve symptom management and quality of life.