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Historic data were used in a longitudinal analysis of prereproductive mortality to examine the relationship between mortality patterns and family structure during and after the demographic transition. Linked vital records assembled for all children who died between birth and age 15 in the population of Sanday, Orkney Islands, Scotland, provided the following information: sex and age of ego, cause of death, and familial characteristics including parental age, birth order, sibship size and birth interval. Age-sex and cause specific standardized mortality rates were computed for two age groups, zero to four and five to 14, between 1855 and 1974.The primary source of the secular decline in mortality was a decrease in exogenous causes of death (respiratory and infectious diseases). For the entire time period, mortality risks were higher for males than for females, and for children in the younger age group. However, female risk of mortality due to exogenous causes of death was highest in the older ages of childhood and during periods of population stress. There was a stronger association between mortality levels and characteristics of the family of origin (parental age, birth order, sibship size and birth interval) if death occurred prior to age five, than in the later childhood ages. Results are compared with those observed in other populations.