America’s kids are safer now than a decade ago when it comes to many types of injury, with two glaring exceptions: drugs and guns.

That’s the crux of a new study that looked at injury trends among U.S. children and teenagers between 2011 and 2021.

It found that nonfatal injuries from accidents and assaults fell by 55% and 60%, respectively, during that time period. That included substantial drops in injury due to car crashes, falls and other accidents that have long been leading causes of injury among kids.

Countering those gains, though, was the harsh reality of guns and drugs.

Firearm fatalities among children and teens rose by 87% during the study period, while nonfatal gun injuries more than doubled. Meanwhile, deadly drug overdoses also doubled.

“As a society, we’ve done a great job at targeted interventions,” said senior researcher Dr. Rebekah Mannix, of Boston Children’s Hospital.

Everything from better car and roadway design, to helmets, to childproof household products have made kids safer in many ways, Mannix said.

“But what we’ve missed,” she added, “is that the most lethal means of injury are still incredibly accessible to kids.”

The findings, published Oct. 5 in the journal Pediatrics, come at a time when a record number of U.S. kids, mainly older teenagers, are dying from gun-related injuries.

In 2020, firearms became the leading cause of death among Americans ages 1 to 19 — surpassing motor vehicle accidents for the first time. The pattern continued into 2021, when guns claimed a record 4,752 young lives, according to another recent study in Pediatrics.

Almost two-thirds of those deaths were homicides, while about 30% were suicides, researchers found.

The latest study puts things in a broader perspective, Mannix said, looking at recent trends in all kinds of pediatric injuries, fatal and nonfatal.

In many ways, her team found, kids are safer now. During the study period, motor vehicle occupant injuries fell by 47%; fall-related injuries declined by 53%; and injuries related to overexertion dropped by 67%. There was also a 63% decrease in “struck by or against” injuries, which can happen during sports, for example.

“Overall, kids are being injured less often,” Mannix said.

Unfortunately, her team found, fatal injuries rose during the study period: from a rate of 14 per 100,000 U.S. kids in 2011, to just over 17 per 100,000 by 2021. That was fueled mainly by the rise in fatal injuries from guns and drug “poisonings” (which include overdoses).

And while nonfatal injuries mostly declined over time, there were a couple notable exceptions: gun injuries and self-harm injuries by any means. The latter rose by 57% in the past decade.

Mannix said it all paints a worrisome picture: A growing number of kids in mental health crisis, too often with access to lethal means of harming themselves.

The fact that firearms are now the leading cause of death among U.S. kids reflects two different stories, according to Dr. Patrick Carter, co-director of University of Michigan’s Institute for Firearm Injury Prevention.

“It’s a failure to address firearms on one hand, and a success story in reducing motor vehicle injuries,” said Carter, who was not involved in the new study.

He noted that it took many years, and changes on multiple levels, to make roads safer for kids — from seat belt and car seat laws, to improvements in vehicle technology and road design, to addressing drunk driving.

And initially, Carter added, there was resistance to those measures.

There needs to be the same kind of multi-prong “push” when it comes to firearms, he said. That could mean changes in laws and improved technology that makes firearms themselves safer, Carter said.

For parents who have a firearm in the home, he said, keeping it locked and inaccessible to kids is a basic safety measure.

But when a child is having mental health issues that raise the risk of self-harm, Carter said parents should go a step further and temporarily remove the gun from the home. He noted that gun shops sometimes offer storage, or parents can legally transfer the firearm to a family member for a time.

To Mannix, the reductions in other types of pediatric injuries show what is possible.

“We’ve taken on hard things before,” she said. “We’ve made the world safer. What went on in the 1970s and 1980s worked.”

More information

The American Academy of Pediatrics has advice for parents on gun safety.

SOURCES: Rebekah Mannix, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, associate professor, pediatrics and emergency medicine, Harvard Medical School, Boston; Patrick Carter, MD, co-director, Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor; Pediatrics, Oct. 5, 2023, online