Car crashes used to be the top cause of death for children. Now, it's drugs and guns.

The number of children who die as a result of guns and drugs has skyrocketed in the past decade, prompting researchers to call for a focus on preventing easy access to those hazards and better access to mental health services.

Researchers from Boston Children’s Hospital looked at fatal and nonfatal injuries among people 18 and younger from 2011 to 2021 and found that while the rate of nonfatal injuries had decreased, the rate of fatal ones had increased.

The increase in fatal injuries was driven by children and teens dying from gun injuries and drugs. The rate of deaths from guns increased by 87%, and drug-related deaths rose by 133%, according to the paper published Thursday in Pediatrics, the journal of the American Academy of Pediatrics.

Health experts say the stark contrast of fewer nonfatal and far more fatal injuries among kids and teens highlights the success of public health strategies that addressed sources of injuries such as car crashes but not more lethal ones such as guns and drugs.

Public health and legislative strategies focused on mental health and access can help reduce fatal outcomes, said study author Dr. Rebekah Mannix, senior associate in pediatrics at Boston Children’s division of emergency medicine.

“We took the less deadly mechanism off the table but left the deadly mechanisms out there,” she said. “As a result, we’re seeing a significant rise in fatalities."

Mannix and her colleagues say it's clear the nation is not doing enough to prevent gun and drug deaths.

Mental health crisis as backdrop

The new research builds upon growing evidence that children today are less likely to reach adulthood in part because of a mental health crisis that predated but was exacerbated by the COVID-19 pandemic.

Interestingly, the study found that pediatric injury deaths sharply increased during pandemic years, from 2020 to 2021. And while nonfatal injuries declined overall, injuries resulting from self-harm increased by 57% over the past decade.

Dr. Kait Brown, clinical managing director for America’s Poison Centers, said she has seen a similar trend in calls to poison centers.

“Overall, we’re not seeing too much change in the cases reported. But when we zoom in, we see that increase in fatal overdoses,” she said. “For that that older age group, the fatal calls are likely related to self-harming behavior.”

School avoidance: Students are increasingly refusing to go to school. It’s becoming a mental health crisis.

A growing number of calls are related to prescription and illicit opioids, but Brown said many calls involve teens trying to overdose on medications commonly found in most households, such as ibuprofen, acetaminophen and antidepressants, among others.

Experts say earlier research also suggests mental health concerns may play a big part in gun deaths among children. A report from the Pew Research Center found the number and rate of children and teens killed by gunfire in 2021 was higher than at any point since data was first collected in 1999. Homicides accounted for 60% and suicides for 32% of gun deaths in 2021, while only 5% were attributed to accidents.

“When you’re suicidal and depressed, as a kid, and impulsive – and you have access and you grab those lethal means – you have no opportunity to regret that attempt because that one attempt is fatal,” Mannix said.

Access and safe storage

In addition to a growing mental health crisis, health experts say, easy access to guns and drugs may play a role in the rising rate of child mortality.

Evidence suggests having a firearm in the home increases the risk of suicide among adolescents, according to the American Academy of Pediatrics.

While data shows the share of American households with least one gun has remained relatively steady since the 1970s, a 2018 survey published in the American Journal of Public Health found that more than half of U.S. gun owners didn’t safely store all their guns.

Safe storage can apply to drugs, too. Although safety caps have been successful in preventing children from accessing bottled medications, Brown says, no such public health strategy has been widely adopted to keep them out of the reach of older children and teens.

She recommends that parents keep small quantities of over-the-counter drugs rather than buy in bulk at warehouse stores. She also noted it's important to safely dispose of all unused medications.

And as the opioid epidemic rages on, she urges adults to keep nalaxone in the home, which makes it possible to reverse an opioid overdose. The medication is available as an injection or over-the-counter nasal spray called Narcan.

Community solutions

Community-based organizations in some areas that have experienced this dramatic increase in tragedies are taking steps to prevent fatal and nonfatal injuries in kids.

In Louisiana, which has the second-highest rate of child mortality in the country, a community-based student wellness program has partnered with New Orleans Public Schools to provide medical, mental and behavioral services to children on campuses. ThriveKids Student Wellness Project at Children’s Hospital New Orleans also helps families connect and navigate medical care at the hospital.

“We watched kids roll in with gunshot wounds weekly,” said ThriveKids director Chelsea Moore. “We’re trying to be proactive instead of reactive and trying to treat the trauma that’s happening in our area.”

The program also helps coordinate families with medical care. Meanwhile, another Children’s Hospital New Orleans program distributes gun locks to promote responsible gun ownership. The hospital has given away more than 700 locks since April and plans to dispense more during several events in the next few weeks.

“No one wants kids to be hurt,” Mannix said. “After we get through that sentence and agree that’s universal, the next step is the hardest: Now, what do we do about it?”

If you or someone you know is experiencing a mental health crisis, call the 988 Suicide and Crisis Lifeline which provides confidential 24/7 support by dialing 988, or visit 988lifeline.org. Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.

To speak with a poison expert, parents can call Poison Help at 1.800.222.1222 or visit PoisonHelp.org for support and resources.

Follow Adrianna Rodriguez on X, formerly Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Childhood mortality spike driven by guns, drugs