ED visits for pediatric firearm injuries nearly doubled during COVID-19 pandemic

ByRose Weldon

Fact checked byCarol L. DiBerardino, MLA, ELS

Key takeaways:

Visits by children to an ED for firearm injuries nearly doubled during the pandemic.
A second study found that nearly 50% of child homicides were firearm related.

Pediatric ED visits for firearm injuries nearly doubled during the COVID-19 pandemic compared with earlier trends, according to a study published in Pediatrics.

Last year, the AAP issued a policy statement recommending that firearms — which remain the leading cause of death for children and young adults in the United States — be regulated on the level of motor vehicles, with requirements for training, licensing, insurance coverage and registration.

One of the authors of the new study said the investigation was prompted by her own experiences as a pediatric emergency medicine physician.

“What I've seen on the ground is that more children are coming into my own emergency department with firearm injuries over the last few years,” Jennifer Hoffmann, MD, MS, a pediatric emergency medicine physician at Lurie Children’s Hospital of Chicago and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, told Healio. “We wanted to see if this trend was occurring across the country.”

‘Widening disparity’

Hoffman and colleagues studied ED visits by children for firearm injuries from 2017 through November 2022.

“This [was] captured a few years before and a few years after the onset of the COVID-19 pandemic,” Hoffmann said. “We looked at health record data from nine children's hospitals across the country.”

They identified 1,904 ED visits by children for firearm injuries during the study period — 694 before the pandemic and 1,210 during it. Just over 52% involved older adolescents aged 15 to 17 years old, 63.5% involved Black youth, and two out of three firearm injury visits were by youth from under-resourced neighborhoods.

Increases beyond expected rates were seen for 10- to 14-year-old children (RR = 2.61; 95% CI, 1.69-5.71), females (RR = 2.46; 95% CI, 1.55-6), males (RR = 2; 95% CI, 1.53-2.86), Hispanic children (RR = 2.3; 95% CI, 1.3-9.91), and Black non-Hispanic children (RR = 1.88; 95% CI, 1.34-3.1).

“Unfortunately, we found that emergency visits for firearm injuries by Black and Hispanic youth increased after the pandemic, while visits by white youth remained steady,” Hoffmann said. “This showed widening disparity and injury rates, which is troubling. We also found that two out of three firearm injuries visits were by children from under-resourced neighborhoods.”

Visits increased in multiple different neighborhood types, including “both poor and wealthy neighborhoods,” Hoffman added.

“This shows that no child is immune to the growing risks of firearm violence in our society,” Hoffman said.

She noted the worsening of U.S. teens’ mental health during the pandemic.

“Other studies have shown increases in suicide attempts among teenagers,” Hoffmann said. “We know that firearms are the leading means for teens to die by suicide, and so it's important to understand how much that's contributing to the increases.”

Hoffman said the data show a need to “do more to protect children and keep them safe from guns.”

“Overall, these data should serve as a wake-up call,” Hoffmann said. “It doesn't have to be this way. Children deserve to be safe, and the fact is that we already know some evidence-based strategies that work.”

‘There must be a significant investment’

A second study exploring firearm homicides among American children precipitated by intimate partner violence (IPV) found that, from 2003 to 2020, among a total of 11,594 child homicides captured by the National Violent Death Reporting System, 49.3% were firearm homicides, and 12% of those were related to IPV.

Additionally, 86% of the homicides involved children who were in a home where ongoing conflict was occurring between current or former partners, and the remaining 14% of homicides involved adolescents whose death was caused by a current or former dating partner.

In an accompanying commentary, Maya I. Ragavan, MD, MPH, MS, and Alison J. Culyba, MD, PhD, MPH, from the University of Pittsburgh School of Medicine, wrote that “a public health approach focused on evidence-based policies and practices is urgently needed.”

“There must be a significant investment in evidenced-based prevention programming focused on strength-based approaches to prevent youth violence,” they wrote. “Health care, community, and policy-level solutions are critical to protect IPV survivors and their children and promote family-centered thriving.”