Introduction: Under 5 mortality is a leading indicator of the level of child health and overall development of a coun-try. In Malaysia, progressive reduction has been observed from 1990 however since 2000 progress has been static. Further understanding about this trend is crucial. The objective of this study was to identify causes of mortality for better policy development in order to further reduce this rate. Methods: Analysis of mortality trends was done using data from Department of Statistics and causes of mortality using data collected through the Stillbirth and Under 5 Mortality Reporting System (SU5MR) in 2016. Results: The trend for Under 5 mortality rate between 2006 till 2016 is still plateaued and hovered between 8 to 9 per 1000 live births at the national level. High percentage of death is seen among the neonatal group (51%), followed by children 28 days to 1year (31%) and toddlers 1-4 years (18%). Percentage of preventable deaths increased with age i.e. 21% among neonates, 41% among children 28 days to 1year and 48% among toddlers. The leading causes of death are conditions from perinatal period (34.4%), congen-ital malformation (30%), injuries and external causes (6.4%), respiratory (5.6%) and certain infectious and parasitic disease (5.1%). Conclusion: To further reduce under -5 mortality focus needs to be on preventable deaths; to reduce neonatal deaths will require political commitment to ensure adequate resources; interagency collaboration is needed to reduce toddler mortality and family and community awareness on prevention of injury and infection.