This is the companion post to the PEM Currents: The Pediatric Emergency Medicine Podcast episode that I recently produced with Libby Ireson, Pediatric Resident at Cincinnati Children’s. The goals of this episode are to:

  1. Report statistics of pediatric firearm-related injuries/deaths in the United States 
  2. Review the American Academy of Pediatrics’ recommendations on firearm safety 
  3. Discuss strategies for counseling your patients and families on firearm safety
  4. Talk about how we can support patients and families who are victim or survivors of gun violence 

A full transcript of the episode is below:

Resources

The American Academy of Pediatrics’ Gun Safety Campaign Toolkit

The Brady Center’s ASK Campaign

The Everytown for Gun Safety BeSMART Campaign

If you or anyone you know is considering suicide, please reach out for help. You can reach the National Suicide Prevention Hotline via phone at 1-800-273-6255 or by texting 741-741. 

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Transcript

In the United States, firearm-related injuries and deaths represent a major public health crisis. Each year, more than 39,000 people in the U.S. die as a result of gun violence, and tens of thousands more suffer non-fatal gun injuries. A child or adolescent is killed with a gun every 2 hours and 48 minutes in the U.S. – which means 83 children every day. In fact, fire-arm related injuries are a leading cause of child and adolescent deaths, second only to motor vehicles collisions. There are prominent racial disparities in gun violence. Firearm-related deaths are the leading cause of mortality among Black youth and Black youth are 10x more likely to die from gun-related homicides than White children. 

Of the 3,000 children and adolescents that die from firearm-related injuries in the U.S. each year, about 60% are from homicides, 35% from suicide, and the rest due to unintentional or unknown causes. 71% of people attempt suicide within an hour of deciding to do so. Using a gun for attempted suicide results in death 83% of the time. When examining means of attempting suicide, firearms account for the greatest proportion of suicide deaths. This is especially harrowing now, with the heightened mental health needs many of our patients and colleagues are experiencing in relation to the COVID-19 pandemic. 

There are approximately 5.4 million children living in U.S. homes with at least one loaded, unsecured firearm. Prior studies have shown that 75% of children ages 5-14 years old know where firearms are stored in the home and 22% reported handling a gun without their parents’ knowledge. Children as young 3 years old are strong enough to pull the trigger. In 2020, there were at least 269 unintentional shootings by children in the United States. 

Gun violence has a broad and lasting impact on individuals and entire communities. According to the American Public Health Association, gun violence costs the U.S. $280 billion annually. This high economic toll is due to work loss, medical/mental health care, criminal justice activities, and more.  

The American Academy of Pediatrics reports that the safest home for children and teens is one without guns. If there is a gun in the home, the AAP recommends the firearm is stored unloaded, locked up, and with the ammunition stored separately.  

As healthcare providers, we all share the responsibility of promoting child safety. Our everyday interactions with our patients represent important opportunities to discuss firearm safety and provide anticipatory guidance. So how can we do that? 

First, ask your co-workers and mentors if firearm safety screening is part of the clinical flow where you practice. If not, here are some tips to get started and some resources to share.  

You and your patients’ families share the same goal of keeping their children safe. This is such an important and unifying aspect of the patient-clinician relationship! Prior studies have shown that the majority of parents think it is appropriate for their pediatricians to talk about firearm safety. Here are some talking points you can use in any patient encounter to get the conversation started: 

  • I talk with all of my patients’ families about ways to keep their children safe. One important topic is firearm safety. Are there any firearms in your home? 
  • As a pediatrician I care deeply about keeping kids safe. I always ask my patients’ families if there are firearms in their home? 

The ASK campaign, which stands for Asking Saves Kids, emphasizes the importance of asking about the presence of firearms in several different settings – like when parents are dropping kids off for a playdate, when teens are taking a new babysitting job, or when young adults are moving in with roommates. You can normalize asking about the presence of firearms in all of these settings! The ASK campaign website, sponsored by the Brady Center, provides resources to help parents ask these questions. 

If there is a firearm in the home – an important follow-up question is: How is it stored? Encourage adults to store firearms unloaded, in a locked location, with the ammunition stored separately. Some examples include trigger locks, rifle safes, or standard lock boxes always with a separate lock box for ammo. Empathize with parents that their children are naturally very curious! Hiding the gun is never enough. Children may think the gun is a toy and even toddlers are strong enough to pull the trigger. In addition, adolescents who are considering suicide often act impulsively. If they know where and how to access a firearm, their suicide attempt is likely to be deadly. Regardless of how old the children in the home are, safe firearm storage can save lives!  

The Be SMART campaign is another excellent example of modeling firearm safety conversations. S stands for “secure all guns in your home and vehicles.” M stands for “model responsible behavior around guns.” A stands for “ask about the presence of unsecured guns in other homes.” R stands for “recognize the role of guns in suicide.” T stands for “tell your peers to be SMART.” Check out the references for this PEM Currents episode for links to the ASK and Be SMART campaign websites.  

You can use these techniques to talk about firearm safety in well child checks, subspeciality clinic visits, hospital admissions, the emergency department or anywhere you interact with kids and their families! 

Unfortunately, most health care providers will care for victims and survivors of gun violence. People impacted by gun violence can experience ongoing trauma, including a high risk of suicide. The mental health effects are long term and devastating. The trauma-response is different for everyone – especially at different ages and levels of development. We should ensure that our patients and their families receive early access to mental health support after firearm-related crises.  

Let’s review what we talked about today. 

  • In the United States a child or adolescent dies from firearm-related injuries every 2 hours and 48 minutes. Firearms are a major cause of suicide deaths. 
  • The AAP states that the safest home for children and adolescents is one without firearms. 
  • Talking to your patients and families about firearms may feel uncomfortable. You both want to keep their kids safe! 
  • Normalize asking about firearms in every patient encounter, and encourage your patients’ parents to ask when planning playdates, babysitting jobs, etc. 
  • Counsel families that firearms should be stored unloaded, in a secure, locked location, with the ammunition stored separately.  
  • Victims and survivors of gun violence – including your patients and their family members – are at high risk of experiencing long-standing mental health difficulties due to trauma. 

This is not always an easy topic to discuss. If you or anyone you know is considering suicide, please reach out for help. You can reach the National Suicide Prevention Hotline via phone at 1-800-273-6255 or by texting 741-741.  

Thanks for listening today! We hope you feel equipped to promote firearm safety with all of your patients! 

References

Campbell BT, Thaker S, Fallat ME, et al. A Multicenter Evaluation of a Firearm Safety Intervention in the Pediatric Outpatient Setting. J Pediatr Surg. 2020 Jan;55(1):140-145.

“Gun Violence is a Public Health Crisis.” The American Public Health Association.

“Youth Firearm Injury and Death.” The Farley Health Policy Center. 

Parikh K, Silver A, Patel SJ et al. Pediatric Firearm-Related Injuries in the United States. Hosp Pediatr. 2017 Jun;7(6):303-312.

Schaechter, Judy. “Guns in the Home.” HealthyChildren.org, The American Academy of Pediatrics.