A girl, thought to be six years old, has died at Birmingham Children's Hospital after contracting swine flu.
NHS West Midlands said the girl, who had other serious health problems, died on Friday evening. It is not known if flu contributed to her death.
It was initially reported she was nine years old. Her death is the third swine flu-related fatality in the UK.
The other two deaths were in Scotland. There have been 1,604 confirmed cases in England since Friday.
The total number of cases in England has reached 4,968 with the UK's total now rising to 5,937.
The Health Protection Agency confirmed 588 new cases of swine flu in the West Midlands region on Monday, taking the total number of cases in the region to 2,104.
The youngster who died is believed to have been a pupil at a special school in Birmingham which caters for children with learning difficulties.
Dr Helen Carter, consultant in public health for NHS West Midlands, said: "Our thoughts are with the family of the patient at this very sad time.
"The family have asked for the patient's identity to be kept private and we will not be releasing any further details.
"It is important to remember that our experience here has been that the vast majority of cases with swine flu are mild."
Dr Helen Carter, NHS West Midlands: "Our thoughts are with the family"
Health Secretary Andy Burnham said: "Tragic as today's death is, I would like to emphasise that, across England, the majority of swine flu cases have not been severe.
"I would reiterate that the risk to the general public remains low and we can all play our part in slowing the spread of the virus by following simple hygiene procedures."
Asked if he feared more West Midlands deaths, Professor Steve Field, chairman of the Royal College of General Practitioners, said: "(We) thought there would be a few more than this with the numbers of cases that we've got.
"Actually, it's a surprise that more people haven't died in a way because you'd expect more from seasonal flu.
"More people will die from the heat in the next few days if we're not careful than they will from flu."
Last week health officials in the West Midlands and London said swine flu cases would be clinically diagnosed, rather than being confirmed by laboratory results.
The new policy means swabbing will take place only for a small number of cases to keep track of the strength of the virus.
Doctors will also use the drug Tamiflu more selectively, targeting only people with symptoms.
Chief medical officer Sir Liam Donaldson stressed that many parts of the UK were still in the containment phase.
But he warned there could be "tens of thousands of cases" of swine flu each week by the autumn because the virus was more likely to thrive in the colder months.
Dr Hamish Meldrum, head of the British Medical Association (BMA), said on Monday the public could rely on doctors to "step up to the mark" as swine flu spreads.
Some 366 retired GPs have joined a BMA register, saying they are willing to treat patients if the flu pandemic reaches crisis point.
In Denmark, health officials confirmed they observed a case of resistance to Tamiflu in a patient with swine flu.
The State Serum Institute, which aims to prevent and control infectious diseases, said: "The person is well now and no further contagion with the resistant virus has been detected."
This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.