•Eight patients (five previously undescribed) died due to aspiration of pepper. Seven deaths involved homicides, and one death was accidental in a child with documented pica. The pepper was administered by the mothers in three children and by a foster mother, the mother's boyfriend, an adult male friend, and the child's godfather in one case each. Homicidal pepper aspiration shares many of the features of more conventional child abuse: in each instance, the child was being punished, four of the seven assailants initially gave incorrect histories, and four children were chronically abused. The facts that each death occurred in a different state and that five of the seven homicides occurred within the two years preceding the preparation of this report suggest that this form of child abuse is not confined to any single part of the country and may be increasing in frequency.