A new study shows that the number of American children to die from self-inflicted gunshot wounds grew sharply in 2014 compared to seven years earlier with medical experts saying safe firearm storage could reduce deaths.
Among American children and teens aged 17 or younger, 1.6 per 100,000 killed themselves with guns in 2014, compared with 1.0 per 100,000 in 2007.
An average of 493 children died of gun-related suicides each year covered by the study, which was led by Katherine Fowler and Linda Dahlberg of the US Centers for Disease Control and Prevention and published in the online journal Pediatrics.
"Suicides are often impulsive in this age group, with previous findings indicating that many who attempt suicide spend 10 minutes or less deliberating," the research paper said.
All told, nearly 1300 children in the US aged 17 or younger died of gunshot wounds each year, with boys accounting for the vast majority of the victims, according to the study.
For decades, gunshot wounds have ranked second behind car crashes as the leading cause of death from injuries for US children. But while car travel has become safer, gun fatalities have remained high in that age group, paediatric experts say.
"Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children," the study said.
"Understanding their nature and impact is a first step toward prevention."
The rise in fatal gunshot wounds runs counter to a decline in the overall death rate among American children over the last several decades, as well as a decrease in the number of children who were homicide victims.
African-American boys are the most likely of any demographic group to be shot and killed by someone else, while white and Native American children are four times more likely to kill themselves by firearms than black and Hispanic children, the study found.
The study is the most comprehensive analysis of firearm deaths and injuries among American children ever conducted, according to two paediatric experts who were not involved in it.
"We take care of these kids, as paediatricians it's not abstract," Dr Robert Sege, chief medical officer of the Massachusetts-based research group Health Resources in Action, said.
Firearm deaths among children have remained roughly constant, with the higher suicide rate cancelling out progress in lowering homicides with guns, Dr Sege said.
The American Academy of Pediatrics has said the safest households are those with no firearms.
But parents often are not open to hearing that message from a doctor, given the widespread acceptance of gun ownership in the US, writes Dr Eliot Nelson, a University of Vermont College of Medicine professor who did not participate in the latest research.
Doctors should focus on sharing information about safe storage of firearms, he wrote in a separate paper in Pediatrics.
"Given the impulsivity, risk-taking and unpredictability of adolescence, we should promote safe storage as a routine measure rather than only when a concern or crisis arises," he said.