Child Death Rates in the United States Have Increased, Study Finds

The overall death rate of children and adolescents in the United States increased 6.6% between 2020 and 2023, researchers report May 13 in the New England Journal of Medicine.

Many of the top causes of death in young people—including firearms, car accidents, and poisoning—lead to injuries that are treated in emergency departments. It was seeing these cases and experiencing the feeling that comes with a child’s death, that led Caroline Raymond-King, MD, PhD, an emergency medicine resident at Yale School of Medicine, to identify the leading causes of child mortality in the United States.

For the study, Raymond-King and her colleagues analyzed data from 2018 to 2023. The findings are the most comprehensive update to this type of analysis since 2020, capturing three full years of post-pandemic mortality trends among children and adolescents aged 1 to 19.

In 2023, 22,841 children and adolescents died in the United States, the researchers found. Since 2020, the overall crude death rate (total deaths divided by the number of children aged 1-19 in the United States) in this age group rose 6.6%.

Firearms remained the leading cause of death for the fourth consecutive year. "In 2020, firearm deaths surpassed motor vehicle crashes as the leading cause of death for children in the United States," says Raymond-King, lead author of the study. "Not only has that persisted, but the risk of firearm deaths has increased over the last three years." In 2023, 4,455 children and adolescents were killed by guns—a 3.9% increase since 2020.

While motor vehicle crash deaths rose 8.6% over the same period, drug poisoning deaths, including overdoses, were the third leading cause of death, up 12.7% since 2020.

For respiratory illnesses, as COVID-19 cases fell, influenza and pneumonia became the ninth leading cause of death in 2023, with a 33.3% increase since 2020. COVID-19 was the eleventh leading cause of mortality and accounted for 125 deaths among children and adolescents in 2023, down from a peak of 547 in 2021.

Among the other top causes were cancer (fourth), suffocation (fifth), congenital anomalies (sixth), drowning (seventh), heart disease (eighth), and fire (tenth).

Raymond-King notes evidence-based actions parents can take to reduce risk of injury or death.

The first is removal or safe storage of items that put children at risk. If firearms are present, they should be stored locked, unloaded, and separately from ammunition. Medications should be securely stored out of reach of children.

Further, the fatalities from influenza, COVID-19, and pneumonia during the study period highlight the ongoing importance of vaccination, Raymond-King says. "Flu, COVID-19, and routine childhood vaccines—staying up to date on all of them matters."

In addition, Raymond-King notes the importance of connecting young people to psychiatric care, as a significant proportion of firearm deaths in this age group involved suicide. Mental health care remains a critical and under-addressed gap, she says.

Overall, her message to parents is to talk to their pediatrician.

"They have the best evidence on how to keep kids safe," she says.

Edward Melnick, MD, associate professor of emergency medicine, was a coauthor of the paper.