This paper examines the trends in and determinants of child death rates in the U.S. over the period 1980 to 1998. We extend the previous literature on childhood death rates in three ways. First, we look at how trends differ across causes of death, ages of children, and race. We show that while the overall death rates between black and non-black children narrowed over the final two decades of the twentieth century, the gap was still sizeable in 1998. Further, this pattern of narrowing gaps did not hold across all causes of death. Second, our paper examines a variety of different determinants of these trends that have been identified in the literature, and assesses the robustness of their estimated effects to the inclusion various controls including state fixed effects and state-specific trends. Our third innovation is to ask whether the remaining unexplained variation in child mortality rates is primarily affected by child-specific factors, or whether trends can be explained by improvements in factors that also drive death rates among adults.