Firearm-related homicides among children and adolescents in the United States often occurred at home, with younger children disproportionately affected, according to data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System for 2020 to 2021 (48 states plus DC). Of 2,196 pediatric firearm homicides, 24% (n = 536) occurred at home; among children 12 years and younger, 63% did.
Incidents in the home were frequently linked to murder-suicide, child abuse, and intimate partner violence. When an assailant relationship was known (310 cases), a parent was identified in 42% (129/310). Compared with homicides elsewhere, victims killed at home were younger, more often female, and more likely to die in multiple-fatality events.
Handguns predominated. Among incidents with an identified firearm type (57%), handguns accounted for about 91% overall and about 88% of those in the home.
Across all pediatric firearm deaths in 2020 to 2021 (n = 3,839), 46% occurred at home. In that setting, suicide was the leading cause (56%), followed by homicide (31%) and unintentional injury (11%).
A temporal analysis of 14 consistently reporting states (2005 to 2021) found that pediatric firearm homicide rates rose from about 0.69 per 100,000 in 2013 to 1.82 in 2021; in-home homicide rose from about 0.18 per 100,000 in 2010 to 0.38 in 2021. The proportion occurring at home was stable over time.
This retrospective cohort used the CDC’s restricted National Violent Death Reporting System database (2020 to 2021: 48 states plus DC; 2005 to 2021: 14 states). Researchers noted missingness in incident details, reliance on medical examiner/coroner and law-enforcement narratives that could enable misclassification, and county-level geography that limited neighborhood-level inference. An invited commentary highlighted similar limitations in location classification, perpetrator relationships, and narrative variability.
Researchers argued that traditional safe-storage approaches may have been inadequate for caregiver-perpetrated in-home homicide and suggested evaluating extreme-risk protection orders (ERPOs) and mandatory domestic-violence–related firearm relinquishment. The commentary underscored the need for targeted interventions, noting that in-home deaths were underrecognized and that ERPOs/relinquishment may be insufficient when perpetrators are legal guardians; broader prevention infrastructure and evaluation are needed.
“Tailored, evidence-based strategies—such as safe storage laws, extreme risk protection orders, and violence intervention programs—are available to address different types of firearm injury, recognizing that risk factors vary significantly,” wrote Chethan Sathya, MD, MSc, and colleagues in the invited commentary.
Disclosures: The original investigation reported no conflicts of interest.
Source: JAMA Surgery & Commentary
