Background Violence and firearms are common features of South African society: the leading cause of death being those resulting from violence and homicide, with firearms being ranked as a leading external cause of non-natural deaths. The Red Cross Children Hospital is the only hospital in Africa with a dedicated trauma unit for children and has been dealing with gunshot wounds since 1991.

Methods A retrospective review of firearms injuries which presented to the Red Cross Children’s Hospital between 1991 and 2011 was performed. Data recorded included the folder numbers; sex; date of birth; age; date of presentation; date discharged and in-patient stay; firearm type; number of shots; circumstances; injury sites; injury type, treatment; resulting morbidities and survival.

Results 441 children presented with firearm injuries during the review period. The results showed a steady decrease in incidence from 2001–2011. There was a greater incidence amongst older children and males. Contrary to studies in adults, the majority of children were shot unintentionally, as innocent bystanders and in crossfire. During the first decade (1991–2000) there was a gradual increase in incidence of children suffering from firearms injuries with time, peaking in the year 2000, while the number of gunshots gradually declined during the second decade (2001–2010). The study showed a decline in total firearm injuries in children since 2001, coinciding with the legislation introduced in 2004 and the changes in government opinion since 2000. Mortality also reduced significantly from the previous study (6% to 2.6%), as did the total number of in-patient days (1063 to 635).

Conclusions This study showed a significant reduction in the number of children presenting with a firearm-related injury after the implementation of the New Firearm Bill. Mortality rate and in-patient stay were also significantly reduced. This study shows the impact that the Firearms Control Act has had in terms of paediatric firearm-related injury and provides clear evidence of the important role civil society mobilisation can play in the prevention of fire-arm related injuries in children.