(December 2002) From the standpoint of American parents, the best news of the 20th century was the steady, long-term decline in the risk of death for infants and children. Around the time of World War I, 1 in 10 babies born in the United States died before age 1. The infant mortality rate for minority infants approached 1 in 5. These rates are similar to those found today in some of the poorest countries of the world, such as Sierra Leone and Ethiopia. Today infant and child deaths are much less common. There are 7 infant deaths for every 1,000 babies born in the United States. In 2000, the death rate for children ages 1 to 4 was 0.3 per 1,000 population, down from 19.8 in 1900.

In the early years of the century, most child deaths were caused by infectious diseases. The top three causes of death for those ages 1 to 4 were respiratory diseases (pneumonia and influenza), gastrointestinal diseases (diarrhea, enteritis, and ulceration of the intestines), and tuberculosis. The threat to children from these traditional killers has largely been eliminated, mainly through improved standards of living (well-fed children are less likely to succumb to infectious diseases, and families living in less crowded conditions are less likely to transmit respiratory infections), cleanliness, and preventive and curative medical care. Beginning in the 1930s, sulfa drugs — and later penicillin and other antibiotics — were used to treat infections. From the 1920s through the 1990s, new vaccines were proven effective against diseases that formerly killed or crippled large numbers of children, including diphtheria (a diarrheal disease), pertussis (respiratory), tetanus, poliomyelitis, measles, mumps, and rubella.

By the end of the 20th century, death rates were much lower, and injury had replaced infection as the greatest danger to children. The top three causes of death for 1- to 4-year-olds in 2000 were accidents, congenital anomalies/deformations/chromosomal abnormalities (e.g., spina bifida, Turner’s Syndrome), and cancer.


[1915 to 1969] U.S. Census Bureau, Historical Statistics of the United States, Colonial Times to 1970, Bicentennial Edition, Part 1 (Washington DC: U.S. Government Printing Office, 1975); [1970, 1975 to 1998] S.L. Murphy, “Deaths: Final Data for 1998,” National Vital Statistics Report 48, no. 11; [1971 to 1974] National Center for Health Statistics, Mortality Vital Statistics of the United States 1981, Volume 2 (Hyattsville, MD: National Center for Vital Statistics, 1986); [1999] D.L. Lyert et al., “Deaths: Final Data for 1999,” National Vital Statistics Reports 49, no. 8 (2001); A.M. Minino et al., “Deaths: Final Data for 2000,” National Vital Statistics Reports 50, no. 15 (2001).