For decades, auto accidents have been the leading cause of death among children, but in 2020 guns were the No. 1 cause, researchers say.

Overall firearm-related deaths increased 13.5% between 2019 and 2020, but such fatalities for those 1 to 19 years old jumped nearly 30%, according to a research letter in New England Journal of Medicine.

Researchers analyzed data collected by the Centers for Disease Control and Prevention showing that there were a record 45,222 firearm-related deaths in the U.S. in 2020.

Patrick Carter, one of the authors of the research letter and co-director of the University of Michigan's Institute for Firearm Injury Prevention, said about 10% of those deaths — 4,357 in total — were children.

Studies have shown that firearm violence increased during the course of the COVID-19 pandemic. However, according to the research letter, the reason behind the increase in child deaths attributed to guns is unclear.

For decades prior to 2020, motor vehicle accidents were the leading cause of death among children. Carter tells NPR that the reason the two have swapped places is a "tale of two stories."

"Firearm deaths we haven't made much progress on, in fact it increased in recent years. And we have had a decrease in moto vehicle deaths," he said.

According to a separate study, motor vehicle crashes were the leading cause of child deaths for more than 60 years. But over time, cars have become safer and driver education has improved. The National Highway Traffic Safety Administration and others have pushed for better child safety in cars, taking a scientific approach to the problem, Carter said.

"We can do the same thing with firearms. We just haven't been able to do that in the same amount of years yet," he said. "It takes time to figure out what the underlying issues are with the problem and then finding the solutions."

The figures between adults and children and firearms are almost an inverted image of each other. For adults, 65% of gun related deaths are attributed to suicide, while 30% are homicides and about 2% come from accidental discharges, Carter said. For children, 65% of firearm deaths are homicides and 35% are categorized as suicide, he said.

And though mass shootings, which have drastically increased over the past 30 years, are clearly part of the problem, the vast majority of kids are killed by guns in smaller, day-to-day incidents.

"Most commonly what makes the news is these horrific mass shootings, but they are a small aspect of the overall problem," Carter said. "The smallest portion are the mass shootings. ... it's these daily deaths that are occurring making up the totality of what we are seeing."

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