BACKGROUND: Pediatric firearm-related injuries are now the leading cause of death among children in the US. We sought to characterize the experience of a large, free-standing children's hospital treating children with firearm injuries. STUDY DESIGN: We reviewed all 2012 to 2022 gunshot wound encounters using the institutional trauma database of an urban level 1 pediatric trauma center in Texas. Patient demographics, incident characteristics, and clinical outcomes were analyzed. Statistical analysis was performed using ANOVA and chi-square tests to evaluate the influence of socioeconomic factors. Injuries from recreational firearms like BB and pellet guns were excluded from this analysis. RESULTS: Two hundred eleven pediatric patients were treated for gunshot wounds during the study period. There was an upward trend in the number of injuries per year, ranging from 6 in 2012 to 39 in 2021. The average patient age was 10.2 years. Violent injuries accounted for 51.7%, whereas accidental injuries led to 44.1%, and self-inflicted injuries made up 4.3%. Based on the Child Opportunity Index, 63.0% of patients lived in neighborhoods in the lowest opportunity quartile, whereas only 2.8% of patients lived in neighborhoods in the highest opportunity quartile. As defined by an Injury Severity Score of greater than 15, 22.7% of patients sustained injuries characterized as "major trauma," and 8.5% of patients died. CONCLUSIONS: Firearms pose a substantial risk to children in the US. There has been an increasing trend in pediatric firearm injuries during the last decade. The majority of children treated for firearm injury at our institution sustained injuries in the setting of gun violence. Injury prevention efforts should be aimed at decreasing intentional pediatric firearm injuries.