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When Children Die. (Real Numbers).

The death of a child is a special sorrow, an enduring loss for surviving mothers, fathers, brothers, sisters, other family members, and close friends. No matter the circumstances, a child's death is a life-altering experience. In 1999, approximately 55,000 children ages 0 to 19 died in the United States.

Fortunately, in the United States and other developed countries, death in childhood is no longer common. Many infants who once would have died from prematurity, complications of childbirth, and congenital anomalies (birth defects) now survive. Likewise, children who would have perished in the past from an array of childhood infections today live healthy and long lives, thanks to sanitation improvements, vaccines, and antibiotics.

In the course of a century, the proportion of all deaths in the United States occurring in children under age 5 dropped from 30 percent in 1900 to just 1.4 percent in 1999. Infant mortality dropped from approximately 100 deaths per 1,000 live births in 1915 to 7.1 per 1,000 in 1999.

Because adults account for most deaths in the United States, programs of palliative and end-of-life care understandably focus on adults, especially older adults who account for over 70 percent of deaths each year. Health care professionals and others are, however, increasingly responding to the special needs of gravely ill or injured children and their families, including palliative and end-of-life care that reflects differences in the major causes of death. A comprehensive study of this issue can be found in the Institute of Medicine report When Children Die: Improving Palliative and End-of-Life Care for Children and their Families.
Greatest risk at birth

About half of all child deaths occur during infancy, and most of these
deaths occur soon after birth

Percentage of Total Childhood Deaths by Age Group (1999)

Neonatal 34.3%
Postneonatal 16.9%
1-4 years 9.6%
5-9 years 6.4%
10-14 years 7.6%
15-19 years 25.3%

Note: Table made from pie chart

Accidents become important later

Reflecting the concentration of child deaths among infants, an array of
newborn and infant conditions are among the leading causes of child
mortality. Another large fraction of child deaths--about 30 percent--is
accounted for by unintentional and intentional injuries.

Percentage of Total Childhood Deaths by Cause (1999)

Heart Disease 2%
Placental Cord Membranes 2%
Congenital Anomalies 12%
Complications of Pregnancy 2%
Short Gestation 8%
Respiratory Distress 2%
Cancer 4%
Other 33%
Homicide and Suicide 8%
Unintentional Injuries 22%

Note: Table made from pie chart

Causes of death differ with age

Patterns of child mortality differ considerably from patterns for
adults, especially elderly adults who die primarily from chronic
conditions such as heart disease and cancer. Among newborns, most deaths
are due to congenital abnormalities or complications associated with
prematurity, pregnancy, or childbirth. For older infants, sudden infant
death syndrome (SIDS) is an important cause of death. Fatal injuries
dominate among children and adolescents.

Numbers of Deaths by Cause and Age Group (1999)

Age Group (years)
Infant (<1) 1-4

Congenital anomalies Accidents
5,473 1,898

Short gestation and low birth weight Congenital anomalies
4,392 549

SIDS Malignant neoplasms
2,648 418

Complications of pregnancy Homicide
1,399 376

Respiratory distress syndrome Diseases of the heart
1,110 183

Age Group (years)
Infant (<1) 5-14

Congenital anomalies Accidents
5,473 3,091

Short gestation and low birth weight Malignant neoplasms
4,392 1,012

SIDS Homicide
2,648 432

Complications of pregnancy Congenital anomalies
1,399 428

Respiratory distress syndrome Diseases of the heart
1,110 277

Age Group (years)
Infant (<1) 15-24

Congenital anomalies Accidents
5,473 13,656

Short gestation and low birth weight Homicide
4,392 4,998

SIDS Suicide
2,648 3,901

Complications of pregnancy Malignant neoplasms
1,399 1,724

Respiratory distress syndrome Diseases of the heart
1,110 1,069

Regional differences

Reflecting social, economic, physical, and other differences, states and regions show considerable variation in child mortality by cause. Variation at the state level is more dramatic. In 1999, the District of Colombia had the highest infant mortality rate (15.0 per 1,000 live births), followed by South Carolina (10.2 per 1,000 live births). Maine and Utah had the lowest rate at 4.8 deaths per 1,000 live births. In the same year, for those aged 0 to 19, Wyoming led the nation in motor vehicle fatality rates (23.5 per 100,000), followed by Mississippi (20.9 per 100,000). The lowest fatality rates were for Hawaii (3.6 per 100,000) and Rhode Island (3.8 per 100,000). Juvenile homicide rates also differ substantially among states. Maryland led the nation in 1999 with a homicide rate of 7.8 per 100,000, followed by Illinois at 7.25 per 100,000. Hawaii and Utah had the lowest rates at 0.6 and 0.75 per 100,000, respectively. Juvenile homicides are concentrated among males in impoverished areas of large urban counties.

Gender, race, and ethnicity also matter

Demographic variation is also significant. Across all age ranges and for
most causes of deaths, boys have a higher death rate than girls. At all
ages, the death rates for black children is higher than for white or
Hispanic children

Deaths Due to Injury Compared to Other Conditions, by Age and Race

 Injury Rate per 100,000 (number) Other Conditions
 Rate per 100,000

Age Black/White
(years) Black White Ratio Black

1-4 27.4 (609) 13.4 (1,605) 2.0 30.6 (693)
5-9 14.8 (465) 7.2 (1,129) 2.1 13.2 (418)
10-14 13.8 (426) 10.7 (1,650) 1.3 13.9 (416)
15-19 69.6 (2,119) 51.2 (8,009) 1.4 22.9 (692)

 Other Conditions Rate per
 100,000 (number)

Age Black/White
(years) White Ratio

1-4 16.1 (1,936) 1.9
5-9 8.2 (1,278) 1.6
10-14 9.1 (1,385) 1.5
15-19 13.9 (2,156) 1.6

Source data for all tables and figures: National Center for Health

Marilyn J. Field ( was study director and coeditor for the Institute of Medicine report When Children Die: Imp roving Palliative and End-of-Life Care for Children and their Families (National Academy Press, 2003).
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Author:Field, Marilyn J.
Publication:Issues in Science and Technology
Geographic Code:1USA
Date:Mar 22, 2003
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