There are no type 1 diabetes (T1DM) mortality data on Australian children and limited contemporary data on their international counterparts. Fatalities in children and adolescents (1–17 yr) with T1DM were identified from the Western Australia Children's Diabetes Database between 1987–2011. Seventeen thousand four hundred and fifty-three patient-years of diabetes data were analysed and 13 deaths were confirmed (six male). The overall standardised mortality ratio was 3.1 [95% confidence interval (CI), 1.7–5.3] and was highest in the 10–14 yr age group, at 4.6 (95% CI, 1.5–10.8). Median age at death was 16.4 yr (range 5 to 17.8 yr), and median haemoglobin A1c at death was 10.5% (range 6.7 to >14). Cause of death was attributed to diabetes in 10 (77%) cases. Two patients were found ‘dead-in-bed’. All diabetes-related deaths in subjects with known T1DM occurred outside the hospital setting.