On the positive side are record lows in the death rate for children between ages 1 and 4 and the adolescent birth rate. And young children are more likely to receive their recommended immunizations.

However, serious problems persist: Children are more likely to live in poverty; infants are more likely to be of low birthweight; and youth are more likely to commit or be a victim of a violent crime.

The Federal Interagency Forum on Child and Family Statistics compiled the report, which presents a comprehensive look at critical areas of child well-being -- including health status, behavior and social environment, economic security and education.

Fewer Teen Moms

The adolescent birth rate for 2003 was 22 for every 1,000 girls ages 15 to 17 -- down from 23 in 2002, according to the report. Since 1991, the adolescent birth rate has dropped by more than two-fifths -- from 39 births for every 1,000 girls. The decline followed a one-fourth increase in the teen birth rate from 1986 to 1991.

"For the sixth consecutive year, the adolescent birth rate has reached a record low," said Duane Alexander, MD, Director of the National Institute of Child Health and Human Development of the National Institutes of Health. "We welcome this trend and hope it continues."

Teen mothers face a number of problems unique to their age, Dr. Alexander noted. They are much less likely than other girls their age to finish high school or to graduate from college.

Infants born to teen mothers are more likely to be of low birthweight, which increases their chances for blindness, deafness, mental retardation, mental illness, cerebral palsy and infant death.

Adolescent birth rates varied by racial and ethnic group. The rate for Hispanics for 2003 was 50 for every 1,000 girls.

Among Black, non-Hispanics, the rate dropped by more than half to 39 for every 1,000 girls in 2003 since the 1991 peak of 86.

The birth rate was at 30 for for every 1,000 American Indians/Alaska Natives, 12 for White non-Hispanics and 9 for Asian/Pacific Islanders.

Immunizations Up

The report's health indicators show two other strong gains for children: The percentage of young children receiving the recommended series of immunizations -- the 4:3:1:3 combined series to protect against diphtheria, tetanus and pertussis; polio; measles; and Haemophilus influenzae type b (Hib) vaccine -- has increased.

In 2003, 81 percent of children ages 19-35 months had received the 4:3:1:3 series, up from 78 percent in 2002. Children living below the poverty level were less likely to receive the immunization series (76 percent) than were children above the poverty line (83 percent).

"Immunizations are one of the most important ways to protect our children against serious disease," said Dr. Edward J. Sondik, Director of the National Center for Health Statistics. "We need to continue efforts to monitor immunization rates as an important health indicator."

Child Mortality Down

Another indicator, child mortality, shows that children from ages 1 to 4 years were less likely to die than in recent years. In 2002, there were 31 deaths for every 100,000 children in this age group, down from 33 deaths per 100,000 in 2001.

Death rates for this age group have been declining in the last two decades, the report notes, dropping by more than half between 1980 and 2002. This decline reflects the drop in injuries -- the leading cause of death in children -- and, in particular, the drop in these deaths due to motor vehicle crashes.

Increased use of safety seats and other child restraint systems may have greatly reduced early childhood deaths, Dr. Sondik explained.

The death rate for children from 5 to 14 years of age did not change between 2001 and 2002. However, the death rate for children in this age group -- 17 deaths per every 100,000 children -- had dropped by approximately 45 percent since 1980.

Increase in Low Birthweights

The percentage of infants born at low birthweight increased -- from 7.8 in 2002, to 7.9 in 2003. The percentage of low birthweight infants has increased slowly and steadily since 1984, rthe eport states, when it was 6.7 percent.

Low birthweight infants are those weighing less than 2,500 grams, or 5 lb. 8 oz. Low birthweight results from an infant's being born preterm (less than 37 weeks) or from being small relative to gestational age.

Part of the increase in low birthweights is attributable to a rise in the number of twin and other multiple pregnancies, the report notes, because multiples are more likely than singletons to be born prematurely.

Still, low birthweight also increased among singletons. Changes in obstetric practices have contributed to the rise in low birthweight and preterm delivery -- particularly the increased rates of Cesarean delivery and induced labor. Both procedures may be undertaken preterm because the fetus is in distress.

Asthma, Lead Levels

This year's report includes special features related to health. The first special feature, on asthma, points out that at some point in their lives, about 13 percent of children were diagnosed with asthma.

In 2003, about 9 percent of children were reported to have asthma, and two-thirds of these children had experienced one or more asthma attacks in the previous 12 months.

In some cases, asthma can seriously limit a child's activities, cause visits to hospitals and emergency rooms, and even result in death.

Another special feature, on lead in the blood of children, reports that in 1999-2002, about 2 percent of children from ages 1 to 5 had elevated blood lead levels (greater than or equal to 10 micrograms per deciliter).

This figure has decreased substantially from 1976-1980, when 88 percent of children had elevated blood lead levels.