children would not benefit from palliative or hospice services because they die suddenly and unexpectedly, leaving caregivers to tend to the bereaved family.

The next three sections of this chapter review death rates and major causes of death for children by broad age groups. Later sections consider socioeconomic and other disparities in death rates and causes of death.


Because so many deaths occur during pregnancy and in the first year after birth and because understanding the causes of such deaths is of particular interest, a number of terms have been developed to describe and differentiate these deaths. Table 2.3 lists the most widely used terms and their definitions and also includes other common terms and definitions relating to this period.

Death Rates and Numbers

Table 2.4, which shows trends in infant, fetal, and perinatal mortality rates since 1950, reveals continuing mortality decreases in the last half-century. In 1999, the infant mortality rate in the United States reached a low of 7.1 infant deaths per 1,000 live births, or 28,371 total infant deaths. After infancy, the mortality rate drops significantly and does not rise again to similar rates until people reach their mid-50s.

More children die in the first year of life than in all other years of childhood combined (27,937 infants compared to 26,622 children aged 1 to 19 years in 1999) (see Figure 2.2). Two-thirds of infant deaths occur in the neonatal period (18,728 of 27,937 deaths).

Of some 6.2 million pregnancies each year, about 63 percent result in a live birth, 20 percent in an induced abortion, and 15 percent in a fetal death (Martin and Hoyert, 2001). Ninety percent of spontaneous fetal losses occur within the first 20 weeks of pregnancy. A large percentage of these end so early that the pregnancy is unrecognized. Most of the decline in fetal death rates in recent decades has occurred in the late fetal period.

Leading Causes of Infant Death

Understanding the common causes of infant death is important in understanding the potential role of supportive care for these children and their families. Table 2.5 reports the five leading causes of infant, neonatal, and postneonatal death. These causes account for approximately 54 percent of all infant deaths. In contrast, the next five causes (complications of placenta, cord, and membranes; infections; unintentional injuries; intrauterine

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