Guns Now Leading Cause of Death for Children

Health & Gender Policy Brief #152 | By: Lynn Waldsmith | June 2, 2022

Header photo taken from: The New York Post




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A memorial is seen outside Robb Elementary School in Uvalde, Texas, following the attack there this week in which 19 students and two adults were killed.

Photo taken from: Brandon Bell / Getty Images

Policy Summary

It’s a shocking statistic that should make every American pause and reflect: guns are now the leading cause of death for children in the United States.

Let that sink in. According to the CDC, firearms became the leading cause of death for kids one and older in 2020, marking the first time that motor vehicle crashes have not been the number one cause of death. 

Nearly two-thirds of the 4,368 U.S. children up to age 19 who were killed by guns in 2020 were homicide victims, according to CDC data. Another 30 percent of firearm-related child fatalities were suicides, 3 percent were accidental and 2 percent were of undetermined intent. Motor vehicle crashes, formerly the leading cause of death for kids one and older, killed nearly 4,000 children.

Last month’s school massacre of 19 children and two adults at an elementary school in Uvalde, Texas was the 27th school shooting in the U.S. this year. The tragedy came just 10 days after a mass shooting at a Tops supermarket in Buffalo, N.Y., that took the lives of 10 people.

About 500 children and teens have lost their lives to gun violence in the U.S. so far in 2022, according to the Gun Violence Archive, an independent data collection organization. The Gun Violence Archive has also counted 212 mass shootings that have occurred so far this year, and 2022 is not even half over. It defines a mass shooting as an incident in which four or more people were shot or killed, excluding the shooter.

Policy Analysis

Among other stark finding in the CDC data are gender and racial realities: Male youths are significantly more likely to be killed by guns, while vehicle crashes claim more females. In addition, the firearm death rate for Black children is more than four times that of white children, and white children are still more likely to be killed by motor vehicles than guns.

Because the National Rifle Association (NRA) continues to maintain a stranglehold on the Republican Party, many Americans, despite voicing increasing outrage, are not optimistic about the likelihood of Congress passing gun control laws any time soon. Members of the medical and educational communities say a more realistic approach may lie in treating the gun catastrophe facing children as a public health crisis, rather than a political battle.

“As the progress made in reducing deaths from motor vehicle crashes shows, we don’t have to accept the high rate of firearm-related deaths among U.S. children and adolescents,” researchers recently wrote in a New England Journal of Medicine article that focuses on the trend.

“Preventable deaths among young people not only are associated with tremendous medical costs, but take a great personal toll on families and communities. To reverse the trend of increasing firearm-related deaths among U.S. children, experts and policymakers should be intentional in their efforts to develop and implement a multipronged scientific strategy centered on continuous improvement.”

Twenty years ago, the CDC proclaimed the reduction in deaths attributable to motor vehicle crashes to be one of the most substantial public health achievements of the 20th century. But while the National Highway Safety Administration (NHTSA) could take the lead addressing road-traffic fatalities, the researchers point out that firearms are one of the few products whose safety isn’t regulated by a designated federal agency.

The auto industry has introduced numerous safety improvements over the past two decades, including: automatic emergency braking, electronic stability controls, lane-departure warnings, blind-spot detection, front and side airbags, and rear-facing cameras. By contrast, guns sold to civilians are becoming more lethal as gun manufacturers are selling weapons designed for military use. 

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Why Not Smart Guns in This High-Tech Era? The gun industry lacks not the high-tech know-how, but the fortitude to advance the safety of its weapons in the face of gun-lobby politics and threats.

Photo taken from: Daniel Borris / The New York Times

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The New England Journal of Medicine article also notes that the firearms industry has made little effort to develop or market personalized “smart” guns. Because such weapons can be only be fired by the authorized user only, so-called smart guns should reduce the risk of children unintentionally shooting themselves or others and of adolescents using guns for homicide or suicide.

Traffic safety has also benefitted from universal state-level requirements for the licensing of drivers and the registration of vehicles. States created graduated-licensing programs for new drivers in the late 1990s, which reduced fatal crashes among teenagers. States also introduced booster-seat laws, and guidance for parents on age-appropriate child car seats, which further reduced deaths from motor vehicle crashes among children.

Meanwhile, many states have made it easier for children and young adults, as well as adults with criminal records, to gain access to firearms. Some states don’t require background checks when firearms are purchased from private sellers, such as at gun shows. 


According to the New England Journal of Medicine article, “in recent years, many of the same states have passed legislation allowing people to carry a concealed weapon without a permit. At the federal level, the government has given the firearm industry partial protection against certain tort-liability suits (i.e., against negligence claims contending that they could have foreseen their product being diverted for criminal use), which has reduced the industry’s incentive to help prevent firearm-related deaths.”

The researchers say it’s time for treating gun safety the way motor vehicle safety has successfully been improved: Begin with a system that tracks firearm-related injuries and promotes the type of continuous reduction in injury rates that has been seen for motor vehicle crashes, especially among children. They advocate establishing a federal agency whose mission is to prevent harm caused by firearms.

Among other things, they also recommend federal and state laws, such as strong child-access prevention laws, which hold firearm owners liable if a child gains or could gain access to a firearm. Using evidence-based research to make incremental improvements has proven to be the key to the science of injury prevention.

Engagement Resources​

Click or tap on resource URL to visit links where available 

Mortality from Motor Vehicle Crashes and Firearms among Children, Adolescents, and Young Adults, United States, 2000–2020:,%20April%2016,%202022%20DM940106_NEJM_Subscriber&bid=936195133

CDC full report on current Causes of Death in Children and Adolescents in the US:

The New England Journal of Medicine: Crossing Lines — A Change in the Leading Cause of Death among U.S. Children:,%20April%2016,%202022%20DM940106_NEJM_Subscriber&bid=936195133

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Gun violence archive 2022:


Firearm mortality by state:

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