Handguns represent the major contributor to firearm injuries affecting children and adolescents. At least half of all fatal and hospitalized nonfatal pediatric firearm injuries are caused by handguns. Of the roughly 500 unintentional firearm injury deaths each year, most of which affect boys younger than 15 years of age, most involve handguns found in the home of victims, relatives, or friends. The majority of firearm homicides and suicide involve handguns, and media accounts have identified semiautomatic handguns as the weapons used in recent firearm homicides involving children and adolescents. Statistics and other research indicate that about half of homes in the United States contain firearms, that no handgun safety regulations exist for consumers, that social factors foster dangerous gun use patterns by children and adolescents, that developmental vulnerabilities of children and adolescents contribute to injury patterns, and that firearm safety programs directed at children are being promoted by some localities. Because firearm injuries to children are particularly devastating not only to children but also to families and society, pediatricians and other child health care providers should provide effective leadership in efforts to stem the national firearm injury epidemic. Specific recommendations developed by the American Academy of Pediatrics are offered to minimize the risk of firearm injuries to children and adolescents. 20 references and 2 tables