At least two Little League lineups worth of children are shot in America every day. Three die, on average. Most are boys, and a disproportionate number are black.

These are the findings of a significant new study by the Centers for Disease Control and Prevention, a federal agency that has come under fierce criticism for largely abandoning gun-related research more than two decades ago. The authors of the study, which is slated to appear in the July issue of Pediatrics, estimate that an average of 1,297 children ages 0 to 17 die each year from a firearm injury. Another 5,790 children show up in a hospital emergency department to be treated for a firearm-related injury.

Gun homicides among children 17 or under have declined 36 percent since 2007, but gun suicides have increased 60 percent, the study found.

“These are preventable injuries that have a major public health impact on early death and disability among children,” wrote Katherine Fowler, the study’s lead author, in an email.

The CDC significantly scaled back its research into gun violence in the mid-1990s after Congress adopted an amendment broadly interpreted as blocking the agency from conducting research on firearm deaths and injuries into an appropriations bill. Today, less than $5 million is spent each year on gun research.

Fowler and one of her co-authors, Linda Dahlberg, work in the CDC’s violence-prevention division. They have done research on firearm injuries in the past.

For gun deaths, the researchers relied on the National Violent Death Reporting System (NVDRS), which draws on death certificates, medical examiner records, and law enforcement reports in 17 states. The study examined the years 2002 to 2014.

Boys account for eight of every 10 child firearm deaths, the study found. Older children are also overrepresented: the gun death rate among kids ages of 13-17 is a dozen times higher than the rate among those ages 12 and younger. As with adults, gun homicides among children are distributed unevenly by race: Between 2012 and 2014, black children were four times as likely to be shot and killed than Hispanic children, and 10 times as likely to die from a bullet wound than white children.

Gun suicide, however, is concentrated most heavily among white and American Indian children.

Boys and older children also accounted for the largest share of nonfatal firearm injuries treated in the emergency department (84 percent and 88 percent respectively). Nonfatal injury data was culled from the National Electronic Injury Surveillance System (NEISS), which uses a sample of hospitals with emergency departments to get nationwide estimates.

Children tend to die from gun homicide most often in Southern and Midwestern states, with Louisiana and the District of Columbia bearing the highest rates for firearm mortality overall.

The study determined that childhood firearm homicides decreased 36 percent between 2007 and 2014. Over the same period, gun suicides among children ages 10 and older jumped 60 percent.

The study sketches a picture of common circumstances for each type of death. Younger children were most often killed in a home, while teens were equally likely to be killed in a home or on the streets. The homicides of younger children were often correlated with intimate-partner violence or a bystander situation. Deaths of older children were often related to crime, drugs, or gang-related circumstances. In terms of unintentional gun deaths, both younger and older children commonly died while playing with a gun. Childhood suicides, on the other hand, “were most often precipitated by acute crises and life stressors such as relationship, school, and crime problems.”

The study’s authors propose several possible solutions to help mitigate child firearm injuries and deaths. To tackle suicide, they suggest programs that help kids manage emotions, screening for depression, and safe storage practices to reduce lethal means in a moment of crisis (many suicide attempts are made after deliberation lasting 10 minutes or less, according to previous research). Other strategies for reducing violence include street outreach, early childhood education, and poverty-reduction programs.

Among the paper’s limitations, the authors note that unintentional gun deaths may be “significantly underreported.” Last year, an AP/USA Today investigation tallied 113 fatal gun accidents among children in 2014, a third more than the CDC count for the same year.

“Understanding the nature, magnitude, and health impact of firearm violence against children is an important first step,” the study concludes. “Finding ways to prevent such injuries and ensure that all children have safe, stable, nurturing relationships and environments‍ remains one of our most important priorities.”

[Graphics: Pediatrics]