Child mortality from trauma and sudden death rising in England, study shows

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Child mortality from trauma and sudden unexpected death increased last year, according to figures highlighting the stark impact of poverty on child health.

The analysis, which tracked all child deaths in England between 2019 and 2022, found overall mortality dipped during the pandemic due to a decrease in infectious illnesses, but that numbers of deaths have since returned to pre-pandemic levels. This included a 32% increase in trauma deaths and a 13% rise in sudden unexpected death in infancy or childhood (Sudic) last year compared with pre-pandemic rates.

Prof Karen Luyt, the programme lead for the National Child Mortality Database, based at the University of Bristol, said the figures could be “the first mortality signal” from families struggling with the cost of living crisis.

“This is worrying and I think we’re likely to see things getting worse,” she said. “Certainly for childhood illness and mortality, we know there’s a strong social gradient and we know that more families are now living in poverty.”

Sudic deaths are defined as being unexplained and unexpected at the point death is registered, but may be subsequently found to be due to cardiac arrest after infection or an asthma attack, for instance. It is a broader category than sudden infant death syndrome (Sids), where the cause of death often remains a mystery even after postmortem examination.

Of the children who died in the Sudic category, four times as many came from the most deprived fifth of the population, compared with the least deprived fifth.

The findings cover a period up to March 2022 and Luyt said the team was projecting worse figures for the latest year, given high levels of infection this winter and growing cost of living pressures on families.

Prof Monica Lakhanpaul, at University College London, who has studied the effects of homelessness on child health, said the link between child mortality and poverty was well-established and described the latest figures as a “tragic” result of worsening inequalities.

“The poorer the children, the higher the risk of mortality, but nothing’s been done,” she said. “We’re in a high-income country and this is on our doorstep.”

Lakhanpaul said malnutrition and unheated homes left children in worse health and less able to fight off infection. And unsuitable accommodation was a growing problem that posed separate risks, she said.

“Co-sleeping is a big problem,” she said. “Our recommendation is don’t sleep with your child, but some of these families are going into accommodation where they don’t have a cot. We talk about parental neglect a lot … but I see this as societal neglect.”

The study, published in the journal Jama Network Open, used data from the NCMD cohort, an initiative to collect detailed information on every child death in England. It covered 9,872 child deaths over three 12-month periods spanning 1 April 2019 to 31 March 2022. Of these deaths, 6,257 (63%) occurred under one year of age, the majority (56%) were male (5,534 deaths), and 8,766 (89%) lived in an urban area.

There were 3,409 child deaths recorded in England in 2019-20, the first period studied, but this reduced significantly to 3,035, due to fewer infections in younger children during the first year of the pandemic (2020-21). However, since the pandemic (2021-2022), the number has risen again, to 3,428. It is less clear what is behind the increase in trauma deaths, which rose steadily over the whole three-year period, and covers a wide range of causes from car accidents to knife injuries, drowning and accidents in the home.

The findings follow a report this week that revealed homelessness may have been a contributing factor in the deaths of at least 34 children in England between April 2019 and March 2022.

Dr Laura Neilson, an A&E doctor who led the findings on homelessness, described the figures as “heartbreaking”.

“We were shocked by the number of children this initial research identified as dying with them being in temporary accommodation,” she said. “This data shows the children we’ve lost, the families forever changed because of temporary housing and poverty. As a doctor this is a health issue caused by social factors that can be prevented and stopped.”