That's up from last year's sixth-place showing, compared to other states on 10 measures tracked by the Annie E. Casey Foundation. Utah's improvement was driven in part by declines in teen pregnancy and teen mortality rates.

The state boasts lower-than-average teen delinquency and child poverty rates, and leads the nation with the lowest rate of children in single-parent homes.

"We always rank in the top 10," said Terry Haven, an advocate at Voices for Utah Children.

But one smudge on Utah's record that continues to vex health officials: a creeping child death rate, up 5 percent from 2000 to 2004.

It's not a huge jump, but it's significant considering child fatalities are declining nationally, said Haven.

It's the only measure where Utah scores below the national average, ranking 20th.

Accidental injury continues to be the leading cause of death for youth ages 1 through 14 - responsible for about 40 percent of fatalities, said Gary Mower, injury prevention coordinator at the state health department.

The top killers are motor vehicle accidents, drownings and suffocations.

But Mower has seen no real increase in trauma-related deaths. Nor has he seen sizeable swings in other leading causes: cancer, birth defects, homicide and suicide.

"There's nothing that jumps out. Some things went up a little and other things are down a bit," said Mower.

A thankfully small percentage of Utah's 1-to-14-year-olds die annually - 122 of 602,710 kids in 2004 - making swings more pronounced, said Mower.

But states both large and small fare better than Utah. Rhode Island boasts the lowest death rate, at 11 per 100,000 children, nearly half of Utah's.

Many western states also outrank Utah, including Nevada, Arizona, Wyoming, Colorado and California.

"It's a problem we've overlooked for too long," said Janet Brooks, a child safety advocate at Primary Children's Medical Center.

Parental vigilance is the first, and best, line of defense, said Brooks. In the age of cell phones, long commutes and two-parent working families, it's easy to get distracted, she said.

National surveys have shown injuries don't even register on parents' lists of fears for their children, said Brooks. "But it's killing our kids."

Safety campaigns routinely alert parents to the dangers of neighborhood swimming pools and the need to use child safety restraints.

Health officials embarked on a "Spot the Tot" blitz in 2005 following a rash of parents backing over children in their driveways.

Brooks would like to see Utah join the 38 states that mandate booster seats for children between 4 and 8.

Charles Pruitt, an E.R. doctor at Primary Children's, said he and his colleagues are seeing more injuries related to ATVs and other recreational vehicles.

Another challenge, said Pruitt, is the growing number of Utah children living in poverty with no health coverage, including immigrants.

"The patients we see today are different than those of five or 10 years ago. We get a lot more uninsured and unimmunized kids whose only access to care is through the E.R.," said Pruitt. "At that point we're just patching problems, not preventing them."

For the full Kids Count report, visit www.aecf.org.

kstewart@sltrib.com