Two-thirds of children who die have an underlying chronic condition such as a heart defect, cerebral palsy or cancer, according to a major study of death in childhood.
While the main cause of death in youngsters aged one to 18 is injury, more than 1,000 children a year die from or with a major illness.
The report, commissioned by the Royal College of Paediatrics and Child Health (RCPCH), examined deaths of all children excluding babies under 12 months.
It found deaths in childhood from all causes have declined in all age groups and UK countries between 1980 and 2010 by 50% to 70%.
After injury, most deaths are caused by blood problems or cancer, with children also dying from or with neurological conditions, congenital abnormalities such as heart defects, metabolic disorders, infections and respiratory problems.
Injuries account for 31% of deaths in one to four-year-olds and nearly half (48%) of deaths in teenagers aged 15 to 18. The most common injury involves traffic accidents.
The proportion of deaths caused by injury rises steeply with age, accounting for 58% to 74% of deaths in 18-year-olds.
Boys aged 15 to 18 are also three times more likely to die from injury than girls in the same age group.
The report found that, in 2010 alone, 1,935 child deaths occurred, with 57% in children aged 10 to 18 and 42% among those aged one to nine.
Overall, researchers found that 60% to 70% of children who died had a chronic condition. Between 30% to 40% of were affected by a neurological or sensory condition such as epilepsy or cerebral palsy.
Around half of children who died from causes other than injury died during a hospital admission and a further 20% died in hospital but were not admitted.
Professor Ruth Gilbert, clinical lead for the research, said: “Although the overall number of children dying is decreasing, this research puts into sharp focus the importance of optimal care for children with chronic conditions.
“For some children with serious chronic conditions who are expected to die, this means high-quality end-of-life care for the child and to support their families.
“For others, their death may have been premature or completely preventable.
“Most children with chronic conditions are managed at home by parents with support from primary and community care services as well as hospitals. We need to focus on the quality of long-term care at home for these children as well as in hospital.”
She said the report also showed that the number of children dying from intentional injuries - such as self-harm or assault - has not changed in three decades.
“The report also reveals that children born with the same birth weight were more likely to die if they were born to mothers aged less than 30 years than those with mothers aged 30 to 34 years.
“Young maternal age does not cause child deaths but is associated with factors which increase health risks for children.
“Young maternal age at birth is becoming a marker of social disadvantage as women who have been through higher education and those with career prospects are more likely to postpone pregnancy until their 30s.”
Dr Hilary Cass, president of the RCPCH, said: “Injuries remain the biggest cause of child deaths but are declining, so we need to continue to build upon public policy interventions such as traffic calming.
“The lack of decline in intentional injuries calls for a concerted focus on reducing violence and self-harm in older children.”
Professor Monica Lakhanpaul, programme director for children and young people at UCLPartners, an academic health science partnership for chronic conditions, said: “This report provides yet more evidence that children in the UK suffer worse health-related morbidity and mortality than equivalent economies.
“What is now needed is to turn these findings into real improvements on the ground for children.”
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