Unintentional injuries are the number one cause of death in children in the United States, and they have held that position for more than two decades. According to 2023 mortality data from the CDC, accidents are the leading killer of children in every age group from 1 through 19, accounting for roughly 60% of all child and adolescent deaths.
How Risks Change With Age
The specific threats children face shift dramatically as they grow. For children ages 1 to 4, the top three causes of death are unintentional injuries, birth defects, and homicide. Drowning and vehicle crashes are the most common types of fatal accidents in this youngest group.
For children ages 5 to 9, unintentional injuries still lead, followed by cancer and birth defects. Once children reach 10 to 14, the picture darkens: accidents remain first, but suicide moves into second place, ahead of cancer. By the teenage years (15 to 19), the death rate climbs sharply to 57.9 per 100,000, with accidents, homicide, and suicide as the top three causes in that order. At every stage, injury, not disease, is the dominant threat.
What Types of Injuries Are Most Deadly
Not all accidents look the same. For young children, drowning and car crashes cause the most fatal injuries. Falls are the leading reason children visit the emergency room at nearly every age, but they rarely kill. Among older children and teens, vehicle crashes become overwhelmingly dominant, accounting for 54% to 68% of unintentional injury deaths in the 10 to 14 age range.
Firearms have also reshaped the landscape. Motor vehicle crashes were historically the single deadliest type of injury for children, but firearm-related deaths overtook them in 2019. Between 2011 and 2021, firearm homicides among children and youth ages 0 to 19 increased by 87%, and firearm suicides rose 68%. Unintentional shooting deaths also climbed by 24% during that period. Vehicle crash deaths, meanwhile, had been declining year over year until 2019, when they began rising again.
Infants Are Different
Children under 1 year old are a notable exception to the pattern. For infants, the leading causes of death are birth defects, preterm birth and low birth weight, pregnancy complications, and sudden infant death syndrome. Unintentional injuries rank fourth. This is why most child mortality statistics start at age 1 when identifying accidents as the top cause.
Infant mortality also reveals stark racial disparities. As of 2018, the infant mortality rate for non-Hispanic Black infants was 10.8 per 1,000 live births, compared to 4.6 for non-Hispanic White infants and 3.6 for Asian infants. These gaps persist even after accounting for education level. Black infants born to highly educated mothers still had a 46% higher mortality rate than White infants born to less educated mothers.
Racial Disparities Beyond Infancy
The inequities extend well past the first year of life. Black children face higher death rates from both injury-related causes (firearms, drowning, and fire or burns) and medical causes. Black youth die from heart disease at 2.1 times the rate of White youth, and from chronic respiratory diseases like asthma at 6.3 times the rate. Black and Hispanic very preterm infants are also more likely to be born at hospitals with the highest morbidity and mortality rates, a structural factor that compounds biological risk.
Disease-Related Causes
Among non-injury causes, cancer is the most significant, responsible for about 9% of all child and adolescent deaths. It is the only medical condition that ranks among the top five overall causes. The good news is that the cancer death rate for children dropped 32% between 1990 and 2016, reflecting real progress in detection and treatment. Heart disease and chronic respiratory conditions each account for smaller fractions of childhood deaths, at roughly 3% and 1% respectively.
The Global Picture Looks Different
Outside the United States, the leading causes of childhood death are largely infectious. Globally, acute respiratory infections, diarrheal diseases, and malaria remain top killers of children under 5, alongside complications from preterm birth and birth trauma. The number of newborn deaths worldwide fell from 5.2 million in 1990 to 2.3 million in 2023, but progress has been slower for newborns than for older children. In wealthier countries where infectious disease is better controlled, injuries dominate. In lower-income countries, preventable infections still claim far more young lives.
Prevention That Works
Because the leading cause of death in children is injury rather than disease, much of it is preventable through environmental changes and parental awareness. Car seats, pool fencing, safe firearm storage, and age-appropriate supervision address the specific risks that kill the most children. A clinical trial published by the American Academy of Pediatrics found that structured injury prevention counseling during routine well-child visits significantly reduced parent-reported injuries, particularly among low-income and minority families who face the highest risk. The program, called TIPP (The Injury Prevention Program), provides age-specific safety guidance at each pediatric checkup, covering everything from car seat use to choking hazards.
The core reality is that most childhood deaths in the U.S. are not caused by illness. They are caused by preventable events, and the type of event that poses the greatest danger depends on a child’s age, where they live, and what safety measures surround them.