WASHINGTON — Things are looking up for Dr. Catherine Webb, a pediatric cardiologist at Northwestern University in Chicago. "When I was in training in the `80s, this was a pretty depressing specialty," she said. "But it's not anymore."
True enough. The death rate from heart disease among children is about half what it was in 1980, according to a compendium of federal child-health statistics released last month.
Also down by roughly half are children's death rates from birth defects, cancer, heart disease, pneumonia and flu, as well as injury-related child deaths from motor vehicle accidents, drowning, fires, falls, firearms and suffocation.
Death rates from all causes dropped 53 percent among children ages 1 to 4 and 45 percent among children ages 5 to 14. It adds up to survival for about 8,000 children a year who would've died in 1980.
"It's terrific news," said Harry Rosenberg, retired chief of the Mortality Statistics Branch of the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention.
Better medicine and new safety measures get much of the credit. So does expanded government health-insurance coverage for disadvantaged children, which gives them better access to medical care.
Parents deserve credit, too, said Dr. Frederick Rivara, a professor of pediatrics at the University of Washington in Seattle who specializes in injury reduction. They're drinking and smoking less, for example, which reduces birth defects, fires and car crashes.
"Parents have gotten away from the idea that accidents happen and can't be prevented," Rivara said. "They know that child safety seats save lives and bike helmets prevent head injuries. They believe, as parents, that they can protect their kids. And that's a big change."
Only one leading killer — homicides — hasn't relented significantly.
"They're abuse cases, really," Rivara said.
All racial groups showed similar declines from 1980 to 2004 — the latest year reported — but the death rate for black children remained nearly 40 percent higher when compared with those for Hispanics, Asians and non-Hispanic whites.
Also troubling: Most declines flattened by 2000, for unexplained reasons.
Death rates from each leading cause are reported in "America's Children: Key National Indicators of Well-Being, 2007," which can be read online at http://www.childstats.gov. Its tables describe trends for leading killers annually from 1980 through 2004.
Different explanations underlie each decline. Here are some of the key ones:
— Motor vehicles; deaths down from 7.4 to 3.3 per 100,000 for kids ages 1 to 4; down from 7.5 to 3.7 for kids ages 5 to 14.
Safer cars are a factor, but child safety seats and booster seats are the big difference. Used properly, safety seats cut child fatalities by 71 percent, according to the National Highway Traffic Safety Administration. Tennessee became the first state to require child safety seats in 1978. By 1985, all states did.
Compliance today is nearly total for infants but falls off with booster seats designed for bigger children. That's one reason the mortality rate for older children has dropped less. In addition, older kids more often are allowed to ride in front seats, which are more dangerous.
The best predictor of children's compliance is drivers who buckle up, and that's risen from 12 percent in 1980 to 81 percent, NHTSA says.
— Birth defects; deaths down from 8.0 to 3.6 per 100,000 for children ages 1 to 4; down from 1.6 to 1.0 for children ages 5 to 14.
Improved prenatal diagnoses are a big factor, according to Dr. Howard Saal, the director of clinical genetics at Children's Hospital Medical Center in Cincinnati and a professor of pediatrics at the University of Cincinnati College of Medicine.
Ultrasound in particular — first offered regularly in the early '80s — helped to identify problem fetuses early enough to arrange for their treatment at specialty centers or, in especially severe cases, to terminate pregnancies. Refinements in surgical technique and advances in caring for critically ill children helped, too, Saal said.
— Fires and burns; deaths down from 6.1 to 1.5 per 100,000 for children ages 1 to 4; down from 1.5 to 0.7 for children ages 5 to 14.
Low-cost smoke alarms helped the most, said John R. Hall, chief research analyst at the National Fire Protection Association in Quincy, Mass. They've been found to cut fire-injury rates by as much as 80 percent. Half of U.S. homes had alarms in 1980; by 2000, 95 percent did.
Better trauma care and treatment helped, too. Today, few children with burns over less than 60 percent of their bodies die of them.
Other factors, according to Hall: flameproof pajamas, declines in smoking, the introduction of self-extinguishing cigarettes — which 16 states now require — and the Consumer Product Safety Commission's 1994 mandate that disposable lighters be childproof.
— Drownings; deaths down from 5.7 to 2.8 per 100,000 for children ages 1 to 4; down from 2.5 to 0.7 for children ages 5 to 14.
The vast majority of infant and toddler drownings occur in backyard pools, according to Sue Gallagher, the director of the Tufts Medical School's Health Communication Program in Boston. In the 1970s, Australia found that effective fencing can reduce those deaths by 80 percent.
U.S. jurisdictions followed suit. The best rules require four-sided fences with self-closing, self-latching gates. Three-sided fences with sliding glass doors on the fourth side do little good, according to Dr. Mick Ballesteros, an epidemiologist at the CDC's injury center in Atlanta.
Ballesteros cites indirect factors in the decline in drownings, too. Among them: declines in drinking among adults and one that cuts two ways — less active kids who swim less. — Cancer; deaths down from 4.5 to 2.5 per 100,000 for children ages 1 to 4; down from 4.3 to 2.5 for children ages 5 to 14.
Brenda Edwards and Lynn Ries, surveillance researchers at the National Cancer Institute, attribute the decline to earlier detection plus very aggressive treatment and better chemotherapeutic drugs. Leukemia, especially acute lymphocytic leukemia, the most common form of cancer in children, was the first to yield, said Dr. Alan Wayne, the clinical director for pediatric oncology at the National Cancer Institute.
"In the '60s, AL leukemia was considered a death sentence," Wayne said. "Now the five-year survival rates approach 80 to 90 percent." Brain tumors, the next most common cancer, have yielded somewhat to new surgical techniques and better radiation therapy, Wayne said, "but the improvements have been less dramatic."
— Heart disease; deaths down from 2.6 to 1.2 per 100,000 for children ages 1 to 4; down from 0.9 to 0.6 among children ages 5 to 14.
Cardiologist Webb credits "tremendous advances in surgery for congenital heart disease," plus advances in case management and medications for both congenital heart disease — the most common form among kids — and cardiomyopathy, a heart muscle disease.
— Pneumonia and influenza; deaths down from 2.1 to 0.7 per 100,000 in children ages 1 to 4; down from 0.6 to 0.2 in children ages 5 to 14.
Dr. Joseph Bocchini, the chair of the American Academy of Pediatrics committee on infectious diseases, attributes much of the decline to more effective delivery of flu vaccine to all children ages 6 months to 59 months. And children of all ages with underlying medical conditions that increase their flu risk, such as asthma, go to the head of the line.
— Suffocation; deaths down from 1.9 to 1.0 per 100,000 in children ages 1 to 4; flat at 0.9 for children ages 5 to 14.
The federal Consumer Product Safety Commission led the way with campaigns to reduce the width between slats in cribs, discourage soft bedding for infants and encourage parents to put babies to sleep on their backs to avert sudden infant death syndrome.
— Firearms; deaths down from 0.7 to 0.3 per 100,000 in children ages 1 to 4; down from 1.6 to 0.7 in children ages 5 to 14.
Since 1989, 18 states have passed child access-prevention laws that require gun locks and locked gun-storage cabinets. However, only in Florida and California — two of three states in which violations can be punished as a felony — have the laws had a statistically significant effect on child mortality, according to a 2006 study.
Peter Hamm, spokesman for the Brady Campaign to Prevent Gun Violence, headquartered in Washington, suspects that improvements in trauma care for gunshot victims helped reduce mortality, too.
Rachel Parsons, spokeswoman for the National Rifle Association, gives credit to its nationwide gun-safety education program for children, "Eddie Eagle," which began in 1988. She also credits the NRA's safe gun-storage educational programs for adults.
— Falls; deaths down from 0.9 to 0.3 per 100,000 for kids ages 1 to 4; down from 0.3 to 0.1 for kids ages 5 to 14.
Most fatal falls for kids are from apartment windows. New York's rate dropped 96 percent after the city's health department required in 1979 that the landlords of multifamily buildings whose occupants included children younger than 11 provide $3 window guards for them. Other urban areas followed suit.
(Researcher Tish Wells and Jeanette Hudson, senior librarian for the Children's Safety Network in Newton, Mass., contributed to this story.)
ON THE WEB
To review the latest assessment of U.S. child welfare, go to http://www.childstats.gov/americaschildren/index.asp. To review its statistics on child mortality, go to Appendix A of the report and click on PHY6.b and PHY6.c.
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