Examining the Evidence: A Pediatric Perspective on Firearm Safety Research

Statement of Problem

On December 14, 2012, 20 children and 6 adults were the victims of gun violence at Sandy Hook Elementary in Connecticut. Following this profound tragedy, families, educators, health professionals, and policymakers issued an urgent call for immediate action to prevent this kind of gun violence in the future, particularly to protect the most vulnerable among us: children.

In response to the Sandy Hook tragedy, Children’s Hospital of Philadelphia (CHOP) established the Center for Violence Prevention (CVP), a multidisciplinary effort to reduce the exposure to and impact of violence among children, teens, and families through community-focused research and evidence-based programs. CVP, a PolicyLab partner, has since become a nationwide leader in hospital-based and community-delivered violence prevention interventions.

As of 2018, despite increased attention across the country to the epidemic of gun violence and the dangers firearms pose for youth, firearm-related injury remained the second-leading cause of death for children. Of the youth killed by guns in high-income countries, a staggering 92% are killed in the United States, and the overall rate of firearm fatalities among children has continued to increase. Throughout the country, the rate of firearm-related suicide in children has steadily risen since 2008, and firearm-related homicide has increased by 28% between 2014 and 2016.

This public health crisis impacts children and families physically and emotionally, and takes a toll on the vibrancy and economies of the communities it touches. Many policy proposals exist to prevent firearm injuries, but research specifically looking at the impact on child injury and death—including data that could inform solutions to move the needle on this issue—is lacking.


In 2019, PolicyLab and CVP launched a collaboration to bring an evidence-based, child-focused lens to the issue of firearm safety. For our first joint resource, we released an Evidence to Action brief in fall 2020 to take a deep dive into the existing evidence on gun-related policies and interventions that could have an impact on unintentional firearm injury and death among youth based on the strength of the available data, and offer recommendations for policymakers, providers and others who have an impact on child health.

We recognize that there are many other issues around firearms that profoundly affect the physical and emotional health of children and families. However, in this brief, we limited our focus to unintentional firearm-related injury and death among youth; this is an issue we felt provided a specific opportunity for action, and that has become even more critical as gun sales have spiked during the COVID-19 pandemic and children are spending more, potentially unsupervised, time at home.

For this project, we conducted both a policy analysis and research review, with a focus on policies and public health approaches that:

  • could prevent children from unintentionally firing a gun, a primary cause of firearm injury among young children
  • could decrease adolescent gun possession, as older children are more likely to experience unintentional harm due to mistakenly firing a gun at friends or bystanders.

We reviewed research and analysis on policy and public health approaches including: Encouraging safe storage, gun safety design, comprehensive background checks, and more.

We found that while the research we uncovered on many policies was limited, it is clear that some policies—such as Child Access Prevention laws and comprehensive background checks—have enough evidence behind them to warrant immediate action among decision-makers to move them forward. There is also a critical need for more research and funding to determine additional policy strategies and implementation approaches that are effective in preventing child injury and death. For more recommendations for policymakers, providers, health care systems, parents and community organizations, read the full brief here.

In spring 2021, PolicyLab and CVP released an accompanying policy brief that builds out guidance for research to address evidence gaps and identify which policies work to prevent firearm injury among youth.

Next Steps

In the coming months, we’ll look to advance our recommendations and produce additional supportive guidance that could be valuable to leaders working in this space. It is our hope that these resources can guide policymakers looking to make evidence-informed decisions to keep families safe in their communities and across the country.

This project page was last updated in February 2021.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Examining the Evidence: A Pediatric Perspective on Firearm Safety Research [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].