Child Death Review Data Release: Year ending 31 March 2024
1. Introduction
The National Child Mortality Database (NCMD) was launched on 1 April 2019 and collates data collected by Child Death Overview Panels (CDOPs) in England, from reviews of all children who die at any time after birth and before their 18th birthday. There is a statutory requirement for CDOPs to collect these data and to provide them to NCMD, as outlined in the Child Death Review statutory and operational guidance. The guidance requires all Child Death Review (CDR) Partners to gather information from every agency that has had contact with the child, during their life and after their death, including health and social care services, law enforcement, and education services. This is done using a set of statutory CDR forms and the information is then submitted to NCMD.
Every child who dies is a precious individual and their deaths represent a devastating loss for parents, siblings, grandparents, carers, guardians, extended family and friends. With all child deaths there is a strong need to understand what happened, and why. We must ensure that anything that can be learned to prevent future deaths from happening is identified and acted upon.
The data in this report summarise information about child deaths in England up to 31 March 2024 and the findings of reviews carried out by a CDOP on or before 31 March 2024.
It should be read in conjunction with the data tables, where more detail is available.
2. Child death notifications
There were 3,577 child (0 – 17 years) deaths in England in the year ending 31 March 2024, an estimated rate of 29.8 deaths per 100,000 children. The number of deaths decreased by 4% on the previous year but remained higher than 2019-20. Infant (children under 1 year) deaths decreased by 2% on the previous year and deaths of children aged between 1 and 17 years decreased by 8% (Figure 1). Although the number of infant deaths decreased, the estimated infant death rate increased from 3.8 to 3.9 per 1,000 live births.
Figure 1. Number of child death notifications, by year ending 31 March
The child death rate varied across regions in England, with the rate ranging from 24.2 to 40.7 per 100,000 population of 0-17-year-olds (Figure 2).
Figure 2. Estimated child death rate per 100,000 population, by region
The child death rate in the year ending 31 March 2024 remained highest for children of black or black British ethnicity (55.4 per 100,000 population) and Asian or Asian British ethnicity (46.8 per 100,000 population) (Figure 3). The rates for all ethnic groups have decreased in comparison to the previous year.
Figure 3. Estimated child death rate per 100,000 population, by ethnicity
Within these ethnicity groupings, over a five-year period, the child death rate was highest for children of Asian Pakistani ethnicity (57.0 per 100,000 population), followed by any other Asian background (51.8 per 100,000 population), black African (51.3 per 100,000 population) or black Caribbean (51.3 per 100,000 population) (Figure 4). This was more than double the rate of children from a white British ethnic background (22.9 per 100,000 population). The child death rate was lowest for those of Chinese ethnicity (16.4 per 100,000 population).
Figure 4. Estimated death rates for children aged between 0 and 17 years per 100,000 population, by ethnicity (years ending 2020-2024)
The child death rate for children resident in the most deprived neighbourhoods of England was 42.9 per 100,000 population, more than twice that of children resident in the least deprived neighbourhoods (17.2 per 100,000 population) (Figure 5). The child death rates decreased from the previous year for both quintiles, although the difference in rates between these areas is still higher than any year recorded before 2023.
Figure 5. Estimated child death rate per 100,000 population, by most/least deprived quintiles
Over the five-year period, death rates for children of black and Asian ethnicity remained higher than for children of white British ethnicity across all five deprivation quintiles (Figure 6).
Figure 6. Estimated death rates for children aged between 0 and 17 years per 100,000 population, by IMD quintile and ethnicity (Years ending 2020 – 2024)
For children aged between 1 and 17 years, the highest death rate continued to be for children aged between 15-17 years (19.3 per 100,000 population), followed by 1-4-year-olds (16.1 per 100,000 population) (Figure 7). Death rates for all age groups decreased in comparison to the previous year.
Figure 7. Estimated death rates for children aged between 1 and 17 years per 100,000 population, by age group
Infant deaths
Deaths of infants (babies under 1 year of age) accounted for 61% of all child deaths in the year ending 31 March 2024.
The infant death rate was 3.9 per 1,000 live births, an increase from the previous year (3.8), and remained higher than 2019-20 (Figure 8). For infants born at 24 weeks or over, the estimated death rate was 2.7 deaths per 1,000 live births of the same gestational age; the same rate as the previous two years.
Figure 8. Estimated infant death rate per 1,000 live births
Patterns of infant deaths were similar to those reported for all child deaths. The estimated infant death rate continued to be highest for infants of black or black British ethnicity (6.8 per 1,000 live births); more than double the rate of infants of white ethnicity (3.2 per 1,000 live births) (Figure 9). The death rate of infants of Asian or Asian British ethnicity (5.4 per 1,000 live births) also continued to be higher than for white infants.
Figure 9. Estimated infant death rate per 1,000 live births, by ethnicity
Within these ethnicity groupings, over a five-year period, the infant death rate was highest for infants of black Caribbean ethnicity (9.2 per 1,000 infant population), followed by black African (8.4 per 1,000 infant population), and Asian Pakistani (7.2 per 1,000 infant population) (Figure 10). This was higher than the rate for white British ethnic background (2.8 per 1,000 infant population).
The death rate of infants who were resident in the most deprived neighbourhoods of England (5.5 per 1,000 infant population), remained more than twice that of infants resident in the least deprived neighbourhoods (2.0 per 1,000 infant population) (Figure 11). Similar to all child deaths, the infant death rates for the most and least deprived areas have decreased compared to the previous year but the difference in rates between these areas remained higher than the prior three years.
Figure 11. Estimated infant death rate per 1,000 infant population, by most/least deprived quintiles
Infant mortality varied across regions of England, with rates ranging from 3.1 to 5.7 per 1,000 live births (Figure 12).
Figure 12. Estimated infant death rate per 1,000 live births, by region
Neonatal deaths
Neonatal deaths (deaths of babies under 28 days of age) accounted for 42% of all child deaths in the year ending 31 March 2024.
The estimated neonatal death rate was 2.7 per 1,000 live births, an increase from the previous year (2.6) and remained higher than 2019-20 (Figure 13). The estimated neonatal death rate for babies born at 24 weeks or over was 1.6 deaths per 1,000 live births of babies born at 24 weeks or over; the same as the previous two years. The neonatal mortality rate ambition is to reduce to 1.0 deaths per 1,000 live births of babies born at 24 weeks or over, by 2025.
Figure 13. Estimated neonatal death rate per 1,000 live births
80% of neonatal deaths were of babies born at a premature gestational age (before 37 weeks) (Figure 14), which was an increase from those seen in previous years. The proportion of neonatal deaths notified to CDOPs of babies born under 24 weeks gestation also increased (39% vs 33% in the year ending March 2020).
This increase in deaths of babies under 24 weeks is difficult to interpret but may be impacted by multiple factors, such as more consistent recognition of signs of life by clinical teams, babies receiving survival focussed care, appropriate completion of MCCDs (medical certificate of cause of death), and better reporting to CDOPs.
Figure 14. Proportion of neonatal deaths by gestational age at birth
Further information on child death notifications can be found within Tables 1-13, including a breakdown of infant and child death rates by Integrated Care Boards, further breakdowns of ethnicity groupings and child death rates by ethnicity and deprivation.
3. Child death reviews by CDOPs
3,345 child deaths were reviewed by CDOPs in England between 1 April 2023 and 31 March 2024 (some of these deaths may have occurred in earlier years); a similar number to the previous year and the highest number since 2019-20 (Figure 15).
The proportion of reviews that identified modifiable factors continued to rise with 43% of deaths reviewed in the year ending 31 March 2024 identifying modifiable factors. The proportion of reviews with modifiable factors varied per region from 34% to 57% (Table 14).
Figure 15. Number of child death reviews by CDOPs, by year of review and modifiable factors
The most common primary category (i.e., the likely cause) of death for reviews in 2023-24 was Perinatal/neonatal event, which was recorded for 31% of all child death reviews, followed by Chromosomal, genetic and congenital anomalies (24%), Sudden unexpected and unexplained death (8%), Acute medical or surgical condition (8%) and Malignancy (8%) (Figure 16). These patterns were similar to previous years.
The most common primary category of death for children under 1 was Perinatal/neonatal event; for children aged between 1 and 9 years it was Chromosomal, genetic and congenital anomalies; and for children aged between 10 and 17 years it was Malignancy. Figure 16 shows the number of reviews by primary category of death and age group.
Figure 16. Number of child death reviews by CDOPs by primary category of death and age group, year ending 31 March 2024
The CDOP is responsible for identifying any modifiable factors in relation to the child’s death. Modifiable factors are defined as factors which, by means of nationally or locally achievable interventions, could be modified to reduce the risk of future child deaths.
Deaths categorised as Trauma or other external factors had the highest proportion of reviews with modifiable factors (76%), followed by Sudden unexpected and unexplained death (75%), Deliberately inflicted injury, abuse or neglect (73%) and Suicide or deliberate self-inflicted harm (68%) (Figure 17).
Figure 17. Number of reviews completed by CDOPs by primary category of death and whether modifiable factors were identified, year ending 31 March 2024
Contributory and modifiable factors identified in child death reviews
As part of the child death review process, CDOPs must record any contributory factors identified during the review and decide which may be modifiable. Definitions of these terms can be found in the statutory child death analysis form or guidance notes can be found in the contributory factors guidance. More than one factor can be identified in each child death review.
The most common recorded modifiable factors by CDOPs during reviews of infant deaths were smoking by a parent/carer (198, 27% of infant death reviews with categorised modifiable factors, 10% of all infant death reviews), high maternal body mass index (BMI) (169, 23%, 8%), and smoking in pregnancy (164, 22%, 8%) (Figure 18).
The most common recorded modifiable factors by CDOPs during reviews of deaths of children aged 1 – 17 years were poor communication between agencies (46, 12% of child death reviews (1 – 17 years) with categorised modifiable factors, 4% of all child death reviews (1 – 17 years)), issues with treatment (e.g., delay in starting treatment, side effects or complications developed as a result of treatment, or medical or surgical error) (37, 9%, 3%) and lack of appropriate supervision (e.g., young child unsupervised in a bath) (34, 9%, 3%) (Figure 19).
Known to social care
For reviews completed in the year ending 31 March 2024, 15% of children were known to social care at the time of their death; a similar proportion to previous years (14%) (Figure 20). A further 14% were reported as previously known to social care, which has increased each year from 10% in the year ending 31 March 2020.
Of the 499 reviews where the child was known to social care at the time of their death, 46% identified modifiable factors. The proportion of reviews that identified modifiable factors remains higher for children who were known to social care (46%) than children who were never known to social care (40%).
Figure 20. The proportion of child death reviews by CDOPs, by year of review and whether the child was known to social care
For reviews completed by CDOPs in 2023-24, 4% of the deaths were subject to a local or national Child Safeguarding Practice Review (CSPR) (Figure 21), which is a similar proportion to the previous year (3%). Of the 114 reviews where a CSPR took place, 81% of CDOP reviews recorded modifiable factors, an increase from the previous year (74%).
Figure 21. The proportion of child death reviews by CDOPs, by year of review and whether there was a Child Safeguarding Practice Review
Timeliness of CDOP reviews
42% of reviews in the year ending 31 March 2024 were completed by the CDOP within 12 months of the death, a decrease from the previous year, and a continuing fall from 2020 where 67% of reviews were completed within 12 months (Figure 22). The median time taken to complete reviews in 2023-24 was 411 days (around 14 months).
Figure 22. Proportion of child death reviews completed by CDOPs within 12 months of the death
4. Technical information
All reference tables including further breakdown of data can be found here.
A child for these purposes is defined as a child aged 0 up to their 18th birthday, excluding stillbirths and planned terminations of pregnancy carried out within the law.
All CDOPs continue to submit data to NCMD on an ongoing basis. NCMD is dependent on accurate data entry by the CDOPs, and specifically, category of death is presented within the data release as it was submitted by the CDOP. The data included within this release represent child deaths that were submitted to NCMD that were going to be, or had been, reviewed by a CDOP in England. In a small number of reviews, this may include deaths of children usually resident outside of England.
CDOPs are required to assign a category of death to each death reviewed within the Analysis Form, the final output of the child death review process. The classification of categories is hierarchical where the uppermost selected category is recorded as the primary category should more than one category be selected. The definitions for each category can also be found in the analysis form.
The estimated neonatal and infant death rates reported have been calculated using ONS data for live births, and the rate is presented per 1,000 live births.
The estimated child (0-17 years) death rate and death rate of children aged 1-17 years have been calculated using population data of children the same age in England, from the ONS mid-year population estimates (for years ending 31 March 2020, 2021, 2022 and 2023, 2024), or Census 2021 data (for all years). The rate is presented per 100,000 children of the same age. ONS publish live births data and population estimates using calendar years. As this CDR data release uses financial years, live births and population estimates that correspond to the largest proportion of the financial year were used, for example, 2019 live births and mid-year population estimates were used to calculate rates for deaths occurring in the year ending 31 March 2020, and so on.
Table 4 uses the population of infants (0-year-olds) as a proxy measure for live births, as the data for live births by deprivation and region was not available. This may have a small impact on the rates presented. Due to availability of published population data, each table uses different underlying populations. This means that there may be a small difference in rates reported at national and regional level between tables.
The populations for tables 1 and 2 use the most recent data for all years; for tables 3, 4 and 11 populations for year ending 31 March 2023 are used for year ending 31 March 2024; for tables 6, 12 and 13 Census 2021 data is used for all years.
The data sources are reported under each table and figure.
In some instances, the number of deaths presented is low, and therefore the confidence intervals will be wider. Therefore, all rates should be interpreted alongside actual number of deaths.
Changes were made to data collection of ethnicity by NCMD in April 2021, April 2023 and January 2024 so the following categories are likely to be underestimated. In April 2021 ‘Gypsy or Irish Traveller’ was added to ‘White’ and ‘Arab’ was added to ‘Other ethnic group’. In April 2023 ‘Roma’ was added to ‘White’ and added to the paper forms in January 2024.
For further information on NCMD data processing please see our Privacy Notice.
5. Acknowledgements
The National Child Mortality Database (NCMD) Programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, and the Royal College of Nursing. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations, and crown dependencies. www.hqip.org.uk/national-programmes.
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