The United States has the highest rate of firearm-related deaths among industrialized countries. The overall rate of firearm-related deaths for American children younger than 15 years old is nearly 12 times greater than that for 25 other industrialized countries. The difference in these rates is apparently related largely to the ease of availability of guns in the United States compared with other industrialized countries. In 1997, 306 children and adolescents younger than 20 years old who were killed by firearms died as a result of unintentional firearm-related injuries. Twenty-four percent of firearm-related deaths in children younger than 5 years old were attributable to unintentional shootings. Because firearm-related injury to children is associated with death and severe morbidity and is a significant public health problem, child health care professionals should provide effective leadership in efforts to stem this epidemic. The American Academy of Pediatrics (AAP) affirms that the most effective measure to prevent firearm-related injuries to children and adolescents is the absence of guns from homes and communities. Firearm regulation, including bans on handguns and assault weapons, is the most effective way to reduce firearm-related injuries. Pediatricians and other child health care professionals should inform parents about the dangers of guns in and outside the home. Questions about guns should be incorporated in information on patient history, and parents who possess guns should be urged to remove them from the home. Further, the AAP urges that guns be subject to safety and design regulations, just as are other consumer products. 72 references