The risk of death or injury by gunshot wound for children and adolescents in the United States is significantly higher than in any other developed nation in the world. As such, a clear understanding of the epidemiology and circumstances of gunshot injuries will give professionals the knowledge they need to intervene in the risk behaviors associated with firearm-related deaths and injuries. The authors examined 263 deaths that occurred by gunshot wound for individuals under 19 years of age during the study period in New York City. Of these deaths, 242 were homicides, 17 were suicides, and 4 were accidents. Homicides occurred 11 times more often for males than for females. Among the homicides, 96 percent were Black or Hispanic and 68 percent involved persons aged 17 or 18 years. Fifty-six percent of the homicides and 53 percent of the suicides presented with ethanol and/or illicit drugs. Of the suicides, 18 percent left a note while 35 percent expressed orally their intent to commit suicide. Seventy-seven percent of suicides occurred in the home, while half of the homicides occurred on the street. Aggressive and multidimensional approaches to the prevention of firearm-related injuries are of paramount importance to protecting this vulnerable segment of the population. Tables, references