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and families living with life-threatening medical problems has to be put in the context of child health as it has improved during the last century. First, in the United States, death in childhood is now rare rather than commonplace. Second, causes of death in childhood have changed. Third, children have different patterns of mortality than adults. Fourth, although most children are now healthy, a significant fraction lives with serious health problems.
Death in Childhood Is No Longer Expected
In 1900, 30 percent of all deaths in the United States occurred in children less than 5 years of age compared to just 1.4 percent in 1999 (CDC, 1999a; NCHS, 2001a). Infant mortality dropped from approximately 100 deaths per 1,000 live births in 1915 (the first year for which data to calculate an infant mortality rate were available) to 29.2 deaths per 1,000 births in 1950 and 7.1 per 1,000 in 1999 (CDC, 1999b; NCHS, 2001a).2
This decrease in mortality reflects a century’s worth of advances in public health, living standards, medical science and technology, and clinical practice. Many infants who once would have died from prematurity, complications of childbirth, and congenital anomalies (birth defects) now survive. Children who previously would have perished from an array of childhood infections today live healthy and long lives thanks to sanitation improvements, vaccines, and antibiotics. In the United States, the average life expectancy at birth rose from less than 50 years in 1900 to more than 76 years in 1999, due in considerable measure to continuing reductions in infant and child mortality (NCHS, 2001c).
Nonetheless, each year in this country, thousands of parents lose their children to conditions such as prematurity, congenital anomalies, injuries, and diseases such as cancer and heart disease. Thousands more siblings, grandparents, other family members, friends, neighbors, schoolmates, and professional caregivers are touched by these deaths. Instead of being a sad but common family experience, death in childhood now stands out as a particular tragedy, at least in developed nations such as the United States.
Despite such progress, the United States ranked twenty-seventh in infant mortality among 38 countries in 1997, lower than such nations as the Czech Republic and Portugal and tied with Cuba (NCHS, 2001c). The relatively high infant mortality rate in the United States has been attributed in part to this country’s large number of low birth weight infants, which in turn, reflects underlying social and economic problems and disparities (see, e.g., Guyer et al., 2000; Hoyert et al., 2001).