By Jennifer Fernandez
The latest national “report card” on how U.S. children are faring shows North Carolina struggling in key areas, from categories as broad as educational outcomes to individual measures like low birth weight.
Overall, the Tar Heel state dropped one spot to rank No. 34 in the national 2025 KIDS COUNT Data Book. The 50-state report is compiled annually by the Annie E. Casey Foundation. The private philanthropic organization says it focuses on improving the lives of children through “strengthening families, building stronger communities and ensuring access to opportunity.”
The report ranks states on 16 factors across four broad categories. North Carolina’s ranking dropped from the 2024 report in two of those categories: economic well-being and health.
Two of the health areas tracked in KIDS COUNT — low birth weight and child death rates — were highlighted earlier this year by the North Carolina Child Fatality Task Force in its report to the governor and General Assembly. The legislative study group’s report showed that state and national infant mortality rates — driven largely by low birth weight — remained steady, though North Carolina’s rate has consistently been worse than the national rate.
On top of that, Black babies in North Carolina die at three times the rate of white babies.
The state report also showed that mortality rates of children ages 1 to 17 increased slightly across all age groups over the past decade. Teens ages 15 to 17 experienced the largest increase, 31 percent, said Kathleen Jones-Vessey, an epidemiologist with the North Carolina Department of Health and Human Services.
Though traffic accidents still account for a large portion of those deaths in older teens, firearm violence has played an increasing role in recent years. It outpaced motor vehicle deaths in 2023, state data shows.
The KIDS COUNT report shows that North Carolina’s overall child and teen death rate remains much higher than the national rate.
Rate of child and teen deaths in NC, US by Jennifer Fernandez
“This data gives us a good idea of where we need to make meaningful, smart investments that strengthen families across our state and make North Carolina first in children,” said Erica Palmer Smith, executive director of the nonprofit NC Child, in a news release. “We should strive to be the best when it comes to the lives of our children.”
‘An uphill battle’
The U.S. is facing a “child health crisis,” according to the KIDS COUNT authors, who cite high rates of chronic disease, mental illness and deaths from firearms, drug overdoses and suicides as driving forces of the crisis.
They emphasized the importance of early interventions.
“Good health begins before birth, and experiences during childhood, particularly the first years of life, provide the underpinnings for future health and well-being,” the authors wrote.
North Carolina health officials have been focused for years on reducing infant mortality, which is driven in part by low birth weight. In particular, they want to bring down the death rate for Black babies, which remains stubbornly high.
Reducing the infant mortality disparity ratio is a goal for Healthy North Carolina 2030 and the North Carolina Perinatal Health Strategic Plan.
State data shows the disparity between Black and white infant deaths widened from 2014 to 2023.
In 2014, 2.51 more Black babies per 1,000 died than white babies. By 2023, 3.01 more Black babies per 1,000 died within their first year than white babies, Jones-Vessey told Child Fatality Task Force members earlier this year. The task force is a long-running legislative study committee of volunteer experts in child health and safety, state agency leaders, community leaders and state legislators.
Black infants died 2.74 times more often than white ones in 2022, but that ratio increased in only one year. In 2023, Black infants died 3.02 times more often than white infants — a reflection of the Black infant mortality rate rising while the white infant mortality rate fell, she said.
“This is not the direction that we want to be going as a state,” she said.
Health disparities have worsened in recent years, especially since the COVID-19 pandemic, said Christina Peterson, child and family health manager for the North Carolina Partnership for Children/Smart Start.
“It just feels like we’re fighting an uphill battle,” she said.
Prematurity and low birth weight ranked as the leading cause of North Carolina infant deaths in 2023, making up 17 percent of deaths. Birth defects followed at 16 percent.
The highest rates of prematurity and of low birth weight occurred among Black infants. They are 1.6 times more likely to be born too early and 2.2 times more likely to be underweight than white babies, Jones-Vessey said.
In North Carolina, 9.4 percent of infants are born underweight compared with 8.6 percent of infants born nationally, according to KIDS COUNT. In that report, low birth weight is defined as the percentage of live births where the baby weighs less than 5.5 pounds.
North Carolina had the 10th highest infant mortality rate among states in 2023, the N.C. Child Fatality Task Force told legislators.
Infant deaths consistently make up about half of child deaths every year in North Carolina, Jones-Vessey said.
“When we’re talking about child deaths, we really need to keep maternal and infant health at the forefront of all our discussions,” she said.
Child, teen deaths high
Child and teen deaths increased at the state and national levels from 2019 to 2023, according to KIDS COUNT. The report defines the death rate as the number of deaths, from all causes, of children ages 1 to 19 per 100,000 children in this age range.
North Carolina children and teens, however, are dying at a higher rate than their peers in the country, the report shows. And the gap is growing.
From 2019 to 2023, the national death rate for people ages 1 to 19 increased by 16 percent, from 25 per 100,000 to 29 per 100,000. In that same time period, North Carolina’s rate increased by 29.6 percent, from 27 per 100,000 to 35 per 100,000.
The state Child Fatality Task Force’s report to lawmakers also showed North Carolina struggling with deaths among children and teens.
North Carolina had the 17th highest rate in the nation of deaths of children ages 1 to 17 in 2023, the report showed. The year before, the state had the 12th highest rate.
After infants, teens ages 15 to 17 make up the largest portion of child deaths. This group consistently accounts for the largest proportion of child homicides, Jones-Vessey said. They also make up the largest portion of suicides among children, averaging 32 deaths per year compared with an average of 16 suicide deaths per year among younger children, she said.
Firearms have played an increasing role in the deaths of North Carolina’s teens.
A firearm was involved in 95 percent of homicides involving teens ages 15 to 17 in the most recent five-year period that the state tracked.
Firearms were also involved in 44 percent of suicides of North Carolina teens ages 10 to 17 in 2023.
That same year, North Carolina launched a safe firearm storage initiative to help keep children from accessing guns; research shows keeping firearms out of reach of children can save lives. One study published in JAMA Pediatrics in 2019 estimated that a “modest increase” in safe storage of firearms in gun owners’ homes could prevent up to 32 percent of youth suicides.
For example, if 20 percent of U.S. households storing at least one unlocked gun instead locked up all guns, between 72 and 135 youth firearm fatalities could be prevented each year, the study showed.
Lawmakers approved the program, called NC S.A.F.E., which encourages gun owners to “secure all firearms effectively.” But they did not include funding for it. While it has continued with temporary funding, the Child Fatality Task Force has repeatedly recommended that the General Assembly support it with recurring funds in the state budget.
Pending budget bills don’t include money for the program.
NC Child leaders are keeping an eye on House Bill 578, which would require suicide prevention training for all educators in K-12 schools, said Neil Harrington, research director for the organization, which advocates for public policies that improve the lives of children.
He said NC Child has been “laser focused on the rising number of youth suicides,” in recent years.
HB 578 passed the N.C. House but is sitting in a state Senate committee.
Programs that could help
North Carolina has made several moves to address some of the factors that might result in improved outcomes for children, said Peterson with NC Partnership for Children/Smart Start.
Improving the subsidy rate for child care, for example, appears to have support from the North Carolina Senate and House of Representatives for the upcoming budget.
The Senate’s budget plan, passed April 16, included $80 million to increase child care subsidy rates — although that is much less than what advocates say is needed. That same amount is in the House’s budget committee report.
“The affordability and the access to quality child care is … a recognized strategy to support … child well-being, including the prevention of child maltreatment and death,” Peterson said.
Harrington touted the state’s investment in mental health in recent years — thanks to federal pandemic aid and a bonus the state received from the federal government when it expanded Medicaid. The General Assembly earmarked $80 million of that to help children with behavioral health needs. Investments in telehealth are also addressing issues with accessing mental health care, he said.
Other programs that could help have not fared as well.
The Child Fatality Task Force has recently encouraged lawmakers to enable Medicaid reimbursement for doula services. Doulas are nonmedical trained professionals who provide physical, emotional and informational support before, during and after childbirth. Parents having the support of a doula has increased babies’ birth weights, research has shown.
“We know that doula services are known to produce better birth outcomes and reduce those disparities,” Peterson said, referring to the racial disparities in infant deaths.
Bills that would allow Medicaid to cover doula services have stalled in the General Assembly.
Peterson said the Healthy Opportunities Pilot showed promise for the support it gave families. The program, launched in 2022, uses Medicaid funding to address nonmedical health needs of low-income North Carolinians in 33 mostly rural counties. It has provided nearly 35,000 people with help ranging from deliveries of food to rides to doctor’s appointments.
Officials were so happy with the program they were talking about expanding it. Yet spending plans proposed by the state House and Senate effectively eliminated funding for the program.
Jay Ludlam, the state Medicaid head, informed program partners in a June 2 letter that Healthy Opportunities would cease operations on July 1 due to that lack of funding. The announcement led supporters to descend on the legislature last week to plead with lawmakers to reconsider funding the program.
“Over the last couple of years, we have looked to improve and expand access to services that reduce the cost of health and health care in North Carolina, and Healthy Opportunities was part of that,” Ludlam told NC Health News last week. “This is a good program for North Carolina, and we think we should continue.”
Staff writer Jaymie Baxley contributed to this report.
The post NC struggles in key child health measures, new report shows appeared first on North Carolina Health News.
