Firearm injury and young children: a critical review

Firearms are the leading cause of death in children in the United States. Rates of firearm injury and death are rising among young children, ages 0-5 years, yet data-driven prevention strategies are lacking. The goal of this critical review was to provide a developmentally-informed overview of the patterns and prevalence, contexts, and impacts for all-cause firearm injury among children ages 0-5 years. We review findings from interdisciplinary, peer-reviewed studies to inform considerations for prevention strategies. We present disparities in injury and death rates in this age group, with males and non-Hispanic Black children most impacted. We review data regarding the contexts of firearm injury and death among young children; although most injuries in this age group occur at home, young children also experience firearm injury through community violence. The physical, psychological, and social impacts of injury on individual children, their families, and their communities are also reviewed. Integrating these findings, we present strategies for firearm injury prevention in this age group, informed by the bioecological systems model of development and the Haddon Matrix for injury prevention, considering factors in the child's proximal physical and social environment and broader social context. Most research does not specifically focus on young children, resulting in limited data on firearm injuries within this age group. Consequently, we recommend that future qualitative and mixed-methods studies prioritize this developmental period, actively engaging parents and community members connected to young children. This approach will contribute to a better understanding of the nature of firearm injuries and death among young children and inform effective prevention. We also call for research-community partnerships to evaluate the impact of policy and community-based prevention initiatives on injury rates in young children. We hope that this critical review serves as an initial roadmap for researchers, public health professionals, clinicians, and anyone working with parents and young children, providing a reference for preventing avoidable injuries and deaths in the youngest members of our population.