In a recently reported study, researchers found that child and adolescent all-cause mortality is rising at the sharpest rate in the past 50 years (Woolf et al., 2023). Using all-cause mortality data for 1999-2021 (Centers for Disease Control and Prevention [CDC], 2022a, 2022b) mortality rates in children aged 1 to 19 years increased by 10.7% from 1999 to 2020 and an additional 8.3% between 2020 and 2021 (Woolf et al., 2023). What is most alarming is that these increases in mortality followed decades of progress in reducing pediatric mortality, mostly due to public health campaigns focused on vehicle safety restraints, bicycle safety, and home fire prevention as well as pediatric advances in the prevention and treatment of lethal illness.

The most common cause of pediatric mortality during this period was not Covid-19, but rather injury. In children aged 1 to 9 years, injury accounted for 63.7% of all deaths (CDC, 2022b). The increase in pediatric injury deaths began in 2007 with an increase in suicide and homicide increasing significantly between 2019 and the onset of Covid-19 with death due to suicide increasing by 69.5% and deaths by homicide increasing by 32.7% (CDC, 2022a). Researchers attributed this increase to factors such as an increased access to firearms and opioids as well as a growing mental health crisis among children and teens, which the Covid-19 pandemic likely exacerbated (Woolf et al., 2023). Transportation and fire-related deaths also increased during this period by 15.6% and 45.9% (CDC, 2022b).

Deaths related to injury were more common among males and differed across race and ethnicity with Black and Hispanic youth aged 1 to 19 years more likely affected, accounting for 47.8% of the increase in all-cause mortality in 2020 (CDC, 2022b). Gun violence is now the leading cause of death in youth ages 0 to 24 years (Lee et al., 2022). The number of children and teens killed by gun violence in the United States increased by 50% between 2019 and 2020 and it seems that hardly a week goes by where we do not hear of another mass shooting involving our youth. According to the Pew Research Center, half of parents in the United States are concerned that their child may be shot, with parents from more urban and low-income areas most concerned (Gramlich, 2023).

The American Academy of Pediatrics (Lee et al., 2022), the American Nurses Association (ANA, 2022), and the American Academy of Nursing (AAN, 2023) have issued policy statements on firearm-related deaths and injuries calling for gun control legislation and more research into prevention, and the relationship between gun violence and systemic racism. Specifically, ANA and the AAN have called for Congress to pass legislation on background checks as a prerequisite to purchasing a gun and to authorize $50 million in funding for gun violence research. Through this legislation, pediatric nurses should feel empowered to conduct screenings, initiate patient counseling, and make referrals to mental health services for individuals exhibiting potentially dangerous behaviors. Parents view nurses as trusted clinicians and advocates; thus, they may be open to their advice about gun safety. Although gun violence is currently the number one killer of children and teens, pediatric nurses need to remain attentive to the need of injury prevention in general.

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