Childhood mortality has been dropping dramatically in England and Wales since the 1840s. The rates halved between 1980 and 1999, and are likely to continue falling. The main challenge now is to reduce social inequalities in childhood death. The infant mortality rate in social class V is double that for social class I. Infants with mothers born in the Caribbean experience twice the mortality of those whose mothers were born in the UK. Infants with mothers aged under 20 years experience twice the mortality of those with mothers in their early 30s. Two-thirds of all infant deaths are in those weighing less than 2500 g at birth. For those aged over 1 year, the biggest killers are injuries and cancer, where there is potential for both prevention and improved treatment. At all ages, boys are at greater risk than girls.