The state's Child Fatality Task Force says the 2015 child death rate was largely unchanged from the previous year.
The report released Tuesday says there were more infant deaths, but fewer teen suicides last year. Infant fatalities still make up the majority of child deaths.
The task force also says there continue to be racial disparities in the numbers. The death rate for black children is nearly twice as high as white children.
"We'll continue to work on things like quality pre-natal and peri-natal health care, but one of the things that we have to definitely turn our attention to is called social determinants of health," said task force executive director Kella Hatcher.
"It's those social factors like economic security, education, combating racism, that really can make a difference in both the infant mortality and child death rates," she said.
The death rate for children from infants to age 17 in 2015 was 58.3 deaths for every 100,000 children.
North Carolina's rate has dropped significantly in recent decades, but is slightly worse than the national average, according to the Centers for Disease Control and Prevention.