Objective Although infections are mostly innocent and self-limiting, we regularly admit children with life-threatening infections. In this study we examine the changes in mortality due to infectious diseases in childhood during the last decades. Methods We analysed mortality data among those aged less than 20 years due to infectious diseases from 1969 to 2006, obtained from the Central Office of Statistics (CBS) in The Netherlands. We reviewed mortality data of all Dutch paediatric intensive care units (PICU) in 2005 and infectious causes of death in all children, admitted to our PICU from 1997 to 2006. Results This study shows a steep decline of infectious disease mortality in the 1970s, followed by a relative stabilisation in the years thereafter. This steep decline was caused by an isolated decline in infectious disease mortality in infants (40 to 10 deaths per 100 000 children) and children between 1 and 5 years of age (7.9 to 2.6 per 100 000). In children over 5 years of age the infectious disease mortality remained stable over the whole study period. Analysis of mortality data of our PICU shows an increasing trend in mortality due to infectious diseases in children with underlying illnesses over the last 10 years. Conclusion Infections in childhood remain a stable burden of mortality during the last decades, despite major improvements in therapeutic and preventive measures. This might be explained by increasing numbers of fatal infections in children with an underlying medical condition, known to increase the risk of severe infections.