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Gun injuries are now the leading cause of death in children. This arises from increased access to guns across the U.S. More firearm injuries are presenting to emergency departments and non-trauma centers. We identified 52,414 children with firearm injuries, including 19,583 extremities. Most were treated with antibiotics, bedside I&D, and non-operative stabilization for simple wounds of <1 cm without contamination and stable fracture patterns. More complex injuries with larger soft tissue defects usually caused by high-velocity weapons with contamination, bone loss, operative fracture patterns, intraarticular projectiles, vascular injuries, compartment syndromes, and nerve injuries warrant further treatment in the operating room and IV antibiotics. Only 28% of nerve injuries regained function. Loss to follow-up was high (43%). Growth arrest and lead toxicity are long-term sequelae that must be monitored, especially given the decrease in acceptable blood lead levels to <3.5 mg/dL by the CDC in 2020. Evaluation of the child’s environment and access to guns and education is important for preventing future injuries on an individual level, however, research and legislation are needed to decrease this epidemic of gun violence injuring and killing children today.