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Why This Topic Is Important
Millions of children and young adults are treated for non-fatal injuries in U.S. emergency rooms each year, and hundreds of thousands require hospitalization (1). Although most of these injuries are unintentional—resulting from accidents such as falls or car crashes—the intent to cause harm, such as through assault or self-injury, accounts for a large and growing share of youth injury hospitalizations nationwide (1). For some young people, injuries can lead to chronic pain, permanent disability, mental health problems, and decreased ability to participate in educational and social activities (2). Family members often must care for an injured child, which can cause stress and lost income (2). Considering medical and other expenses, work loss, and reduced quality of life, non-fatal injuries among U.S. children and young adults under age 25 are estimated to cost more than $545 billion per year (3).

Injuries caused by firearms, which may be intentional or unintentional, disproportionately affect young people—particularly adolescents, males, and youth of color (4, 5). The need for public health efforts aimed at preventing youth firearm injuries and violence, while addressing inequities across communities, is urgent (4, 5).
For more information, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (n.d.). WISQARS: Nonfatal injury data. Retrieved from: https://www.cdc.gov/injury/wisqars/nonfatal.html

2.  Jones, S., et al. (2021). The impact of injury: The experiences of children and families after a child's traumatic injury. Clinical Rehabilitation, 35(4), 614-625. Retrieved from: https://journals.sagepub.com/doi/10.1177/0269215520975127

3.  Peterson, C., et al. (2021). Economic cost of injury — United States, 2019. Morbidity and Mortality Weekly Report, 70(48), 1655-1659. Retrieved from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7048a1.htm

4.  Lee, L. K., et al. (2022). Firearm-related injuries and deaths in children and youth: Injury prevention and harm reduction. Pediatrics, 150(6), e2022060070. Retrieved from: https://publications.aap.org/pediatrics/article/150/6/e2022060070/189686/Firearm-Related-Injuries-and-Deaths-in-Children

5.  Naik-Mathuria, B. J., et al. (2023). Defining the full spectrum of pediatric firearm injury and death in the United States: It is even worse than we think. Annals of Surgery 278(1), 10-16. Retrieved from: https://journals.lww.com/annalsofsurgery/fulltext/2023/07000/defining_the_full_spectrum_of_pediatric_firearm.3.aspx
Policy Implications
Most childhood injuries are unintentional and preventable, and many can be addressed by policies and programs focused on safety. Intentional injuries, usually occurring as a result of assault or self-harm, also can be prevented through policies focused on social determinants of health and multipronged approaches that strengthen individuals, families, schools, and communities (1, 2, 3, 4).

Injuries involving firearms, whether intentional and unintentional, are a growing public health crisis disproportionately affecting male youth of color (1, 5).

In addition to the lasting physical and mental health effects that injuries can have on those impacted directly, including disabilities and psychological trauma, childhood injuries in the U.S. cost society hundreds of billions of dollars annually (5, 6, 7).

Policy and program options that could prevent injuries among young people and reduce disparities across youth groups include:
  • Educating families on firearm safety laws and on preventing children's exposure to other lethal means such as medications and to household dangers such as windows and stoves (1, 8, 9)
  • Advocating for comprehensive, multisector approaches to youth firearm injury prevention, integrating public safety policies and regulations, coordinated hospital-based programs, and community violence intervention programs (1, 5)
  • Promoting community development measures to ''clean and green'' neighborhood spaces, particularly in under-resourced areas, as these efforts are linked to decreased violence (1)
  • Addressing root causes of violence and firearm injury disparities by strengthening social, economic, and education opportunities for youth and families; e.g., ensuring that adequate safety net programs and affordable housing are available to families in need (1, 4)
  • Promoting safe, stable, and caring family relationships; as part of this, supporting evidence-based approaches—such as home-visiting programs—that provide parents and caregivers with training and support (4, 10)
  • Supporting research-based, cross-sector strategies to promote positive emotional health for youth and families, including routine, accessible, and culturally appropriate mental health screening and services (3)
  • Promoting school policies that foster a positive school climate—where students feel safe, connected, and supported at school—which is associated with lower levels of student violence and high-risk behavior, including substance use (2, 4)
  • Offering youth meaningful opportunities to work and learn outside of school, along with connections to caring adults, through mentoring and other community programs (2, 4)
  • Improving motor vehicle safety—e.g., through continued investments in the comprehensive Safe Systems strategy—while strengthening and promoting awareness of laws concerning car seats, seat belts, graduated driver licensing systems, and drunk or distracted driving (11, 12)
  • Expanding non-fatal firearm injury surveillance, researching effective approaches to prevention, and advancing understanding of risk and protective factors (1, 5)
For more information, see kidsdata.org’s Research & Links section. Also see Policy Implications on kidsdata.org under Child Abuse and Neglect, Deaths, Hospital Use, and Youth Suicide and Self-Inflicted Injury.

Sources for this narrative:

1.  Lee, L. K., et al. (2022). Firearm-related injuries and deaths in children and youth: Injury prevention and harm reduction. Pediatrics, 150(6), e2022060070. Retrieved from: https://publications.aap.org/pediatrics/article/150/6/e2022060070/189686/Firearm-Related-Injuries-and-Deaths-in-Children

2.  Joshi, S. V., et al. (n.d.). K-12 toolkit for mental health promotion and suicide prevention. HEARD Alliance. Retrieved from: https://www.heardalliance.org/help-toolkit

3.  National Academies of Sciences, Engineering, and Medicine. (2022). Responding to the current youth mental health crisis and preventing the next one. National Academies Press. Retrieved from: https://nap.nationalacademies.org/catalog/26669/responding-to-the-current-youth-mental-health-crisis-and-preventing-the-next-one

4. Centers for Disease Control and Prevention. (2022). Preventing youth violence. Retrieved from: https://www.cdc.gov/violenceprevention/youthviolence/fastfact.html

5.  Naik-Mathuria, B. J., et al. (2023). Defining the full spectrum of pediatric firearm injury and death in the United States: It is even worse than we think. Annals of Surgery 278(1), 10-16. Retrieved from: https://journals.lww.com/annalsofsurgery/fulltext/2023/07000/defining_the_full_spectrum_of_pediatric_firearm.3.aspx

6.  Peterson, C., et al. (2021). Economic cost of injury — United States, 2019. Morbidity and Mortality Weekly Report, 70(48), 1655-1659. Retrieved from: https://www.cdc.gov/mmwr/volumes/70/wr/mm7048a1.htm

7.  Jones, S., et al. (2021). The impact of injury: The experiences of children and families after a child's traumatic injury. Clinical Rehabilitation, 35(4), 614-625. Retrieved from: https://journals.sagepub.com/doi/10.1177/0269215520975127

8.  California Department of Justice, Office of Gun Violence Prevention. (n.d.). Firearm safety laws. Retrieved from: https://oag.ca.gov/ogvp/laws

9.  Head Start Early Childhood Learning and Knowledge Center. (2023). Injury prevention starts at home. U.S. Department of Health and Human Services. Retrieved from: https://eclkc.ohs.acf.hhs.gov/publication/injury-prevention-starts-home

10.  Centers for Disease Control and Prevention. (n.d.). Preventing child maltreatment through the promotion of safe, stable, nurturing relationships between children and caregivers. Retrieved from: https://www.cdc.gov/ViolencePrevention/pdf/CM_Strategic_Direction--Long-a.pdf

11.  American College of Emergency Physicians. (2022). Motor vehicle safety: Policy resource and education paper. Retrieved from: https://www.acep.org/siteassets/new-pdfs/preps/motor-vehicle-safety.pdf

12.  Ehsani, J. P., et al. (2023). The future of road safety: Challenges and opportunities. Milbank Quarterly, 101(Suppl. 1), 613-636. Retrieved from: https://onlinelibrary.wiley.com/doi/10.1111/1468-0009.12644
How Children Are Faring
In 2021, there were 1,315 hospital discharges for non-fatal firearm-related injuries among California young people under age 25—a rate of 10.1 hospitalizations per 100,000 youth. This figure is up from 2019 (7.9 per 100,000) but not as high as in 2016 (10.5 per 100,000), the first year for which comparable data are available. Twenty California counties recorded more than 10 youth hospitalizations related to firearms in 2021, with injury rates ranging from fewer than 4 per 100,000 (Orange) to more than 25 per 100,000 (Solano).

Across years with data, older teens and young adults experience higher rates of firearm injury when compared with younger age groups, yet hospitalization rates among children under age 15 statewide have been climbing steadily, doubling between 2016 and 2021. Young males in California were hospitalized for firearm injuries at seven and a half times the rate of their female counterparts in 2021 (17.4 vs. 2.3 per 100,000), while the rate of discharge among African American/black youth (52.3 per 100,000) was almost five times higher than for Hispanic/Latino youth (10.9 per 100,000), almost 20 times higher than white youth (2.7 per 100,000), and almost 35 times higher than for Asian youth (1.5 per 100,000).

The rate of overall injury hospitalization among California young people ages 20 and under was 214 per 100,000 in 2015, down from 484 per 100,000 in 1991—a difference that amounts to more than 23,000 fewer discharges for non-fatal injuries statewide. Across counties with data in 2013-2015, injury hospitalization rates ranged from 133 (San Luis Obispo) to 347 (Tuolumne) per 100,000.

Between 1991 and 2015, statewide discharge rates for unintentional injuries, which accounted for a majority of injury hospitalizations among children and young adults ages 0-20, also dropped by more than 50% overall and in all age groups but infants ages under age 1, whose rates fell less than 20%. In 1991 infants had the second lowest rate of discharge for unintentional injuries among age groups (298 per 100,000), whereas by 2012 they had the highest (249 per 100,000). By contrast, rates of discharge for intentional injuries consistently are highest among teens ages 16-20 (108 per 100,000 in 2015), followed by children ages 13-15 (80 per 100,000 in 2015).