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Firearm suicides were often precipitated by situational and relationship problems.

The shooter playing with a gun was the most common circumstance surrounding unintentional firearm deaths of both younger and older children.

This is the most comprehensive analysis of firearm-related deaths and injuries among US children to date, examining overall patterns, patterns by intent, trends over time, state-level patterns, and precipitating circumstances.

These findings underscore the need for scientifically sound solutions.

Nonfatal injury estimates have been adjusted to account for hospital nonresponse and changes in the number of US hospital EDs over time.

NEISS classifies injury intent by using standard definitions for the following categories: assault, self-harm, unintentional, and legal intervention.State-level data include deaths of state residents only and exclude deaths of nonresidents, even if the fatal injury occurred within the state in question.Firearm suicides are reported for children aged 10 years and older given how rare they are in children younger than age 10 (ie, 5 cases for the nation over the period 2000–2014) NEISS is a stratified probability sample of US hospitals that have an ED and a minimum of 6 beds, representing large urban, suburban, rural, and children’s hospitals.Firearm suicides are more dispersed across the United States with some of the highest rates occurring in Western states.Firearm homicides of younger children often occurred in multivictim events and involved intimate partner or family conflict; older children more often died in the context of crime and violence.This article provides the most comprehensive examination of current firearm-related deaths and injuries among children in the United States to date.It examines overall patterns of firearm-related death and injury, patterns by type of firearm injury (interpersonal, self-directed, and unintentional), trends over time, state-level patterns, and circumstances surrounding these deaths.NEISS data are collected on the basis of a national probability sample and sample weights are summed to provide national estimates; valid regional- and state-level estimates cannot be obtained from these data.Data on circumstances and other incident characteristics for firearm homicide, firearm suicide, and unintentional firearm deaths among children were derived from the National Violent Death Reporting System (NVDRS).Firearm-related deaths are the third leading cause of death overall among US children aged 1 to 17 years and the second leading cause of injury-related death.Previous studies examined selected outcomes or certain types of firearm injuries.

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