Fact check: What are the leading causes of child deaths in the USA?

1. Why babies die: the persistence of perinatal and congenital causes

U.S. infant mortality remains concentrated in the neonatal and perinatal period, with preterm birth complications, low birth weight, and congenital anomalies repeatedly identified as top contributors to deaths under one year. National Vital Statistics Reports frame infant mortality through maternal and gestational variables—maternal age, race/ethnicity, and gestational age—showing persistent disparities and indicating that structural factors drive much of this burden ^[1]. Global comparisons show the U.S. has improved since 1995 but still trails peer countries, reinforcing that medical and social determinants both matter ^[4].

2. Older children and teens: injuries dominate the death toll

For children and adolescents beyond infancy, injury-related deaths account for a majority of fatalities, with unintentional injuries (motor vehicle crashes, drownings) historically leading and intentional injuries (homicide, suicide) significant among teens. A synthesis of U.S. data found that injury causes comprised over 60% of child and adolescent deaths in past analyses, underscoring that prevention—safety regulations, trauma care, and mental-health access—is central to reducing mortality in these age groups ^[3]. This pattern contrasts with global under-five mortality drivers, where infectious disease and malnutrition remain prominent ^[4].

3. Firearms have emerged as the leading cause for youths in recent years

Recent studies through 2022–2023 indicate firearm injuries are the single leading cause of death among U.S. children aged 0–19, surpassing motor vehicle crashes in several datasets and widening racial disparities—particularly affecting Black and American Indian/Alaska Native children. The 2025 analysis documents this shift and calls for targeted interventions to address both access to firearms and the social conditions linked to violence ^[2]. Earlier trend analyses already flagged injury causes as dominant, but the firearm-specific rise is a recent and policy-relevant development ^[3].

4. Excess youth deaths: the U.S. gap with peer countries

A JAMA Pediatrics analysis quantified over 400,000 excess deaths among U.S. youths aged 0–19 from 1999–2019 compared to similar nations, with infants accounting for the majority of excess deaths. The study highlights that the mortality gap widened in the last decade, driven partly by rising injury deaths in older age groups and persistent perinatal shortcomings, suggesting that both healthcare system performance and broader social policies contribute to the excess ^[5]. This framing places U.S. child mortality trends within an international context where policy differences correlate with varying outcomes ^[4].

5. Disparities: race, geography, and socioeconomic threads

Data across reports consistently point to marked racial and geographic disparities in child mortality. National Vital Statistics emphasize variability by maternal race/ethnicity and state of residence for infant deaths, while firearm mortality studies document disproportionate impacts on Black and Indigenous children in recent years. These patterns suggest that interventions must address structural inequities—healthcare access, poverty, housing, and violence prevention—rather than targeting single clinical causes alone ^{[1] [2]}.

6. Prevention opportunities: what the evidence signals

Reports converge on the idea that many child deaths are preventable through combined clinical and public-health strategies: prenatal care and neonatal interventions for infants, and injury prevention, safe driving policies, firearm-safety measures, and mental-health services for older children. The global child-mortality literature underscores unequal access to healthcare and nutrition as major drivers of preventable deaths, a lesson applicable domestically in addressing perinatal inequities and social determinants ^{[4] [3]}.

7. What’s missing or uncertain in the public conversation

Current analyses highlight gaps: many national reports present cause lists but vary in timeliness and disaggregation, making it hard to track rapid shifts—such as the surge in pediatric firearm deaths—across demographic groups in real time. Studies note slower progress and data lag as obstacles to policy responsiveness, and the global reports remind us that contextual factors like poverty and healthcare access are often underemphasized in U.S.-centric discussions ^{[4] [1] [2]}.

8. Bottom line for policymakers and clinicians

The evidence up to 2023–2025 frames child mortality in the U.S. as a two-part problem: medical-perinatal causes drive infant deaths, while injuries—especially firearms and motor vehicle crashes—drive deaths among older children and adolescents, with persistent racial and geographic disparities amplifying the toll. Addressing this requires integrated strategies spanning prenatal care, injury prevention, firearm-safety policy, and structural investments to reduce inequities; the data suggest targeted, time-sensitive interventions could substantially lower avoidable child deaths ^{[1] [3] [2] [5]}.