Introduction
Firearms have become the leading cause of death for children and adolescents in the United States, eclipsing other causes such as motor vehicle accidents and cancer. While mass shootings and neighborhood gun violence understandably capture public attention and media coverage, a quieter, less discussed tragedy unfolds daily within the walls of American homes — firearm-related homicides affecting children and adolescents in their own residences. Understanding the characteristics and risk factors of these in-home firearm homicides is essential for developing targeted prevention policies and protecting vulnerable youth.
This article examines the recent comprehensive research published in JAMA Surgery (2025) by Rook et al., which analyzed a large national dataset of pediatric firearm homicides by location and sociodemographic factors. The study’s findings highlight critical insights into age-related risks, perpetrator relationships, the role of domestic violence and child abuse, and concerning trends over time.
What the Data Reveal About Pediatric In-Home Firearm Homicides
The researchers examined data from the National Violent Death Reporting System Restricted Access Database encompassing 48 states and the District of Columbia between 2020 and 2021, supplemented by data from 14 states spanning 2005 to 2021. This retrospective cohort study included all firearm-related homicide victims aged 0 to 17 years.
Among 2,196 pediatric firearm homicide cases between 2020 and 2021, about 24.4% (536 cases) occurred at home, contrasting with roughly 75.6% occurring outside the home. Notably, younger children (0–12 years old) faced a disproportionately high risk of in-home homicide: 63.2% of firearm-related deaths in this age group occurred at home, compared to a majority outside the home for older adolescents. Each additional year of age decreased the odds that a homicide would be in the home by 17%, underscoring the vulnerability of younger children in domestic settings.
In-home firearm homicides were strongly correlated with serious family violence dynamics. Compared with homicides occurring elsewhere, those at home showed a much higher association with murder-suicides (23% vs. 1.6%), child abuse (20.1% vs. 2.3%), and intimate partner violence (16.8% vs. 2.4%). Among 310 in-home homicides where the relationship to the assailant was known, 41.6% were perpetrated by parents, 18.1% by acquaintances, 13.5% by siblings, and 11.3% by a parent’s intimate partner.
The longitudinal data revealed a disturbing trend: between 2005 and 2021, in-home pediatric firearm homicides increased steadily, almost doubling from 0.18 per 100,000 children in 2010 to 0.38 per 100,000 in 2021. This increase occurred despite ongoing firearm safety laws and awareness campaigns.
A Case Vignette: The Tragic Story of Emily
Emily, an 8-year-old girl from a suburban neighborhood, loved playing with her younger brother and attending school. Unbeknownst to teachers and neighbors, her household bore the scars of domestic violence. When an argument between her mother and her mother’s partner escalated, firearms stored improperly in the home — despite safe storage laws — became instruments of tragedy. Emily was fatally shot during a murder-suicide event within the family. Her story, unfortunately, mirrors patterns identified in the study, illuminating the peril young children face from violence at home.
Misconceptions and Current Challenges
Many believe that safe storage laws alone are sufficient to prevent firearm injuries to children in the home. However, the data suggest that these laws, while beneficial, are insufficient in isolation. In situations involving domestic violence or child abuse, firearms are often accessible to those posing the greatest risk, including parents or their partners. Furthermore, societal stigma and privacy concerns often leave domestic violence and child abuse unaddressed until it is too late.
Another common misconception is that community violence is the primary source of pediatric firearm homicide. While community incidents are tragic and receive major attention, younger children’s firearm homicides predominantly occur in the home, requiring a shift in focus toward family dynamics.
Addressing Prevention: Beyond Safe Storage
To effectively prevent in-home firearm homicides, especially among young children, multifaceted strategies are required. The study’s authors highlight the potential benefits of Extreme Risk Protection Orders (ERPOs), legal tools allowing temporary removal of firearms from individuals deemed a risk to themselves or others, particularly in domestic violence settings. Mandatory firearm relinquishment in domestic violence cases could prevent firearms from remaining accessible to perpetrators.
Healthcare providers, educators, and social workers must be vigilant in screening for domestic violence and child abuse indicators and actively engage in counseling families on firearm risks. The incorporation of firearm safety discussions into routine pediatric care, combined with education about ERPOs and local resources, may reduce risk.
Community-level interventions to support families experiencing intimate partner violence, coupled with increased mental health services, can also mitigate underlying risk factors.
Expert Insights and Commentary
Dr. Benjamin Carter, a pediatric trauma surgeon and firearm injury prevention advocate, notes, “This study challenges us to expand our vision of pediatric firearm prevention. It’s not just about locking up guns; it’s about addressing the family environment and ensuring that guns don’t become instruments in domestic tragedies.”
Legal scholar Professor Maya Rodriguez emphasizes, “ERPOs represent an underutilized yet powerful policy leverage. If designed and implemented well, they can save young lives by temporarily removing guns from volatile homes.”
Conclusion: Toward a Safer Home Environment for Children
Firearm-related homicides among children and adolescents frequently occur where they should be safest — at home. Younger children are particularly at risk, with family members often the perpetrators. The rising incidence of these tragedies points to critical gaps in prevention, especially concerning domestic violence and child abuse.
Traditional safe storage laws, although necessary, do not sufficiently guarantee safety. Policymakers must consider laws that prioritize risk-based firearm removal, such as ERPOs, and reinforce provisions for domestic violence-related firearm relinquishment.
Protecting children requires a coordinated effort across healthcare, legal, social services, and community systems to recognize risks and intervene. By doing so, we honor the promise of a safe and nurturing home for every child.
—
References
1. Rook JM, Orji W, Walker SC, et al. Child and Adolescent Firearm-Related Homicide Occurring at Home. JAMA Surg. 2025 Sep 26:e253429. doi:10.1001/jamasurg.2025.3429.
2. Monuteaux MC, Lee LK, Fleegler EW. Predicting Pediatric Firearm Injuries: A Guide for Clinicians. Pediatrics. 2019;143(1):e20180952.
3. Swedo E, Alaniz RL, Walter HJ, et al. Extreme Risk Protection Orders and Gun Violence Prevention: A Review. JAMA. 2021;325(9):903–904.
4. Kagawa RM, Marshall SW, Beletsky L, et al. Firearm Injury Prevention Research: Scientific Gaps and Opportunities. Inj Prev. 2022;28(2):128-134.
—
