Majority of kids who die in mass shootings killed by family members, Stanford Medicine-led study shows

When U.S. children die in mass shootings, most of the time the perpetrator is a family member, new Stanford Medicine-led research shows.

The findings, which will be published online Feb. 10 in JAMA Pediatrics, come from the first analysis of the relationships between mass shooting perpetrators and pediatric victims, those who are younger than 18 years old.

“It was surprising that domestic violence was so pervasive, that 59% of kids who died in mass shootings were at the hands of a family member,” said the study’s senior author, Stephanie Chao, MD, associate professor of surgery. The lead author is Pamela Emengo, MD, a research fellow in pediatric surgery.

In 2020, gun violence surpassed car accidents as the No. 1 killer of children in the United States, underscoring the need to protect kids from firearm injuries, Chao said. Yet most of the public does not understand where the threat comes from, especially with regard to mass shootings.

“When American parents are surveyed about their concerns, everyone is worried about school shootings,” she said. “The message from our data is really simple: Our fears are incorrectly placed. Our homes may, in fact, be more dangerous than schools.”

Understanding gun deaths

Chao’s team used a strict definition of mass shootings in their analysis, studying incidents that resulted in at least four fatalities, excluding the perpetrator. The researchers examined 121 such mass shootings, all of which took place in the United States between Jan. 27, 2009, and Dec. 25, 2020, and included at least one fatality in a victim under 18 years of age. These incidents caused a total of 308 pediatric deaths. The races and ethnicities of the victims were similar to the racial and ethnic profile of the U.S. population as a whole.

More than 40% of pediatric mass shooting victims were killed by a parent, the analysis found, and 59% of them died at the hands of a relative, including parents, aunts and uncles, siblings, grandparents, and cousins.

After relatives, the most common categories of relationship between shooter and victim were acquaintance (14.6%), stranger (12%), classmate (6.8%), neighbor (2.6%) and criminal associate (0.6%). In about 4% of pediatric deaths, the research team could not determine the relationship between the victim and shooter.

Chao hopes the new findings will be used to increase awareness about the most prominent sources of gun violence.

“People tend to think that gun violence occurs mostly at random events that they cannot protect their child against,” she said, adding that this perception is heightened by media’s focus on rare shootings at schools, concerts and public events. “Domestic violence doesn’t make headlines because it happens with more frequency. But that is precisely why it is more dangerous, because of the frequency. Over 22 million U.S. children live in a home with a gun. If a domestic disturbance arises in those homes, the risk of death dramatically increases.”

The data points to tactics for how to reduce pediatric gun deaths. For example, Chao said, there may be opportunities to prevent incidents of domestic violence by removing firearms from homes where relationships between adults are deteriorating or mental health concerns are rising.

“We need research and policies that approach gun violence as a public health problem, so we can best understand how to prevent it and treat it,” Chao said.

In addition to their research on the epidemiology of firearm violence, Chao’s team is developing a curriculum to educate children in K-12 schools about firearm injuries, called PLEDGE.

A researcher from the Eastern Virginia Medical School contributed to the study. The research was funded by the National Center for Advancing Translational Sciences (grant KL2TR003143).