Kiesha Fraser Doh, MD
kiesha.fraser @emory.edu

As of June 14^th there have been 23 school shootings this year!  A total of 1,392 children have been killed or injured by firearms. In comparison during the influenza season from October 2017 to May 2018 a total of 172 children died. [1]This year of 2018 has been especially deadly for children, with 547 firearm deaths this year. [2]Thus more children died from firearm injuries this year compared to influenza deaths despite frequent media reports about influenza death compared to firearm injuries.

On June 21^st, the first day of summer, the American Academy of Pediatrics and the Brady Campaign Against Gun Violence advocate for firearm safety in the home. This campaign encourages pediatricians to educate their patient’s parents to inquire about the presence of unlocked firearms in the homes their children visit. It is especially important in Georgia as 1 in 3 homes have firearms with the Georgia gun ownership rate of 31.6%.[3]

One third of all children live in homes with guns and 45% of gun-owning households do not store their firearms safely. [4] Seventy-five percent of children know where their parents store their guns. [5]  In 2016,  Georgia had the 4^thhighest death rate in the nation by firearm injury which makes Georgians 2x as likely to die from a firearm injury in compared to New Yorkers[6].

Of note over the last few years at Children’s Healthcare of Atlanta on average we have seen 1 firearm injury every 2.5 weeks. In addition 10% of all Children’s trauma deaths in 2015 were firearm related.

When you consider where the US ranks in the world, 91% of firearm injuries in children of wealthy nations occur in the United States.[7]The U.S. General Accounting Office estimates that 31 percent of accidental deaths caused by firearms might be prevented with the addition of 2 devices: a childproof safety lock and a loading indicator.[8]

In our own Children’s ED-based study we were able to ascertain that when caregivers were educated to ask about firearm storage in the homes of their children’s playmates, 76% indicated they would. Interestingly, in this same study only 16% of parents reported ever being asked about presence of guns in their homes. In a recent published survey at some pediatric practices in Missouri 75% of parents felt pediatricians should ask about firearm safety but only 12% of parents reported having a conversation with their pediatrician.[9]

Thus it behooves us as pediatricians and medical care providers for children to ASK. Just as we ask about other important public safety initiative such as children riding in car seats, helmet while on bike and safe sleep. The AAP and the Brady Campaign have a website askingsaveskids.org which details ways pediatricians can educate their clients. In addition, he American College of Emergency Physicians has  developed a very handy discharge instruction sheet that can be distributed at each visit. (ACEP Discharge Instruction)

So what can you do as health care provider. #1 On June 21^stASK parents about the presence of unlocked firearms?  #2 Educate your nursing staff (Asking Saves Kids Resources) #3 When screening for depressions also inquire if firearms are in the homes of your patients.

Don’t forget to ASK on Thursday, June 21^st, because ASKING SAVES KIDS.

1. Report WUIS. US Virologic Surveillance. Secondary US Virologic Surveillance 2018. www.cdc.gov.
2. Gun Violence Archive. Secondary Gun Violence Archive 2018. gunviolencearchive.org.
3. Kalesan B VM, Keyes K, Galea S. Gun Ownership and Social gun culture. Injury Prevention 2016:22:216-20
4. Crifasi C DM, McGinty EE, Webster DW, Barry CL. Storage Practices of US Gun Owners in 2016. American Journal of Public Health 2018;108:532-37
5. Baxley F, Matthew M. Parental Misperceptions about Children and Firearms. Archies of Pediatric Adolescent Medicine 2006;160:542-47
6. Judd A. You’re twice as likely to be shot to death in Georgian than in New York (and other gun violence facts). Atlanta Journal Constitution2017.
7. Grinshteyn E HD. Violent Death Rates: The US comparent with other High-income OECD Countries, 2010. American Journal of Medicine 2016;129:266-73
8. Accidental Shootings: Many Deaths and Injuries Caused by Firearms Could Be Prevented. In: Office USGA, ed. Chairman Subcommittee on Antitrust, Monopolies, and I3usiness Rights, Committee on the PJudiciary,I7.S. Senate, 1991.
9. Garbutt J BN, Dodd S, Sterkel R, Strunk R. What are Parents Willing to Discuss with Thei Pediatrian about Firearm Safety? A Parental Survey. Journal of Pediatrics 2016;179:166-71