In the United States, firearms are the leading cause of death among children and adolescents ages 1 to 19. This has been the case since 2020, when firearm-related deaths surpassed motor vehicle crashes for the first time. Between 2019 and 2020 alone, firearm deaths in this age group jumped nearly 30%, more than double the 13.5% increase seen in the general population.
The answer shifts depending on the age group, though, and it looks very different when you zoom out to a global scale. Here’s what the data shows.
How the Leading Cause Varies by Age
While firearms are the top killer when you look at ages 1 to 19 as a whole, the picture changes significantly at different stages of childhood. For the youngest children, ages 1 through 4, unintentional injuries (accidents) are the leading cause of death, followed by birth defects and homicide. In that age range, drowning is the single most common type of accidental death, claiming about 2.6 lives per 100,000 children per year.
For children ages 5 to 9, accidents remain the top cause, with motor vehicle crashes being the most common type. Cancer and birth defects round out the top three. By ages 10 to 14, accidents still lead, but suicide rises to the second spot, followed by cancer.
The teenage years are where firearm deaths concentrate most heavily. Among 15- to 19-year-olds, both firearm homicides and firearm suicides climb sharply, which is what drives guns to the top of the overall 1-to-19 statistics. For infants under 1 year old, the picture is entirely different: suffocation is the leading cause of accidental death, and preterm birth complications and birth defects are the primary killers overall.
How Firearms Overtook Car Crashes
For decades, motor vehicle accidents were the undisputed leading cause of death for young people in the U.S. That changed thanks to two trends moving in opposite directions. Car crash deaths among children declined steadily over the past two decades, driven by improvements in seat belt laws, car seat regulations, and vehicle safety technology. Between 2011 and 2021, there were about 40,735 motor vehicle fatalities among people under 20, but the annual rate was dropping.
Firearm deaths, meanwhile, were climbing. Over that same decade, 35,684 young people died from gun-related injuries, and the rate accelerated sharply starting around 2018. The crossover happened in 2020. The increase was not evenly distributed. Black males ages 15 to 19 and Hispanic males in the same age group saw firearm homicide rates rise at roughly 22% per year between 2018 and 2021, though Black males experienced far higher absolute rates (about 104 per 100,000 compared to roughly 18 per 100,000 for Hispanic males in 2021). Black females ages 15 to 19 saw an even steeper percentage increase in firearm homicide, rising about 41% annually from 2019 to 2021.
Firearm suicide among young people also increased over this period. Black females ages 10 to 19 experienced the fastest growth rate in firearm suicide, at about 22% per year from 2016 to 2021.
Racial and Ethnic Disparities
Child mortality in the U.S. falls unevenly across racial and ethnic lines, and this is true from the very start of life. The infant mortality rate for Black women is 2.4 times the rate for white women. For American Indian and Alaska Native families, the rate is 64% higher than for white families. These gaps show up across nearly every cause of death, but they are especially wide for preterm birth complications, where the Black infant mortality rate is more than three times the white rate.
American Indian and Alaska Native infants face particularly elevated risks from sudden infant death syndrome (2.4 times the white rate) and unintentional injuries (2.3 times the white rate). These disparities reflect differences in access to prenatal care, hospital quality, housing safety, and broader socioeconomic conditions rather than any biological inevitability.
The Types of Accidental Deaths
Since unintentional injuries remain the top cause of death for several age groups individually, it’s worth understanding what kinds of accidents are most dangerous. Between 2010 and 2019, motor vehicle crashes were the single largest category, killing more than 4,000 children per year across all ages. Suffocation was second, responsible for roughly 1,200 deaths per year and concentrated almost entirely among infants. Drowning killed about 1,000 children per year, with the highest rates among toddlers ages 1 to 4. Poisoning accounted for roughly 800 annual deaths, and fire or burn injuries caused about 345 per year.
There is some good news in the trend lines. Between 2010 and 2019, motor vehicle deaths among children dropped 15%, fire and burn deaths fell 24%, and fall-related deaths declined 25%. Suffocation deaths, however, increased 12% over the same period.
The Global Picture Looks Different
Outside the United States, the leading causes of child death are dominated by infectious disease and complications around birth. Globally, about 5 million children under 5 died in 2020, and roughly half of those deaths occurred in the first 28 days of life. The top killers worldwide are preterm birth complications, birth injuries, pneumonia, diarrhea, and malaria. All of these are preventable or treatable with basic medical care and clean water.
Malnutrition plays a role in about 45% of deaths among children under 5 globally, not usually as the direct cause but by weakening a child’s ability to survive infections. The contrast with the U.S. is striking: in wealthy countries, infectious disease has been largely controlled, which is why injuries and violence dominate the statistics instead.
What Actually Reduces These Deaths
The decline in motor vehicle deaths among children offers a useful case study. It didn’t happen by accident. Decades of policy changes, from mandatory car seats to graduated driver’s licenses for teens, pushed the numbers down steadily. The same evidence-based approach has worked for other injury types. Educational programs that combine hands-on safety training with home hazard assessments have been shown to cut childhood injury rates significantly. One large community-level intervention found a 7.6% reduction in emergency room visits for children under 3, with the biggest drops in burns and falls.
Supervision also matters enormously for young children. Studies have found that structured parent education programs lead to measurable decreases in the time young children spend unsupervised, along with fewer injuries in the home. For drowning specifically, pool fencing, swim lessons starting at age 1, and constant adult supervision near water are the most effective interventions. For suffocation in infants, safe sleep practices (placing babies on their backs in an empty crib) remain the primary prevention tool.
The firearm side of the equation is more politically contested, but the epidemiological data is clear about where the deaths concentrate: among older adolescents, disproportionately in communities experiencing poverty and systemic disinvestment, and increasingly by suicide across demographic groups.