Childhood Mortality Rates Statistics in US 2025 | Facts

Childhood Mortality Rates in the US 2025

The landscape of childhood mortality rates in the United States continues to present critical challenges for public health professionals, policymakers, and families nationwide. Despite advances in medical technology and healthcare access, the nation faces persistent disparities in child survival rates across different age groups, racial backgrounds, and geographic regions. Understanding these patterns remains essential for developing targeted interventions and improving outcomes for America’s youngest population. Recent data from the Centers for Disease Control and Prevention (CDC) reveals that while some progress has been achieved, significant work remains to protect vulnerable children across the country.

The complexity of childhood mortality in the US 2025 reflects broader societal issues including healthcare access, socioeconomic disparities, and preventable injuries. Federal health agencies continue monitoring these trends closely, with the most recent 2023 final data providing comprehensive insights into the factors contributing to child deaths. These statistics serve as critical indicators of overall population health and guide resource allocation for prevention programs, medical research, and community support services aimed at reducing preventable deaths among infants, toddlers, and adolescents throughout the nation.

Key Stats & Facts About Childhood Mortality Rates in the US 2025

Data Source: CDC National Center for Health Statistics, National Vital Statistics System 2023

The data presented in this table reveals striking patterns in childhood mortality across the United States in 2025. The overall infant mortality rate of 5.61 deaths per 1,000 live births represents a critical public health metric that has remained essentially unchanged from 2022, signaling a plateau in progress after decades of gradual improvement. This stabilization deserves attention from healthcare professionals and policymakers as it may indicate emerging challenges in prenatal care, maternal health, or access to medical services for vulnerable populations. The total of 20,162 infant deaths in 2023 represents thousands of families experiencing devastating loss, with each death reflecting potential opportunities for prevention through enhanced medical care, education, and support systems.

The geographic disparities highlighted by state-level data demonstrate profound inequities across the nation. Mississippi’s infant mortality rate of 8.94 per 1,000 births stands more than three times higher than New Hampshire’s rate of 2.93, suggesting that where a child is born dramatically impacts their survival chances during the first year of life. These variations cannot be attributed to chance alone but reflect complex interactions between healthcare infrastructure, insurance coverage, maternal health services, socioeconomic conditions, and cultural factors affecting prenatal and postnatal care. The racial disparities remain particularly troubling, with Black non-Hispanic infants experiencing mortality rates of 10.93 per 1,000 births, more than triple the rate for Asian non-Hispanic infants at 3.44 per 1,000, highlighting persistent structural inequities in healthcare access and quality that demand urgent attention and comprehensive solutions.

Infant Mortality Rates by Race and Ethnicity in the US 2025

Data Source: CDC National Center for Health Statistics, National Vital Statistics System, Linked Birth/Infant Death File 2023

The racial and ethnic disparities in infant mortality rates across the US in 2025 reveal deeply concerning patterns that persist despite national efforts to improve healthcare equity. Black non-Hispanic mothers experienced the highest infant mortality rate at 10.93 deaths per 1,000 live births, a rate that exceeds the national average by nearly double and represents a stark reminder of systemic healthcare inequities. This elevated mortality rate among Black infants has remained consistently high across decades, reflecting complex factors including differential access to quality prenatal care, higher rates of preterm birth, greater prevalence of chronic maternal health conditions, implicit bias in healthcare settings, and socioeconomic barriers that affect both maternal and infant health outcomes. The 5,374 infant deaths among Black families in 2023 represent not just statistics but profound loss that reverberates through communities already facing multiple health challenges.

American Indian and Alaska Native non-Hispanic populations face the second-highest infant mortality rate at 9.20 per 1,000 births, with 226 deaths among 24,571 live births. These communities often experience geographic isolation, limited access to specialized medical care, higher poverty rates, and historical trauma that compounds health challenges. Native Hawaiian and Other Pacific Islander infants similarly experience elevated mortality at 8.21 per 1,000, demonstrating that indigenous and Pacific Islander populations face unique vulnerabilities requiring culturally competent interventions and improved healthcare infrastructure. In contrast, Asian non-Hispanic infants have the lowest mortality rate at 3.44 per 1,000, though this aggregate figure masks significant variation among diverse Asian ethnic subgroups. The data demonstrates that race and ethnicity remain powerful predictors of infant survival, underscoring the urgent need for targeted public health interventions addressing social determinants of health, improving prenatal care access, and eliminating systemic racism within healthcare institutions.

Leading Causes of Infant Death in the US 2023

Data Source: CDC National Center for Health Statistics, National Vital Statistics System, Linked Birth/Infant Death File 2023

The leading causes of infant death in the US during 2023 illuminate both preventable and complex medical challenges facing newborns and young infants. Congenital malformations, deformations, and chromosomal abnormalities claimed 4,030 infant lives, representing 20.0% of all infant deaths and maintaining its position as the leading cause of infant mortality. These birth defects range from heart defects to neural tube defects and chromosomal abnormalities like Down syndrome. While some congenital malformations result from genetic factors beyond current prevention capabilities, many can be reduced through enhanced preconception health, adequate maternal nutrition including folic acid supplementation, management of maternal chronic conditions like diabetes, avoidance of teratogenic substances, and improved prenatal screening allowing for earlier intervention planning. The rate of 112.1 deaths per 100,000 live births demonstrates the ongoing need for research into genetic causes and preventive strategies.

Disorders related to short gestation and low birth weight accounted for 2,927 deaths and 14.5% of all infant deaths, with a rate of 81.4 per 100,000 births. Premature birth remains a critical challenge in American obstetrics, with preterm infants facing immature organ systems, particularly underdeveloped lungs and brains, that increase vulnerability to infections, breathing problems, and long-term developmental challenges. Addressing preterm birth requires comprehensive approaches including improved management of maternal health conditions like hypertension and diabetes, smoking cessation programs, adequate spacing between pregnancies, and universal access to quality prenatal care. Sudden Infant Death Syndrome (SIDS) resulted in 1,446 deaths representing 7.2% of infant mortality, though this percentage reflects significant progress from historical rates due to successful “Back to Sleep” campaigns educating parents about safe infant sleep practices. However, 1,446 families still experienced the devastating loss of apparently healthy infants, demonstrating that continued education about safe sleep environments remains essential.

Childhood Mortality Rates by Age Groups in the US 2023

Data Source: CDC National Center for Health Statistics, FastStats Child Health 2023

The age-specific mortality patterns for children beyond infancy in the US during 2023 demonstrate shifting causes of death as children grow and develop. Children ages 1-4 years experienced 4,059 deaths with a mortality rate of 27.3 per 100,000 population, representing toddlers and preschoolers navigating developmental milestones while facing environmental hazards. Accidents remained the leading cause of death for this age group, encompassing drownings in swimming pools and bathtubs, motor vehicle crashes where young children were passengers, choking on food or small objects, falls from windows or furniture, fires and burns, and poisonings from household chemicals or medications left within reach. The preventability of most unintentional injuries makes these deaths particularly tragic, as appropriate supervision, childproofing homes, proper car seat usage, swimming lessons, and community safety education could prevent many fatalities. Congenital malformations continued affecting this age group as complex birth defects manifest complications over time, while assault and homicide tragically appear among leading causes, often involving family members or caregivers.

Children ages 5-14 years saw 6,005 deaths with a mortality rate of 14.7 per 100,000 population, representing school-age children and young adolescents. The lower mortality rate compared to younger children reflects improved motor skills, better judgment about dangers, and decreased vulnerability to infections, though significant risks remain. Accidents continued dominating as the leading cause, with motor vehicle crashes becoming more prominent as children become passengers more frequently and eventually begin driving themselves. For children ages 10-14 years, intentional self-harm (suicide) emerges as the second leading cause of death, a heartbreaking trend reflecting mental health challenges among young adolescents. This disturbing pattern has intensified in recent years, demanding urgent attention to adolescent mental health services, bullying prevention, social media impacts, and suicide prevention programs. Cancer ranks among the top three causes across both age ranges, with childhood leukemias, brain tumors, and lymphomas affecting otherwise healthy children.

Infant Mortality Rates by State in the US 2023

Data Source: CDC National Center for Health Statistics, National Vital Statistics System 2023

The state-by-state variation in infant mortality rates across the US during 2023 exposes dramatic geographic disparities that cannot be explained by chance alone. Mississippi maintained the highest infant mortality rate at 8.94 per 1,000 births, with 308 infant deaths among 34,459 live births, continuing a long-standing pattern where Southern states experience elevated mortality. This pattern reflects interconnected factors including higher poverty rates, lower educational attainment, reduced access to comprehensive prenatal care, fewer hospitals with neonatal intensive care units, higher rates of chronic maternal health conditions like obesity and diabetes, greater prevalence of teenage pregnancy, and more limited Medicaid coverage in states that chose not to expand the program. Louisiana followed closely at 7.14, Ohio at 7.16, and Oklahoma at 7.12, all substantially exceeding the national average of 5.61 per 1,000 births. These states share challenges related to rural healthcare access, socioeconomic disadvantage, and healthcare system capacity that contribute to elevated infant mortality.

In stark contrast, New Hampshire achieved the lowest infant mortality rate at 2.93 per 1,000 births, with only 35 deaths among 11,936 live births, demonstrating that substantially better outcomes are achievable within the United States. Vermont (3.16), Massachusetts (3.28), New Jersey (3.69), and Wyoming (3.84) similarly achieved rates well below the national average, representing states with different demographic profiles but sharing advantages including higher median incomes, greater health insurance coverage, robust healthcare infrastructure, comprehensive prenatal care programs, and strong social support systems for pregnant women and new mothers. The threefold difference between Mississippi and New Hampshire demonstrates that geographic location profoundly impacts infant survival, with babies born in high-mortality states facing preventable risks. These disparities represent not just statistical variations but thousands of preventable deaths annually, demanding federal leadership and state-level commitment to improving maternal and infant health outcomes through expanded healthcare access, enhanced prenatal services, better nutrition programs, and comprehensive support for vulnerable families.

Gestational Age and Birth Weight Impact on Mortality in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The relationship between gestational age at birth and infant mortality in the US during 2023 demonstrates the critical importance of carrying pregnancies to term whenever medically possible. Preterm infants born before 37 weeks gestation face dramatically elevated risks, with a mortality rate of 34.74 per 1,000 births, representing more than 15 times the risk compared to term infants. These premature babies account for approximately 65% of all infant deaths despite representing a much smaller percentage of total births, highlighting how prematurity drives overall infant mortality statistics. Early preterm infants born before 34 weeks face even more severe challenges with a mortality rate of 107.87 per 1,000, reflecting the extreme vulnerability of babies born with significantly underdeveloped organ systems. Their lungs lack sufficient surfactant for independent breathing, their immune systems cannot effectively fight infections, their digestive systems struggle to process nutrition, and their neurological development remains incomplete, creating life-threatening vulnerabilities requiring intensive medical intervention. Even late preterm infants born between 34-36 weeks experience mortality rates of 8.31 per 1,000, nearly four times higher than term babies, demonstrating that even near-term births carry significant additional risks.

Birth weight categories similarly predict infant survival with remarkable precision. Very low birth weight infants weighing less than 1,500 grams (3.3 pounds) face a mortality rate of 196.71 per 1,000 births, representing extreme medical fragility requiring months of neonatal intensive care with uncertain outcomes. These tiny infants struggle with multiple organ systems simultaneously, often requiring mechanical ventilation, intravenous nutrition, multiple medications, and round-the-clock monitoring from specialized neonatal teams. Low birth weight infants under 2,500 grams (5.5 pounds) experience mortality rates of 42.33 per 1,000, still twenty times higher than normal weight babies. In contrast, infants born at normal weight of 2,500 grams or more enjoy mortality rates of just 2.10 per 1,000 births, demonstrating how proper fetal growth substantially improves survival odds. The strong correlation between gestational age, birth weight, and mortality underscores the critical importance of preventing preterm birth through comprehensive prenatal care, management of maternal health conditions, adequate maternal nutrition, smoking cessation, appropriate pregnancy spacing, and stress reduction interventions.

Maternal Age and Childhood Mortality Patterns in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The maternal age patterns in infant mortality during 2023 reveal a U-shaped curve where both very young and older mothers face elevated risks, though for different reasons. Mothers under 15 years old experienced a devastating infant mortality rate of 20.95 per 1,000 births, nearly four times the national average, reflecting the profound biological and social challenges of pregnancy during early adolescence. These young mothers often lack physical maturity for healthy pregnancy, experience disrupted education, face family instability, receive inadequate prenatal care due to delayed pregnancy recognition or limited healthcare access, and struggle with nutrition and healthcare compliance. Their babies face increased risks of prematurity, low birth weight, and complications from immature maternal reproductive systems not yet optimized for childbearing. Teen mothers ages 15-19 experienced rates of 10.44 per 1,000, double the national average, though better than younger adolescents, demonstrating that teen pregnancy remains a significant public health concern requiring comprehensive prevention through education, access to contraception, and support services for pregnant teens.

Mothers in their late twenties and early thirties achieved the lowest infant mortality rates, with 25-29 year olds at 5.24 per 1,000 and 30-34 year olds at 4.59 per 1,000, the optimal age range for childbearing from both biological and social perspectives. These women typically possess mature reproductive systems, greater financial stability, completed education, established careers, stronger partner relationships, better access to healthcare, and greater health literacy allowing for optimal pregnancy management. Mothers 30-34 represent the lowest-risk group, benefiting from biological readiness combined with life experience and resources. However, infant mortality begins rising again with advanced maternal age, with mothers 35-39 experiencing rates of 4.94 per 1,000 and mothers 40 and older facing rates of 6.77 per 1,000. This increase reflects age-related fertility challenges, higher rates of chromosomal abnormalities, increased prevalence of chronic health conditions like hypertension and diabetes, greater likelihood of multiple gestations from fertility treatments, and elevated pregnancy complication risks requiring careful medical management and monitoring throughout pregnancy.

Neonatal vs. Postneonatal Mortality Patterns in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The temporal distribution of infant deaths in the US during 2023 demonstrates that the first month of life represents the highest-risk period, with neonatal deaths accounting for 13,113 or 65% of all infant deaths. The neonatal mortality rate of 3.65 per 1,000 births reflects the critical vulnerability of newborns adjusting to life outside the womb, with immature organ systems, potential congenital defects, complications from difficult births, and effects of maternal health conditions manifesting most acutely. Early neonatal deaths occurring in the first week accounted for 10,226 deaths with a rate of 2.84 per 1,000, representing more than half of all infant mortality. These deaths predominantly result from severe prematurity, major congenital malformations, complications during labor and delivery, respiratory distress syndrome in premature infants, infections acquired during birth, and severe neurological events like hypoxic-ischemic encephalopathy from oxygen deprivation. The concentration of mortality in the first hours and days of life underscores the critical importance of skilled obstetric care, immediate access to neonatal intensive care units, and rapid response to newborn emergencies.

Late neonatal deaths occurring between 7-27 days claimed 2,887 infant lives with a rate of 0.80 per 1,000, representing babies who survived the immediate newborn period but succumbed to ongoing complications from prematurity, infections, or congenital conditions. Postneonatal deaths from 28 days through 11 months accounted for 7,049 deaths representing 35% of total infant mortality with a rate of 1.96 per 1,000 births. This period sees shifting causes of death from primarily medical complications toward environmental and social factors including Sudden Infant Death Syndrome (SIDS), unintentional injuries like suffocation in unsafe sleep environments, infectious diseases, and late-manifesting effects of congenital conditions. The postneonatal period also reveals socioeconomic disparities more dramatically as families’ abilities to provide safe environments, access healthcare for emerging problems, and recognize warning signs of illness become critical factors. The declining risk as infants age reflects strengthening immune systems, improved motor control, and developmental maturation, though significant vulnerabilities persist throughout the entire first year of life requiring vigilant parental care and accessible pediatric healthcare.

Hispanic Sub-Population Infant Mortality Rates in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The diversity within Hispanic infant mortality rates in the US during 2023 reveals important variation among different ethnic subgroups that often gets masked in aggregate statistics. Puerto Rican infants experienced the highest mortality rate at 6.43 per 1,000 births, with 426 deaths among 66,203 live births, significantly exceeding the overall Hispanic average of 5.03. This elevated rate reflects complex socioeconomic challenges facing Puerto Rican communities, including higher poverty rates in areas with concentrated Puerto Rican populations, migration-related disruptions, language barriers affecting healthcare access, and potential differences in insurance coverage and healthcare utilization patterns. The Mexican-origin population, representing the largest Hispanic subgroup with 508,127 births, experienced a mortality rate of 5.12 per 1,000 with 2,601 infant deaths, slightly above the overall Hispanic average but still below the national rate of 5.61. These outcomes may reflect the “Hispanic paradox” where some Hispanic subgroups achieve better health outcomes than their socioeconomic circumstances would predict, possibly due to strong family support systems, dietary patterns, and cultural protective factors.

Dominican infants and Central and South American infants both experienced identical mortality rates of 4.59 per 1,000, with 154 deaths among 33,575 Dominican births and 958 deaths among 208,618 Central and South American births. These rates fall below the national average, suggesting relatively favorable outcomes despite potential barriers including immigration-related stressors, documentation concerns affecting healthcare access, and economic challenges. Cuban-origin infants achieved the lowest mortality rate at 3.77 per 1,000, with 113 deaths among 30,001 births, approaching the low rates seen in Asian populations. This favorable outcome may reflect the generally higher educational attainment and economic status of Cuban immigrant families, particularly those from earlier immigration waves, along with strong community networks and healthcare engagement. The significant variation from 3.77 to 6.43 across Hispanic subgroups demonstrates that treating Hispanic populations as monolithic masks important health disparities requiring targeted interventions responsive to specific community needs, cultural contexts, and socioeconomic circumstances affecting different Hispanic origin groups.

Top 10 Causes of Infant Death in the US 2023

Data Source: CDC National Center for Health Statistics, National Vital Statistics System Mortality File 2023

The comprehensive ranking of infant death causes in the US during 2023 provides granular insight into the specific conditions claiming infant lives beyond the top five. The top 10 causes collectively accounted for 13,164 deaths representing 65.3% of all 20,145 infant deaths, while the remaining 6,981 deaths (34.7%) resulted from numerous other less common conditions. Bacterial sepsis of newborn claiming 621 lives represents a significant infectious threat particularly for premature infants with underdeveloped immune systems and those requiring invasive medical procedures like central lines and ventilators that create infection pathways. Despite advances in neonatal intensive care and antibiotic therapy, sepsis remains a persistent challenge requiring vigilant infection control, careful monitoring for early signs, and aggressive treatment protocols. Placental and cord complications caused 569 deaths with a rate of 15.8 per 100,000, showing a notable 10.7% decrease from 2022 when it caused 649 deaths at a rate of 17.7, representing the only significant improvement among leading infant death causes and suggesting potential improvements in obstetric management and fetal monitoring.

Respiratory distress of newborn resulted in 449 deaths, primarily affecting premature infants whose lungs lack sufficient surfactant to facilitate breathing, requiring mechanical ventilation and surfactant replacement therapy that has dramatically improved survival rates over recent decades. Intrauterine hypoxia and birth asphyxia caused 365 deaths, representing oxygen deprivation before or during birth that can result from placental problems, umbilical cord compression, prolonged labor, maternal hemorrhage, or other delivery complications. These hypoxic events can cause severe brain damage or death, underscoring the critical importance of continuous fetal monitoring during labor, skilled obstetric care recognizing warning signs, and immediate availability of emergency interventions including cesarean delivery when necessary. Diseases of the circulatory system claimed 356 infant lives, encompassing various heart defects and cardiovascular conditions ranging from structural abnormalities present at birth to acquired conditions developing in early infancy. The concentration of mortality in these ten categories demonstrates that a relatively small number of conditions account for most infant deaths, suggesting that focused research, prevention efforts, and treatment improvements targeting these specific causes could achieve substantial reductions in overall infant mortality.

Age-Specific Death Rates Across All Age Groups in the US 2023

Data Source: CDC National Center for Health Statistics, National Vital Statistics System Mortality Data 2023

The comprehensive age-specific mortality patterns in the US during 2023 demonstrate that childhood represents the safest period of the human lifespan, with school-age children 5-14 years experiencing the lowest death rate at just 14.7 per 100,000 population. This remarkably low mortality rate reflects the combination of mature immune systems developed through childhood exposures, advanced motor skills reducing accident risks, reduced vulnerability to infectious diseases, and the absence of chronic diseases typically affecting older adults. The dramatic decline in mortality rates for age groups 5 years and older in 2023 compared to 2022 represents significant progress, with improvements ranging from 3.4% to 9.4% across different age categories. The largest reductions occurred in young and middle-aged adults 25-54 years experiencing 7.1% to 9.4% decreases, primarily driven by substantial reductions in COVID-19 deaths, improvements in drug overdose trends, and decreased unintentional injury mortality.

The absence of significant improvement in infant and early childhood mortality (ages 0-4 years) stands in stark contrast to progress in older age groups, signaling that factors driving infant and toddler deaths differ fundamentally from those affecting older children and adults. While older populations benefited from COVID-19 mortality reductions, vaccination campaigns, and improved treatment protocols, infants and young children face persistent challenges from congenital conditions, prematurity, and environmental hazards less amenable to rapid improvement through public health interventions. The J-shaped mortality curve visible in these data shows rates declining from 560.2 per 100,000 in infancy to 14.7 per 100,000 in school-age children, then steadily climbing through adolescence and adulthood, ultimately reaching 4,345.5 per 100,000 in those aged 75-84. This pattern reflects the unique vulnerabilities of newborns combined with age-related disease accumulation in later life, with the childhood years representing a “mortality trough” when death rates reach their lifetime minimum before the inexorable increase associated with aging begins.

Infant Mortality Rates by Birth Plurality in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The relationship between multiple gestation and infant mortality in the US during 2023 reveals exponentially increasing risks associated with twin and higher-order births. Single births experienced a mortality rate of 5.09 per 1,000, representing 17,728 deaths among 3,482,971 births and serving as the baseline risk for singleton pregnancies. Twin births faced dramatically elevated mortality at 20.78 per 1,000, representing 2,294 deaths among 110,393 twin births, a risk more than four times higher than singletons. This elevated mortality primarily stems from the high prematurity rate in twin pregnancies, as the uterine environment optimized for one fetus struggles to support two through full term. Most twin pregnancies deliver before 37 weeks gestation, with many experiencing delivery in the early preterm period when survival odds remain precarious. Twins also face increased risks of growth restriction as two fetuses compete for limited placental nutrients, higher rates of birth defects, increased likelihood of umbilical cord complications, and greater chances of complications during labor and delivery.

Triplet and higher-order multiple births experienced devastating mortality rates of 52.39 per 1,000, with 139 deaths among 2,653 births, representing risks more than ten times higher than singletons. These extreme outcomes reflect the compounded challenges of supporting three or more fetuses simultaneously, with virtually all higher-order multiples delivering prematurely, often in the early preterm period requiring months of intensive care. The rising use of assisted reproductive technologies contributed to increased multiple birth rates in preceding decades, though current reproductive medicine practices increasingly emphasize single embryo transfer to avoid these severe complications. The 110,393 twin births in 2023 represented approximately 3.1% of all births but accounted for 11.4% of infant deaths, while triplets and higher-order multiples though representing less than 0.1% of births contributed disproportionately to infant mortality statistics, demonstrating how multiple gestations substantially elevate population-level infant mortality despite affecting relatively small numbers of pregnancies.

Mortality Rates by Nativity Status in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The nativity-related patterns in infant mortality during 2023 reveal a paradoxical finding where foreign-born mothers experienced lower infant mortality rates (4.76 per 1,000) compared to US-born mothers (5.80 per 1,000), a 22% lower risk that contributes to the broader “immigrant health advantage” documented across various health outcomes. This protective effect persists despite foreign-born women often facing substantial barriers including lower average incomes, higher uninsurance rates, language barriers, immigration-related stress, and limited familiarity with US healthcare systems. Multiple explanations have been proposed for this paradox including health selection effects where healthier individuals preferentially migrate internationally, stronger family and community support networks in immigrant communities, potentially healthier dietary patterns and lower rates of harmful behaviors like smoking and excessive alcohol consumption, and cultural practices surrounding pregnancy and childbirth that may provide protective factors. Foreign-born mothers represent 23.4% of all births with 843,233 deliveries in 2023, contributing substantially to US fertility while achieving favorable infant mortality outcomes.

The 4,018 infant deaths among foreign-born mothers nonetheless represent significant loss, and outcomes vary considerably by region of origin, length of US residence, and level of acculturation. Research suggests the immigrant health advantage tends to diminish with longer US residence and across generations, with second and third-generation individuals experiencing health outcomes more similar to US-born populations. This suggests that environmental and social factors in the United States may negatively impact health over time rather than immigration status itself being protective. The exceptionally high mortality rate of 28.66 per 1,000 among the small number of births with unstated maternal birthplace likely reflects documentation issues, data quality problems, or challenging circumstances surrounding these pregnancies rather than representing a true population group. Understanding the mechanisms underlying the immigrant health advantage could provide valuable insights for improving outcomes among US-born populations, particularly regarding social support, health behaviors, and community-level protective factors that might be fostered more broadly.

Leading Causes of Death for Children Ages 1-4 and 5-14 in the US 2023

Data Source: CDC National Center for Health Statistics, FastStats Child Health 2023

The evolving leading causes of death across childhood age groups in the US during 2023 demonstrates how mortality risks shift dramatically as children develop and face different environmental exposures. For children ages 1-4 years, accidents completely dominate as the leading cause, encompassing drownings in pools and bathtubs, motor vehicle crashes where toddlers are passengers, suffocation from plastic bags or other materials, falls from windows or furniture, burns from hot liquids or fires, poisonings from medications or household chemicals, and choking on food or small toys. The prominence of unintentional injuries reflects the dangerous combination of toddler mobility, curiosity, and limited understanding of hazards, making this age group particularly vulnerable to environmental dangers. Congenital malformations rank second, representing birth defects that manifest complications or become fatal after the first year as complex conditions progress or secondary complications develop. The appearance of assault and homicide as the third leading cause among toddlers represents a tragic reality where young children become victims of family violence, abuse, or neglect situations, with child protective services and violence prevention programs remaining critically important.

Children ages 5-9 years continue facing accidents as the leading cause of death, though the specific types shift toward motor vehicle crashes as children become passengers more frequently, along with bicycle accidents, pedestrian injuries, sports-related trauma, and recreational accidents. Cancer emerges as the second leading cause, with childhood leukemias, brain tumors, and lymphomas affecting otherwise healthy children, representing some of the most heartbreaking childhood deaths as families watch their children endure difficult treatments with uncertain outcomes. For children ages 10-14 years, accidents remain the top killer with motor vehicle crashes becoming even more prominent as adolescents begin riding in vehicles with teen drivers, engage in riskier activities, and some begin learning to drive themselves. The emergence of intentional self-harm (suicide) as the second leading cause represents an alarming trend reflecting the adolescent mental health crisis, with pre-teens and young teenagers experiencing depression, anxiety, bullying, social media pressures, and other stressors leading some to take their own lives. This pattern demands urgent expansion of school-based mental health services, suicide prevention programs, crisis intervention resources, and efforts to reduce stigma around seeking mental health support during these vulnerable developmental years.

Sex-Specific Infant Mortality Patterns in the US 2023

Data Source: CDC National Center for Health Statistics, Linked Birth/Infant Death File 2023

The sex-based differences in infant mortality during 2023 reveal that male infants experienced a 17.3% higher mortality rate (6.04 per 1,000) compared to female infants (5.15 per 1,000), continuing a well-established biological pattern observed globally throughout history. This male vulnerability reflects multiple interacting factors beginning with genetic differences, as females possess two X chromosomes providing genetic redundancy where a harmful mutation on one X chromosome can be compensated by the other, while males with only one X chromosome lack this protective backup. Male fetuses and infants also demonstrate higher rates of prematurity, respiratory distress syndrome, and certain congenital malformations, particularly those affecting the cardiovascular and neurological systems. Hormonal differences may contribute, with testosterone potentially influencing immune function and female hormones providing certain protective effects. Male infants show higher rates of infectious diseases and slower lung maturation compared to females at equivalent gestational ages, creating additional vulnerability during the critical newborn period.

The 11,118 male infant deaths compared to 9,044 female infant deaths represents a substantial absolute difference of 2,074 more male deaths, despite male births exceeding female births by only 83,571 (4.8% more males born). This disproportionate male mortality contributes to gradual equalization of sex ratios over time, with the slight male birth advantage progressively eliminated through higher male mortality throughout childhood and adulthood. The male mortality disadvantage persists across essentially all causes of death and racial/ethnic groups, demonstrating remarkable consistency in this biological pattern. Understanding the mechanisms underlying male vulnerability could potentially identify intervention targets, though many factors remain inherent to biological sex differences rather than modifiable risk factors. The pattern underscores that even within populations sharing environmental exposures and healthcare access, fundamental biological differences continue shaping survival outcomes, with male infants requiring the same vigilant care and medical attention as females despite their biological vulnerability increasing death risks throughout the first year of life.

The trajectory of childhood mortality rates in the United States moving into 2025 and beyond presents both encouraging opportunities and persistent challenges requiring sustained commitment from healthcare systems, policymakers, and communities. Recent stabilization in infant mortality rates after decades of decline signals potential stagnation demanding renewed focus on prevention strategies and healthcare access expansion. Emerging opportunities include technological advances in neonatal care with improved treatments for extremely premature infants, enhanced prenatal screening technologies identifying risks earlier in pregnancy, telemedicine expansion increasing rural access to maternal-fetal medicine specialists, and growing recognition that social determinants of health including housing stability, food security, and economic opportunity fundamentally impact pregnancy outcomes. Artificial intelligence applications may soon help identify high-risk pregnancies requiring enhanced monitoring, while biomedical research continues uncovering genetic factors contributing to congenital malformations and preterm birth, potentially opening new prevention pathways. However, realizing these potential improvements requires addressing fundamental disparities in healthcare access, with particular attention to expanding comprehensive insurance coverage, increasing the number of obstetric care providers in underserved areas, and implementing evidence-based interventions like group prenatal care and home visiting programs proven effective in high-risk populations.

The persistent racial and geographic disparities in childhood mortality represent the most troubling aspect of current trends, demanding comprehensive approaches beyond healthcare alone. Future progress requires confronting structural racism within medical systems through implicit bias training, diversifying the healthcare workforce, implementing quality improvement initiatives specifically targeting disparities, and ensuring culturally competent care for diverse populations. Addressing social determinants of health through policies supporting paid family leave, affordable childcare, stable housing, food assistance, and economic opportunity will likely prove essential for sustainable mortality reductions, as medical interventions alone cannot overcome profound socioeconomic disadvantages affecting maternal and child health. Climate change impacts including extreme heat events, air quality degradation, and increased natural disasters may create new pregnancy risks requiring adaptation strategies. The adolescent mental health crisis reflected in rising youth suicide rates demands urgent investment in school-based mental health services, crisis intervention systems, and reducing stigma around seeking mental health care. Success will require collaborative efforts spanning healthcare, education, housing, economic policy, and community development, with sustained funding, political will, and recognition that investing in maternal and child health represents investing in America’s future. The goal of achieving equity in childhood survival across all races, regions, and socioeconomic groups remains achievable but demands unprecedented commitment to addressing root causes of health disparities rather than merely treating their consequences.

Disclaimer: This research report is compiled from publicly available sources. While reasonable efforts have been made to ensure accuracy, no representation or warranty, express or implied, is given as to the completeness or reliability of the information. We accept no liability for any errors, omissions, losses, or damages of any kind arising from the use of this report.