TORONTO -- Firearms injure a child or youth almost every day in Ontario, say researchers, who analyzed hospital records to determine which groups of young people are most at risk for gun-related accidents or violent assault.

Their study, published Monday in the Canadian Medical Association Journal, found there were 355 firearm injuries on average each year among children and youth, with about 23 to 25 -- or seven per cent -- resulting in death.

"Three-quarters are unintentional, so these are accidents that happen, and about 25 per cent are intentional or assault," said senior author Dr. Astrid Guttmann, a pediatrician at Toronto's Hospital for Sick Children.

When the researchers looked at provincial hospital emergency room records for gun-related injuries, they found Canadian-born youth, particularly males, had the highest rates of unintentional firearm injury -- 12 per 100,000 people versus about seven per 100,000 for immigrant males.

But when it came to firearm injuries due to assault, immigrants and refugees were at much higher risk than their non-immigrant counterparts.

Refugee children and youth were 1.4 times more likely to be shot than Canadian-born residents of the same age, while immigrant children and youth from Africa were almost three times as likely and those from Central America almost four times as likely to be a victim of a firearm assault, the study found.

Males in all three groups were at highest risk of suffering a gunshot injury, said Guttmann, chief science officer at the Institute for Clinical Evaluative Sciences, which collected the data.

"When we looked at unintentional injuries, children who live in rural areas are more likely to suffer one of these injuries," she said. "And when we looked at immigrant versus long-term residents -- the majority of whom would be Canadian-born -- immigrants are much less likely to be injured in accidental shootings.

"We know from other (research) literature that children who live in homes where there are guns are more likely to have an accident with a gun, and we certainly know there are more guns in households in rural areas."

In contrast, firearm injuries due to violent assault tended to be clustered in low-income neighbourhoods in urban centres, where immigrant and refugee children and youth often live when they arrive in Canada, Guttmann said.

The study, which examined health records for millions of Ontario children, teens and young adults between 2008 and 2012, found immigrants from Africa and Central America accounted for almost 70 per cent of assault-related gun injuries.

The researchers did not include suicides in their analysis.

Dr. Natasha Saunders, a pediatrician at Sick Kids and the study's lead author, said there has been little Canadian research on children harmed by firearms, and most of that has focused on those who have died.

"Death is clearly a devastating outcome, but near-misses are also a devastatingly significant issue," said Saunders, noting the study looks at both gun deaths and injuries, which in some cases can lead to severe disabilities.

"It is our hope that understanding the numbers will contribute to efforts that are already being made to reduce the number of victims of both unintentional firearm injuries in Canadian-born children and youth, as well as firearm assault in subgroups of immigrant children and youth."

The Canadian Paediatric Society (CPS), which on Monday issued updated recommendations for preventing firearm injuries among young people, says 635 children and youth under age 24 died between 2008 and 2012 from accidental and intentional gunshots, including those that were self-inflicted. Ninety-four per cent of victims were male.

Among 15- to 19-year-olds, more than half were suicides, while among 20- to 24-year-old, about the same proportion were homicides. For children under age 15, there were 15 suicides, 10 homicides, seven unintentional deaths and two whose cause was undetermined.

Dr. Katherine Austin, who co-wrote the CPS document, said she was pleased to see the Toronto researchers went beyond firearm mortality statistics and looked at data on injuries.

Over the five-year period, Ontario hospitals treated almost 1,600 young people for gunshot wounds.

"That's a lot," said Austin. "Can you imagine any other consumer product that caused one serious injury a day over a period of five years?"

The CPS position paper says doctors and other health practitioners can play a critical role in preventing firearm injuries and deaths by warning parents about the risks of guns being accessible to youth.

"Every family, rural and urban, should be screened for gun ownership," the document states. "Parents who decide to keep a gun in the home should be counselled to store firearms unloaded, with a trigger lock or in a locked container, and separate from ammunition."

The CPS also urged all levels of government to bring in stricter gun controls.

To reduce the availability of firearms to youth, the organization is calling for several measures, including strategies to curtail illegal importation of firearms into Canada, especially from the U.S., and tighter restrictions on semi-automatic firearms.

Austin said there is a pervasive belief that Canada doesn't have a problem with firearms, primarily because the level of gun deaths in the United States is so "spectacular" in comparison.

"It's like being shorter than (NBA star) Wilt Chamberlain," she said of measuring Canada's firearm death rate against that of its southern neighbour.

But take the U.S. out of the equation, and Canada ranks fourth highest out of 22 industrialized countries (after Finland, Austria and France), said Austin, citing a 2010 study.