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The incidence of congenital anomalies at birth and accumulated to five years is presented for live-born children in a large prospective study. Congenital anomalies are not all diagnosable at birth; our data demonstrate that the incidence rate increases approximately three-and-one-halffold for Blacks and approximately fivefold for Whites between six days of age and five years of age. The incidence of congenital anomalies at birth was higher among Black children than White children, but there were no notable differences between the groups in incidence accumulated to age five years. At five years, the incidence rate of severe and moderate (but not trivial) congenital anomalies amounted to 15 per cent; for severe congenital anomalies, 4 per cent. Severe congenital anomalies diagnosed through age five years were observed to have a much higher incidence among children who weighted 2500 gm or less at birth than among those who were heavier.
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