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46 Infant Mortality Infant mortality refers to the death of a baby in its first year of life. Risk factors that attribute to infant deaths include premature or low birth weight, smoking during pregnancy, exposure to secondhand smoke during pregnancy, and inadequate nutrition and insufficient intake of folic acid (a vitamin B) before and during pregnancy. In 2014 Orange County experienced 6 total infant deaths, an increase from 2013 where we experienced 4. Of those six deaths, 3 were white, 2 were African American, and 1 was Hispanic (shown in figure36). Infant mortality racial disparity ratio between African Americans and whites, in Orange County, is 3.76 which is currently higher than both NC (2.39) and the US (2.21). The county’s infant mortality rates are unstable due to the numbers being smaller than 10. Although they are overall lower than NC’s rates, we still see a concerning disparity along racial and ethnic lines65. Children born to mothers who smoke during pregnancy have an increased risk of Sudden Infant Death Syndrome (SIDS) by 20-30%66, increased risk of birth defects including cleft palate or cleft lip,67 heart defects,68impaired neurological and intellectual development, long-term negative impacts on language and cognitive development69, lower scores on math and spelling achievement tests,70 risk for mental retardation71 and lower levels of "good" HDL cholesterol, which may increase their risk of heart attack and stroke later in life.72 Infant Health Preventive health services are available to children from birth to 21 years of age. A child’s vision, speech, hearing, and development can be screened, they can be checked for anemia, lead poisoning and chronic diseases, and they can receive dietary counseling, which are provided through well child and pediatric primary care clinics. The robust system of lactation support throughout the county results in a breastfeeding rate among WIC clients, exclusively breastfeeding, (41.6%) that is 12% higher than the NC average (29.1%) and 17% higher than the average for southeastern US (24%). Two of the county’s three municipalities are working to become “Breastfeeding Family Friendly Cities” by World Breastfeeding Week, 2016. This newly minted designation, developed by the Carolina Global Breastfeeding Institute includes community-wide policy and environmental changes to support breastfeeding. 4.9 4.2 10.9 0.0 5.6 0.0 7.1 5.1 12.8 9.4 6.2 4.0 Total RateWhite RateAfrican American Rate American Indian Rate Hispanic Rate Other Rate Figure 36: 2014 Infant Mortality (per 1,000 live births) Orange County North Carolina