Child deaths are worthy of local prevention efforts. As we review our local child deaths over time, we note that the older children have steadily decreasing deaths reported. This is good news. In the older age brackets, the most common causes of death are accidental injuries. The presence of excellent trauma care in our community may play a part in reducing deaths in older children. Children between the ages of 1 and 4 may die of perinatal issues, child abuse, or accidents. We have excellent hospital care for sick neonates, but how well do we support families taking home these fragile newborns in whom we have invested much? We know that premature infants represent some of the children in this group, and that prematurity is particularly difficult to prevent. Attention to social determinants of health (poverty, food insecurity, transportation, and domestic violence) may do the most to prevent deaths in this age category.