Key points
- 4.9 million children under five died worldwide in 2024 — about one death every 6 seconds (WHO, fact sheet 1 May 2026).
- The global under-five mortality rate in 2024 was 37.4 deaths per 1,000 live births — less than half its 2000 level — but progress has slowed since 2015.
- The leading causes — preterm birth complications, birth asphyxia and trauma, pneumonia, diarrhoea and malaria — are largely preventable or treatable (WHO).
- The WHO/UNICEF Nurturing Care Framework names five components: health, nutrition, safety and security, early learning, and responsive caregiving.
Direct answer: The first five years are when most of the dying happens — and when most of it can be prevented. 4.9 million children under five died worldwide in 2024, about one death every 6 seconds (WHO, fact sheet 1 May 2026). The leading causes are largely preventable or treatable. The WHO/UNICEF Nurturing Care Framework describes what the first years need: health, nutrition, safety and security, early learning, and responsive caregiving. This page is the overview; the companion guides cover newborn care, nutrition, water and sanitation, and immunisation in turn.
How many children die, and why
The figures are WHO’s, from the child mortality fact sheet published 1 May 2026 (data year 2024). 4.9 million children under five died worldwide in 2024 — about one death every 6 seconds. The global under-five mortality rate was 37.4 deaths per 1,000 live births, less than half its 2000 level. But progress has slowed since 2015, and under-five deaths have stagnated at roughly 4.8–4.9 million a year since 2022. More than 27 million children are projected to die before age five between 2025 and 2030 if trends continue, most from preventable causes. The leading causes are preterm birth complications, intrapartum-related events (birth asphyxia and trauma), pneumonia, diarrhoea and malaria — described by WHO as largely preventable or treatable.
Where the deaths are
The deaths are concentrated. Sub-Saharan Africa accounted for 2.8 million under-five deaths in 2024 (58%) and Southern Asia 1.2 million (25%) — together over 80% of the total. Sub-Saharan Africa’s under-five mortality rate was 71.6 per 1,000 live births, nearly 14 times the rate in Europe and Northern America. The geography is the point: the first five years are most dangerous where health systems, nutrition, water and sanitation are weakest, and the same children face several risks at once. A child born in sub-Saharan Africa in 2024 faced a risk of dying before five that was an order of magnitude higher than a child born in Europe or Northern America.
Nurturing care: the five components
The WHO/UNICEF Nurturing Care Framework (2018) describes what the first years need, in five components: health, nutrition, safety and security, early learning, and responsive caregiving. The framework is the reason this page exists as an overview rather than a mortality report: survival is the floor, and the framework describes what comes with it — a child who is healthy, fed, safe, learning and cared for. This page names the five components and goes no further into the framework’s figures: the investment and brain-development figures that circulate with the framework were not verified against the WHO/UNICEF progress report itself in the research behind this page, so they are not published here.
Nutrition in the first five years
Malnutrition runs through the first-five-years picture. About 150 million children under five were stunted, 43 million wasted and 36 million overweight in 2024 (WHO, infant and young child feeding fact sheet, 4 August 2026). WHO states that about half of all child deaths are associated with malnutrition — an association, not a claim that malnutrition alone caused them. Diarrhoea is both a consequence and a cause: it is a leading cause of malnutrition in children under five, and malnourished children are more vulnerable to diarrhoea. The companion guides on child nutrition and on clean water and children’s health carry the detail.
The life-course thread
The first five years do not end at five. WHO’s life-course framing is that health is shaped by biological, social, environmental and behavioural factors, and that experiences in early life affect health decades later — even for future generations. A child with nurturing care, early learning and good nutrition is more likely to succeed at school and enjoy better health later in life. That thread runs through this batch of guides: from the first five years, through maternal health, to healthy ageing. The early-years mental health section of the children’s mental health guide covers the same years from the mental-health side; this page covers them from the survival and development side.
Frequently asked questions
How many children die before their fifth birthday?
4.9 million children under five died worldwide in 2024 — about one death every 6 seconds (WHO, fact sheet 1 May 2026).
What kills most children under five?
Preterm birth complications, intrapartum-related events, pneumonia, diarrhoea and malaria — described by WHO as largely preventable or treatable.
What is nurturing care?
The WHO/UNICEF framework for the first years: health, nutrition, safety and security, early learning, and responsive caregiving.