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Evidence-Based Strategies for Common Clinical Questions

January 2019

What’s an Effective Way to Talk to Families about Guns?

Primary Author: Kristin Streiler, MD | Chief Resident, Children’s Mercy Kansas City

Column Editor: Rupal Gupta, MD | Medical Director, Operation Breakthrough Clinic | General Academic Pediatrics | Assistant Professor, UMKC School of Medicine

About half of all homes in America contain a firearm. This fact means it is highly likely that your patients will be in an environment with a firearm at some point during childhood.1 According to the World Health Organization, the United States has the highest rate of firearm-related deaths among high-income countries.2 The Centers for Disease Control has stated that firearm-related deaths—from homicide, suicide or unintentional injury—remain one of the top three causes of death for American children.3,4 Of the approximately 2,500 deaths attributed to firearms annually among people younger than 20 years, about half are homicides, one-third are suicides, and the remaining minority are from unintentional injury.5 Deaths by firearm pervade local and national media. In November, the National Rifle Association tweeted that doctors ought to “stay in their lane” (and thus, not question families) about guns in the home. Doctors across the country—many of them pediatricians—responded by sharing gruesome accounts of gun violence they had personally encountered in their practice.6

Recognizing the myriad detrimental effects firearms can have on children’s health, the American Academy of Pediatrics consistently advocates for reducing and preventing gun violence. In addition to supporting stronger gun laws, violence prevention programs and firearms research, the AAP believes that pediatricians play a “crucial role in providing anticipatory guidance to patients about health hazards of firearms.”7 The AAP’s 2012 policy statement about firearm-related injuries includes a firm stance that the “absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.”8

How can you advocate for children’s health and safety regarding firearms? First, recognize that most parents are receptive to discussing guns with pediatricians and agree that it is within the pediatrician’s purview to counsel about gun safety.9,10 Unfortunately, firearm injuries are often fatal, and second chances are rare, so primary prevention of firearm injuries is paramount. Consider including firearm safety in your universal anticipatory guidance about injury prevention for all children.

According to Denise Dowd, MD, MPH, a pediatric emergency medicine physician at Children’s Mercy, tailoring your message based on the child’s development is key. It is important to recognize that regardless of age, it is nearly impossible to reliably educate a child not to touch a firearm if they encounter one—thus, protecting children is the adult’s responsibility. In general, young children are curious; older children (including adolescents) are impulsive.1 The importance of preventing injuries through storing guns safely—unloaded, locked and away from ammunition that is also locked—cannot be overstated. This guidance could be incorporated readily into anticipatory guidance.11

Pediatricians may be more comfortable providing education that focuses on child safety and injury prevention rather than on controversial topics such as gun ownership. Thus, consider providing a metaphor about the importance of a multi-layered approach to firearm safety. When discussing water safety, physicians typically include teaching children to swim, building a fence around a pool, or only visiting pools with an adult present. Likewise, clinicians can stress how parents should teach children not to touch guns, store guns safely, or to not have guns in the home at all.1  While parents themselves may not own guns, it is highly likely their child will visit a home with a gun. Providing parents with a script about how to inquire about guns in a playmate’s home, and considering an alternate location for children to play if there are guns in that home, may also help decrease the likelihood of childhood firearm injury.

Thoughtfully considering your approach to firearm injury prevention using these tips may prevent the death or disability of one of your patients. Incorporating a discussion about firearm injury prevention as part of your routine anticipatory guidance for families is a crucial way pediatricians can powerfully advocate for the health of every child they encounter.

 

References:

  1. Firearm Injury Prevention: The Role of the Clinician. Dowd D. Pediatric Annals 2017;46(4):e127-130.

  2. Homicide, Suicide, and Unintentional Firearm Fatality: Comparing the United States with Other High-income Countries, 2003. Richardson E and Hemenway D. J Trauma. 2011; 70:238-243.

  3. Deaths: Final Data for 2014. Kochanek D et al. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Vital Statistics Reports 2016; 65(4).

  4. Deaths: Final Data for 2016. Xu J et al. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. National Vital Statistics Reports 2018; 67(5).

  5. Fatal Injury data. Centers for Disease Control and Prevention. http://www.cdc.gov/injury/wisqars/fatal.html. Accessed Dec. 11, 2018.

  6. Doctors Revolt after the NRA Tells Them to “Stay in Their Lane” on Gun Policy. Haag M. The New York Times. Accessed online Dec. 10, 2018. https://www.nytimes.com/2018/11/13/us/nra-stay-in-your-lane-doctors.html

  7. American Academy of Pediatrics. Gun Violence Prevention: Federal Policies to Keep Children Safe. AAP federal advocacy website. https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/AAPFederalGunViolencePreventionRecommendationstoWhiteHouse.aspx. Accessed Dec. 11, 2018

  8. Policy Statement: Firearm-related Injuries Affecting the Pediatric Population. American Academy of Pediatrics Council on Injury, Violence, and Poison Prevention. Pediatrics 2012;130;e1416.

  9. Is Office-based Counseling about Media Use, Timeouts, and Firearm Storage Effective? Results from a Cluster-randomized, Controlled Trial. Barkin S, et al. Pediatrics 2008;122:e15-25.

  10. Parents’ Attitudes Toward Firearm Injury Prevention Counseling in Urban Pediatric Clinics. Haught K, et al. Pediatrics 1995; 96:649-653.

  11. Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries. Grossman D, et al. JAMA 2005;293;707-714.