OBJECTIVES: The aim of this analysis was to quantify the relative risk of childhood deaths across the whole of England during the first year of the COVID pandemic, compared to a similar period of 2019. DESIGN: This work is based on data collected by the National Child Mortality Database (NCMD) which collates data on all children who die in England. The number of deaths, and their characteristics, from 1st April 2020 until 31st of March 2021 (2020-21), were compared to those from the same period of 2019-20. Relative risk and excess mortality were derived for deaths in 2020-21 vs 2019-20. SETTING: All deaths reported to NCMD in England of children under 18 years of age, between April 2019 and March 2021. PARTICIPANTS: 6490 deaths of children, under the age of 18 years, reported to the NCMD over the study period. RESULTS: Children who died between April 2020 and March 2021 had similar demographics to those who died in 2019-20. Overall, there were 356 (198 to 514) fewer deaths in 2020-21 than in 2019-20 (RR 0.90 (0.85-0.94), p<0.001). Repeating the analysis by category of death, suggested that deaths from infection (RR 0.49 (0.38-0.64)) and from other underlying medical conditions (RR 0.75 (0.68-0.82)) were lower in 2020-21 than 2019-20, and weak evidence (p=0.074) that this was also true of deaths from substance abuse. CONCLUSIONS: Childhood mortality in England during the first year of the SARS-CoV-2 pandemic was the lowest on record, with over 300 fewer deaths than the preceding 12 months. The greatest reduction was seen in children less than 10 years old. It is important that we learn from this effect, that potentially offers alternative ways to improve the outcome for the most vulnerable children in our society.

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