Firearm-related injuries have become the leading cause of death among children and adolescents in the United States, surpassing motor vehicle accidents in recent years. This alarming trend represents a uniquely American public health crisis, with devastating consequences for families, communities, and the health care system at large. Beyond the tragic loss of life, there is a significant, yet often overlooked, burden of morbidity among pediatric survivors of firearm injuries.

A recent study addresses this critical gap. Led by Senior Fellow Nadir Yehya, with Anireddy Reddy, Charlotte Z. Woods-Hill, Garrett Keim, and colleagues, the study provides a comprehensive analysis of the trends and costs of firearm-related hospitalizations in children under age 21 across 48 states. Using the 2019 Kids’ Inpatient Database (KID), the largest all-payer pediatric inpatient claims dataset, the researchers identified nearly 6,000 children with firearm-related hospitalizations, of whom about 5,600 survived. Total charges for treating those hospitalized surpassed $1.05 billion for 2019.

Similar to prior research, their analysis revealed concerning racial disparities and geographic trends that demand urgent attention. Black children were disproportionately hospitalized for assaults, while white children were overrepresented in hospitalizations from gun-related suicide attempts.

The study underscores the need for systemic solutions to address firearm safety and disparities in care. Interventions such as expanding firearm injury surveillance, promoting safe firearm storage, providing gun locks, and enacting strategies for suicide prevention can play a critical role in reducing firearm-related injuries and deaths. 

See our Q&A with Dr. Yehya below to learn more. 

What motivated you to do this research?

Yehya: There has been a fair amount of attention on firearm-related death, but a lot of these kids survive. The clinical experiences of kids who make it to the hospital and the associated costs haven’t been well described.

What is one important finding and why?

Yehya: One of the most striking findings was the significant treatment burden among hospitalized survivors, particularly those who required invasive medical devices such as tracheostomies and feeding tubes. These survivors face long-term health challenges, extended hospital stays, and increased healthcare needs post-discharge. While they made up only about 3% of hospitalizations, their cases highlight the severity of firearm injuries and the lasting impact on children and families. The financial burden is also notable, as these cases accounted for 13% of total hospital costs, underscoring the broader strain on the healthcare system.

What limitations should readers be aware of?

Yehya: The advantage of using a nationally representative database like KID is that it tries to be representative of the entire United States, and with some of the stats we performed, the numbers of patients admitted (and their racial distribution) are reasonably accurate representations of America’s pediatric population. 

The downside is that this dataset requires someone to be admitted, so kids who die on site or in the emergency department – and thus never get admitted to a hospital – aren’t counted. Thus, this report underestimates mortality, but since our focus was on hospitalized patients and the morbidities of hospitalized survivors, we provide accurate numbers for that. Also, the national landscape has not been well-described since 2019, largely because the most representative databases like KID haven’t been updated post-COVID.

What policy recommendations can address the disparities you uncover?

Yehya: Pediatricians have a unique role in addressing firearm presence in homes and engaging families in conversations on firearm safety, especially given the high prevalence of suicides as a cause of death and hospitalization. They are also well positioned to address firearm storage practices, given that 3 million children live in a home with an unsecured firearm in this country and the only messaging families may hear about how to most safely store firearms could be from their pediatrician. The study’s findings can lead pediatricians to engage in discussions around proven interventions and preventative measures, such as safe storage and gun locks—much like they do with bike helmets to prevent concussions and other brain injuries.

Where are you going next with this research?

Yehya: We have an ongoing project started in the CHOP pediatric intensive care unit (PICU) providing gun locks to these families (led by senior LDI fellows Dr. Reddy and Dr. Woods-Hill) and looking at the acceptability of this for families, which we believe is generally high. Based on preliminary results, we were encouraged to expand to additional sites. We are examining regional differences in attitudes of caregivers and clinicians toward firearm storage, including if they are associated with state-by-state differences in firearm legislation. As newer datasets come out, we are interested in looking at updated U.S. and regional data.

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The study, “Firearm-Related Hospitalizations and Newly Acquired Morbidities in Children and Adolescents: A Nationally Representative Study,” was published on October 8, 2024 in the Journal of Pediatric Surgery. Authors include Rebecca Chae, Laura Bricklin, Anireddy R. Reddy, Charlotte Z. Woods-Hill, Garrett Keim, and Nadir Yehya.

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