Firearms are now the number one cause of death for children in the United States, but rank no higher than fifth in 11 other large and wealthy countries, a new KFF analysis finds.

Guns – including accidental deaths, suicides, and homicides – killed 4,357 children (ages 1-19 years old) in the United States in 2020, or roughly 5.6 per 100,000 children.

In each of the peer countries, guns kill fewer children than motor vehicles, cancer, congenital diseases, and other injuries, and often behind other conditions such as heart disease.

The U.S. is the only country among its peers that has seen a substantial increase in the rate of child firearm deaths in the last two decades (42%). All comparably large and wealthy countries have seen child firearm deaths fall since 2000. These peer nations had an average child firearm death rate of 0.5 per 100,000 children in the year 2000, falling 56% to 0.3 per 100,000 children in 2019.