Background: Firearm injuries are the second leading cause of death among children in the United States. Rates of pediatric firearm mortality have risen by over 40% in the past 5 years. Despite these trends, details are limited on the contextual factors associated with childhood firearm deaths; in particular, the interplay between psychosocial factors and firearm access among youth. Objective: To perform a comparative analysis of risk factors among homicide, suicide and unintentional firearm deaths in children. Methods: Data were obtained from child death review team assessments in the United States using the National Fatality Review Case Reporting System. We included all firearm deaths classified as suicide, homicide, or unintentional on the death certificate, in children aged 0 to 18 years from 2007 through 2016. We performed descriptive analyses of risk factors across three categories: demographics, psychosocial factors, and firearm storage/safety characteristics. Results: There were 6024 firearm decedents during the study period from 34 states. The most common manner of death was homicide (57%), followed by suicide (36%), and unintentional (7%). Mean age was 15.5 (±1.5 years) for suicide, 14.0 (±4.6 years) for homicide, and 9.8 (±5.6 years) for unintentional deaths. Suicide (76%) and unintentional (55%) deaths were more common among White, Non-Hispanic children compared with homicides (19%). Mental health/cognitive disability history had highest incidence among suicide decedents (51%). Caregivers received social assistance most often in homicide (55%) and unintentional deaths (39%) compared with suicide deaths (17%). Among all intents, firearms used most often were handguns (76%), shotguns (13%), hunting rifles (8%), and assault rifles (3%). Safety features were present in 22% of firearms and 83% were stored with ammunition. Locked firearm storage was present in 22% of suicides, 4% of homicides and 3% of unintentional deaths. Conclusion: Each manner of firearm death presents its own unique challenges from a psychosocial perspective. Unsafe firearm storage practices remain a central theme in youth firearm violence.

Table 1

Demographic and Psychosocial Characteristics of Firearm Decedents by Manner of Death using the National Fatality Review Case Reporting System, 2007-2016.

Table 1

Demographic and Psychosocial Characteristics of Firearm Decedents by Manner of Death using the National Fatality Review Case Reporting System, 2007-2016.

Close modal
Table 2

Firearm Characteristics and Safety Features by Manner of Firearm Death using the National Fatality Review Case Reporting System, 2007-2016.

Table 2

Firearm Characteristics and Safety Features by Manner of Firearm Death using the National Fatality Review Case Reporting System, 2007-2016.

Close modal