Child mortality

For children between the ages of one and nine years mortality rates have steadily fallen across the UK over time. The current leading cause of death for children is cancer.

Background

  • Factors that contribute to death during early childhood are different to those which contribute to death during infancy or adolescence, with cancer being the biggest cause of death in this age group.
  • There is a strong association between deprivation and the risk of death throughout childhood, with children in deprived areas more likely to die.1

Key findings

  • Mortality rates among one to nine year olds in the UK have declined in the previous five years, from 11.8 to 10.0 deaths per 100,000 children in 2014 and 2018 respectively, although the rate of decline in recent years has slowed.
    • There were a total of 722 registered deaths for children aged one to nine years in the UK in 2018.
  • Falling trends have been mirrored in England and Wales, where the rate in 2018 was 9.9 per 100,000 children.2
  • The mortality rate is higher in Northern Ireland, but low numbers of deaths in there makes it difficult to interpret trends. The rate in Northern Ireland was 10.0 per 100,000 children3 and in Scotland the rate was 9.7 per 100,000 in 2018.4
  • The top three causes of death in the 1-4 age group in England and Wales are:
    • Cancer
    • Accidents (including injuries / poisonings)
    • Congenital conditions.2
  • The top three causes of death in the 5-9 age-group in England and Wales are:
    • Cancer
    • Respiratory causes
    • Accidents (including injuries / poisonings).2

Child mortality rate calculated using the number of child deaths (1-9 years) divided by ONS population estimates for that age group and year, multiplied by 100,000.5

Fluctuations within mortality data from Northern Ireland and Scotland should be read with caution, due to small numbers of registered deaths.

What does good look like?

Focus on environmental and social factors to reduce inequalities. Across all age groups, children who live in poverty and deprivation are less likely to survive than their more privileged peers.1 Efforts to reduce child poverty remain crucial to child survival.6 Universal health visiting services play a vital role in this for pre-school children, particularly for accident prevention guidance.

Better access to high quality healthcare services to support children with long term conditions. The incidence of death during childhood due to non-communicable diseases is higher in the UK than in similar wealthy countries,7 although many children with congenital conditions are living longer. To improve outcomes for both common and rare long-term conditions in childhood, efforts should focus on both advances in clinical knowledge (including improved national data collection) and ensuring the uniform adoption of best practice across the UK, including access to the full range of multidisciplinary child health services.

Policy recommendations

  • NHS England should deliver commitments from the Long Term Plan for children and young people’s cancer services, including:
    • Offering all children with cancer genome sequencing;
    • Access to CAR-T and proton beam cancer therapies;
    • Evidence that children and young person are involved in 50% more clinical trials by 2025;
    • All boys aged 12 and 13 are offered vaccination against HPV-related diseases;
    • Investment in children’s palliative care services in line with clinical commissioning groups.
  • NHS England should support the ongoing establishment of a UK wide clinical network for asthma, as per the NHS Long Term Plan commitment. Appropriate support and resources must be provided to support key network functions at national and regional levels. Networks should include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
  • Scottish Government should commit to publishing an impact assessment of the Strategic Framework for Action on Palliative and End of Life Care 2016 – 2021.
  • Scottish Government should undertake an impact assessment of the Cancer Plan for Children and Young People in Scotland 2016 – 2019.
  • Scottish Government should publish a new cancer plan for children and young people based on the findings of the impact assessment. The plan should consider prevention, diagnosis and treatment.
  • Welsh Government should undertake an impact assessment of the Cancer Delivery Plan for Wales (2016-2020), specifically looking at children and young people’s cancer services, to inform planning for children’s cancer services beyond 2020.
  • The Northern Ireland Executive should deliver the commitment to publish the Northern Ireland Cancer Strategy and delivery plan by December 2020, to ensure that innovative treatments and inclusion of children and young people in clinical trials are prioritised.
  • There should be investment in children’s palliative services to deliver the objectives in ‘A Strategy for Children’s Palliative and End of Life Care’ (2016-26).

What can health professionals do about this?

  • Improve maternal health. Professionals should support efforts to maximise maternal health during pre-conception and pregnancy, including smoking cessation programmes, promoting breastfeeding, and promoting healthy weight in women of childbearing age.
  • Make every contact count. Health professionals in emergency care settings should take advantage of healthcare contacts to offer health promotion advice on injuries and poisonings. Clinical guidance is available from the National Institute for Health and Care Excellence (NICE).8
  • Recognise impact of social determinants of health, and support families in need. Professionals should recognise that families living in difficult circumstances are at higher risk of death in childhood, as well as other poor outcomes. They can support and act as advocates for vulnerable families, signposting referrals to other agencies for help with poverty and adversity if appropriate.

Contributing authors

  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

(1)

Public Health Wales.2016. Child deaths in Wales: Patterns and trends report 2016.

(3)

Northern Ireland Statistics and Research Agency. Registrar General Annual Report 2018, Deaths. November 2018.

(4)

National Records of Scotland. 2019. Vital Events Reference Tables.

(5)

Office for National Statistics. Estimates of the population for the UK, England and Wales, Scotland and Northern Ireland. Mid-2001 to mid-2018 detailed time-series. June 2019.

(6)

Wolfe, I. et al. 2015. UK child survival in a European context: Recommendations for a national countdown collaboration. Archives of Diseases in Childhood.

(7)

Viner, R.M. et al. 2014. Deaths in young people aged 0-24 years in the UK compared with the EU15+ countries, 1970-2008: Analysis of the WHO mortality database. Lancet.

(8)

National Institute for Health and Care Excellence. 2010. Unintentional injuries: prevention strategies for under 15s