Although child mortality has fallen significantly over the past century,1 there is still scope for improvement. In 2005, over 3200 infants (5 per 1000 live births) and 1200 children under the age of 15 (14 per 100 000 population) died in England and Wales,2 with large discrepancies in mortality between different areas and between different socioeconomic and cultural groups. Many of these deaths are preventable—whether they are from external causes or from natural conditions that are not normally fatal. Several studies have concluded that as many as 29% of child deaths may be preventable or contributed to by potentially avoidable factors.1 3 4 It is important, therefore, to examine the causes of child death and learn from them.

The highest risk of death is in infancy, particularly in the first month of life. Risk tails off to low levels in middle childhood before rising again in adolescence. The causes of death also vary with age (fig 1⇓). Perinatal and congenital conditions predominate in the first month. However, in later infancy and middle childhood years, most deaths are from medical causes, although up to a quarter are related to external causes or remain unexplained, including deaths from sudden infant death syndrome. The pattern changes in adolescence, with half of deaths being from external causes.

Whatever the underlying causes, each death is a tragedy for the affected family and the wider community. After the death of a child, the experience of families varies enormously, and for many, professional responses to their bereavement compound rather than help their trauma.5 6 …