States that weakened gun laws saw rise in pediatric mortality, study finds

(CNN) — Firearms have risen to become the leading cause of death among children and teens in the United States in recent years, but a new study joins a growing set of evidence that gun laws can make a difference.

A landmark Supreme Court case in 2010 – McDonald v. Chicago – ruled that the Second Amendment applies to local governments, leading to a flurry of new laws and a deeper divide in state policy around firearms, with some states tightening restrictions and others weakening gun-related laws.

Over the next 13 years, thousands more children died from firearm violence than earlier trends would have predicted – and all of the increase happened in groups of states that had more permissive gun laws, according to a study published Monday in JAMA Pediatrics.

Researchers grouped states into three categories based on firearm ownership and use policies – most permissive, permissive and strict – using a composite of policy scorecards from nonprofit advocacy groups: Brady, Everytown for Gun Safety and the Giffords Law Center.

They found significant increases in the number of children who died from guns in states with looser laws: more than 6,000 additional deaths in states with the most permissive laws between 2011 and 2023, and more than 1,400 additional deaths in states considered to have permissive laws.

Half of the states considered to have strict firearm laws – California, Maryland, New York, and Rhode Island – saw a decrease in pediatric firearm mortality in that time.

Overall, there was an increase in child deaths from firearm-related homicides and an even greater increase in child deaths from firearm-related suicides, the study found. But pediatric mortality from others causes – including other suicides – did not increase in this time.

Experts emphasize that many gun-related injuries and deaths are preventable, especially among children.

“In some ways, suicide can be more preventable than homicide, and a lot of that has to do with what children and youth have access to when they are having suicidal ideation,” said Dr. Lois Lee, chair of the American Academy of Pediatrics Council on Injury, Violence, and Poison Prevention. “Means matter,” said Lee, who has researched the topic but was not involved in the new study.

If more states had adopted stricter gun laws, many more children would be alive today, said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and an assistant professor at Harvard Medical School, who was the lead author of the new study.

“It’s not a pipe dream. The best-case scenario isn’t some fictitious place. The best-case scenario is just a bunch of states that we currently live in, or don’t,” he said.

The new research didn’t identify the specific types of gun policy that were the most harmful or most protective, but earlier research has suggested that background checks, secure storage laws and policies that otherwise prevent child access to guns are associated with lower pediatric firearm mortality.

Dr. Christopher Rees, a pediatric emergency physician at Children’s Healthcare of Atlanta and assistant professor at Emory University School of Medicine, was not involved in the new study but has researched the effects that policy can have on pediatric firearm mortality and cared for patients who have been directly affected.

“It’s not a political issue at the bedside,” he said. “We should approach this as a way of protecting children and keeping children out of the emergency department.”

In his own experience, he has noticed a difference between practicing in Massachusetts, a state which the new study considers to have strict firearm policy, and Georgia, which is considered to be among the most permissive.

“When I was a fellow in Boston at Boston Children’s Hospital, I saw zero firearm-related injuries or fatalities,” Rees said. “Since I have moved to Atlanta, I can’t count how many children I have taken care of who have been involved in firearm-related injuries.”

Firearms surpassed car accidents to become the leading cause of death among children and teens in the US in 2020, and Rees said that the philosophy behind seatbelts can serve as a guide of sorts for gun policy.

“We wear our seat belts all the time because you don’t know when you’re going to get in a car accident,” he said, and it can be difficult to predict with firearms, too. “So, in my mind, the way to avoid unpredictable events is to have smart, preventive pieces in place before those unpredictable moments may come up.”

In 2023, about 3,500 children and teens died in gun-related incidents, according to data from the US Centers for Disease Control and Prevention – accounting for nearly 1 in 5 deaths among those ages 1 to 18.

Research dollars to understand how to best prevent gun injuries and protect children has been lagging for years, and experts warn that recent cuts to federal health programs under the current Trump administration raise risks.

The new study came from unfunded research, Faust said, and relied on data from the CDC’s Injury and Violence Prevention Center – which was recently gutted by staff cuts.

“We do it because we care about it. But that’s not sustainable,” Faust said. “Our system really does function well based on a synergy between public resources and extramural research, and I’m really worried that the cuts to the CDC will make it harder for us to track this and every other epidemic.”

Last month, hundreds of leading national, state, and local medical, public health, and research organizations sent a letter urging federal lawmakers to fund federal firearm violence prevention research.

“Across this country, communities are suffering from preventable firearm-related injuries and deaths,” they wrote. “The freedom of individuals to own firearms can and should be balanced with protecting children and their families from serious harm, and ensuring the health, security, and well-being of all people.”