by Sofia Chaudhary

schaud3@emory.edu

A 2-year old child has wandered into his parent’s bedroom and found an unlocked, loaded gun hidden in the top nightstand drawer.  Seconds later a shot is fired and the parent runs into the room to find their child lifeless.  As pediatricians we have all heard or encountered a similar story- all involving a child having access to an unlocked, loaded firearm.  According to the American Academy of Pediatrics, around 40% of homes with children in the US have a gun with an average of one child under age 10 being killed or disabled by a gun every other day (Pediatrics 2016-1).  In 2014 firearm injury was the 2nd leading cause of injury death in ages 15-19, 4th leading cause for ages 5-9 and 10-14, and 8th leading cause for ages 1-4 (CDC-2016-2).  Although mortality rates are high there is a larger rapid rise of unintentional pediatric injuries from firearms.  In a study reviewing an 8-month period of US pediatric firearm related injuries in 2014: two thirds were non-fatal, 50% of the victims were younger than 13 years of age, 25.3% younger than age 7, 84.3% were the child victims themselves or a family member/friend.  Of note 77% of events took place at the residence and 68% of the families  were the gun owners (J. Trauma Acute Care Surg. 2015-3).

Perhaps the most chilling recent headline from the Washington Post stated “Toddlers have shot at least 23 people this year.” Georgia was the top state with 8 listed self-inflicted shooting, with children ages 2 to 3 with hand guns all found within the home, parental purse, or vehicle (Washington Post-2016-4).  Many non-gun owner caregivers are not aware that there is indeed an accessible and loaded firearm in their home. In 2000, a study in Pediatrics found that in gun-owning homes with children, non-gun owners (87% women) reported significantly lower rates of a gun being stored loaded (7%) and unlocked (2%) in comparison to gun owners (21% loaded, 9% unlocked).  Those with a handgun were more likely to store it loaded and unlocked (Pediatrics-1999-5).  Parental perception of their child’s potential behavior around a firearm is also misleading.  In a survey published in Pediatrics 52% of the parent gun owners stored their firearms loaded or unlocked of which 75% believed that their 4 to 12-year-old child would be able to tell the difference between a toy gun and a real gun, and 23% thought that their child could be trusted with a loaded gun (Brady Center 2016-6)

In the US today 1.7 million children and teens live in a home with a loaded and unlocked gun (AAP-2016-7). One in every 25 admissions to pediatric trauma centers is due to a gunshot wound with major urban trauma centers reporting an increase of 300 percent in the number of pediatric gunshot wounds treated (AAP-2016-8).  Despite this national public health crises, in 2004 Congress banned the CDC from continuing gun violence related research and in 2011 the state of Florida passed a Privacy of Firearm Owners Act prohibiting pediatricians from asking patients and families about firearms in the home-this is currently under review and being appealed later this month.  As pediatricians our first priority is in providing developmentally appropriate advice on how parents can keep their child healthy and safe.  These safety measures include keeping medications out of reach, using appropriate car passenger seats according to age, vaccinating their children, wearing protective helmets when riding wheeled objects, and keeping guns locked and out of reach with the ammunition stored separately.   An AAP policy statement from 2012 reiterates the safest measure to prevent firearm related injuries being the absence of guns from homes and that pediatrician counseling on safe gun storage practices has shown significant reduction in injury. On June 21st the AAP is joining the Brady Campaign and asking parents to ASK (Asking Saves Kids) to save lives.  This campaign is asking parents to ask if there is an unlocked gun where their child plays.  It is encouraging parents to ask these questions as they would discuss other topics for a playdate such as supervision, TV/internet access, or food allergies.  I encourage each and every one of you to not only continue to ASK your patient’s families about firearm storage practices in their homes but also that they in turn ASK their kid’s playmates.

For more information for parents on firearm safety please visit: healthychildren.org

References:

1. American Academy of Pediatrics. Reduce the Risk of Gun Injury. Available at: https://www.healthychildren.org/English/safety-prevention/all-around/Pages/Reduce-the-Risk-of-Gun-Injury.aspx Accessed: April 27, 2016.
2. WISQARS. Center for Disease Control. Injury Prevention and Control: National Center for Health Statistics (NCHS), National Vital Statistics System. 10 Leading Causes of Injury Deaths by Age Group Highlighting Violence- Related Injury Deaths, United States- 2014. Available at: http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_injury_deaths_violence_2014_1040w760h.gif Accessed: June 1, 2016.
3.  Faulkenberry J, Schaechter J. Reporting on pediatric unintentional firearm injury-Who’s responsible.  J. Trauma Acute Care Surg. 2015 79 (3): S2-S8.
4. The Washington Post. Toddlers have shot at least 23 people this year. Posted May 1, 2016. Available at: https://www.washingtonpost.com/news/wonk/wp/2016/05/01/toddlers-have-shot-at-least-23-people-this-year/  Accessed: May 27, 2016.Azrael D, Miller M, Hemenway D.  Are Household Firearms Stored Safely? It Depends on Whom You Ask. Pediatrics. 2000; 106 (3).
5. Farah M, Simon H, Kellerman A. Firearm in the Home: Parental Perceptions. Pediatrics. 1999; 104 (5): 1059-1063.
6. Brady Center to Prevent Gun Violence. Keeping Kids and Families Safe. Available at: http://www.bradycampaign.org/our-impact/campaigns/keep-kids-and-families-safe Accessed: March 27, 2016. 
7. American Academy of Pediatrics. Handguns in the Home. Available at https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Handguns-in-the-Home.aspx. Accessed: May 27, 2016.
8. American Academy of Pediatrics. Council on Injury, Violence, and Poison Prevention Executive Committee. AAP policy statement.  Firearm-related injuries affecting the pediatric population. November 2012; 130 (5)