Each year in the United States, approximately 3,000 children and adolescents younger than age 20 die as a result of homicides, suicides, and unintentional injuries from firearms. The young children, relatives, neighbors, and friends of the 30,000 adults killed by firearms each year in the United States are also affected by this problem, which is unique to the United States. It is estimated that half of all homes in the United States contain 200 million firearms, including 60 million handguns. The advocacy goal for pediatricians should be to reduce the accessibility of guns in the environments of children and adolescents. Each of 17 possible strategies for achieving this goal has advantages and disadvantages. These approaches include the enforcement of existing laws, regulation under current legislation, owner liability for child and adolescent use of handguns, education about handguns, sales taxes, firearm registration and licensure, background checks, ammunition modification, gun modification, bans on assault weapons, banning the possession of handguns in locations where children live and visit, and banning handguns. Although no approach is perfect, many of the available approaches will help and should be used. Chart and 31 references