Statement of Purpose Firearm injuries and fatalities among children in the United States are occurring much too often. This study epidemiologically describes unintentional firearm fatalities nationally, where both the perpetrator and victim are children, aged 0–14 years.

Methods/Approach Ten years of pediatric data from the National Violent Death Reporting System (2009–2018) were extracted. Child fatalities attributed to firearms were reviewed by the study team to identify unintentional fatalities, characteristics of the victim and perpetrator, relationships between the victim and perpetrator, firearm ownership, and circumstances of the deaths, including type of gun involved.

Results The study team identified 279 cases of unintentional firearm fatalities during the study period. 40.9% of victims were 2–4 years old, and 81.4% were male. The majority of cases occurred at the victim’s residence (63.7%), and in most fatalities, the firearm owner was a family member (80.9%). Most perpetrators were male (93.0%), often the victim’s brother, constituting 48.4% among the other-inflicted cases. In 69.9% of all cases, the child was playing with the gun or mistook the gun for a toy when the gun was discharged. In the 0–4 year age group, 80.3% of the cases were self-inflicted, and in the 10–14 year age group, 32.3% of the perpetrators were friends of the victim.

Conclusions Children are shooting themselves and each other in their own homes, and they are often accessing guns from their own family members. Both victims and perpetrators are disproportionately male. Children are frequently playing with the firearm when it discharges.

Significance These findings describe the characteristics and circumstances surrounding unintentional pediatric firearm fatalities. This information can be used to guide prevention efforts, such as child access prevention laws and educating parents on safe gun storage, to minimize the number of pediatric firearm fatalities in the future.