Paediatrics differs from adult in many aspects of which body size and maturational changes plays an important role. Effective medical treatment of paediatric patient is based upon an accurate diagnosis and optimum course of therapy. Irrational drug prescription leads to ineffective treatment, occurrence of adverse effects, prolonged duration of illness and suffering to patient, and an increased economic burden to society. Therefore the aim of our study is to analyse prescribing practices in paediatric department of KIMS Al Shifa Hospital to identify the prevailing disease traits, ADRs, dosage form, route of administration and potential drug interactions among children over 6 months study period. The aim of the study is to assess the prescribing patterns of paediatric patients in a tertiary level referral hospital. A Prospective observational study was conducted for a period of 6 months that focus on Assessment of prescribing practices in paediatric patients. The study was carried out in Paediatric department of KIMS AL SHIFA SUPER SPECIALITY HOSPITAL, Perinthalmanna, Malappuram. The patients were selected based on Inclusion and Exclusion criteria. Out of 87 prescriptions analysed, we found a predominance of male patients as compared to female paediatric patients. The analysed prescriptions were contributed mainly by paediatric age group of 1-3 years (34.5%). LRTI (24.1%) was identified as the most prevailing disease. A total of 466 drugs were retrieved from the study, contributed mainly by antibiotics (24.2%) and antipyretics (11.2%). Among antibiotics cephalosporins (38.1%) were the most common ones. Bronchodilators (45.8%) were the most often used respiratory system drug and proton pump inhibitors (44.9%) were most repeatedly used GI drug. Branded drugs were most commonly prescribed as compared to generic drugs. Among dosage forms, injectable (36.1%) were most frequently prescribed over syrups (32.6%) and tablets (10.1%). Oral route was the most commonly used route of administration of drugs contributing (51.1%) followed by parenteral route (36.1%) and nasal route (10.3%) respectively. In our study of assessment of prescribing practices in paediatric patients in a tertiary level referral hospital in south Malabar region of Kerala, we analysed over 87 prescriptions. According to the results procured from the study, a total of 466 drugs were identified. LRTI was the most prevalent disease and was found to be the primary cause for hospitalisation in paediatric patients. Antibiotics were the most commonly prescribed class, contributed mainly by Cephalosporins. Most enrolled patients stayed in hospital for 3-5 days and majority of the prescriptions had 4 drugs. Among all available routes for administration, oral route was preferred over others, because it is not invasive and carries a low risk of pain. By using NFI, rationality and safety of prescribing pattern were analysed and using Medscape potential drug interactions were identified.