BackgroundThe United States has by far the highest rates of homicide perpetration among high-income countries. The perpetration of homicide by children is often newsworthy, but little is known about the incidence or the circumstances of child homicide perpetration.MethodsWe use data from the sixteen states reporting to the National Violent Death Reporting System (NVDRS) for all years 2005–2012. We read every violent death report that was classified a homicide with a child suspect (aged 0–14). To help ensure that we did not miss any homicide cases we also read those classified as an other-inflicted unintentional firearm injury death with a child shooter, to determine if they were actually homicides.ResultsThere were 154 child suspects, which corresponds to an average annual rate of 1.2 child perpetrators per million child population. We estimate for the United States as a whole, 74 children per year were homicide perpetrators. Nearly 90% were boys, 79% were aged 13–14, and another 13% were aged 11–12. We created five categories, which accounted for over 70% of events with sufficient information to determine what happened: (1) The caretaker, a juvenile, typically an older brother, is given the responsibility to care for an infant. The homicide usually occurs in a residence, and blunt force is used (no guns); (2) Killing an adult family member, typically a parent or grandparent. These cases usually occur in a residence, and the child uses either a gun or a knife; (3) Impulsive shooting during play, the child typically shoots a sibling or friend. Except for some notion of momentary anger, these cases look much like unintentional firearm fatalities; (4) Robbery, a group of youth are trying to steal money, usually from an adult; and (5) Group Assault, a group of youth are fighting, usually other youth.ConclusionsChild homicide perpetrators are typically boys who use guns, and the events can be classified into a small number of relevant categories. Such a categorization of events is useful for understanding the problem and determining solutions.