These risks have been amplified by the increase in the number of homes with guns with the record number of gun sales during the COVID-19 pandemic; exceeding all of 2019 sales by August 2020.⁸ As a result, during the peak of stay-at-home orders, there was 43% increase in pediatric unintentional shootings in March and April when compared to the average gun deaths for the same two months over the last 3 years.⁹ Along with access to an unlocked gun at home, social isolation, increased stressors, and lack of timely access to mental health services have all been independent risk factors for youth firearm-related suicide.¹⁰ Suicide attempts have been noted to be 1.5 times higher in teens during the pandemic compared to previous years.¹¹ Locally, we have seen the impacts of COVID-19 on gun violence as Children’s has cared for almost 100 pediatric GSWs in 2020; a 50% increase compared to 2019 and a 140% increase compared to 2018!¹² 40% of these firearm injuries this past year were unintentional and almost all if not all were preventable.

So what can we as pediatricians do to help change the narrative of pediatric gun violence?

Providing Firearm Safety Counseling

Forty-nine percent of Georgians live in homes with guns and when gun-owning parents in the metro-Atlanta area were asked, more than 50% do not store their guns locked AND unloaded.^13-15 Additionally, 23% of gun-owning families believed they could trust their child with a loaded gun and 75% believed their children could distinguish real from a fake gun, but in reality only 41% could.¹⁶ When 1,246 parents in a large survey study were asked about pediatricians providing firearm safety counseling: 66% agreed that the pediatrician should ask about guns in the home, 75% agreed the pediatrician should advise on safe storage (71% were gun owners), but only 13% had ever had a firearm safety conversation with their pediatrician.¹⁷

The American Academy of Pediatrics recommends that pediatricians and other child healthcare professionals provide firearm safety counseling and ask parents to store all guns locked and unloaded with the ammunition stored separately and locked. It is recommended to store guns in either a lockbox or gun safe and to store out of sight.¹⁸ Each of these safety practices are modifiable risk factors for unintentional injury and pediatric firearm-related suicide. Even motivating 20% of all parents who store one gun unlocked to now store all of their guns locked could save up to 135 pediatric lives and prevent up to 323 pediatric shootings.¹⁹

Considerations for firearm safety conversations:

• Keep the conversation neutral and respect parent’s position on firearm ownership
• Pair counseling with discussion of other injury risks (e.g. ingestions, falls)
• Counsel for high-risk groups including: Adolescents, children with mental health concerns, history of substance abuse, prior suicidal ideation, history of family violence

For high-risk groups discuss storing gun outside of the home (e.g. gun club, with relative or friend). Firearms are the most common means for teen suicide and suicide is the second leading cause of death for teenagers. Teenagers often know lockbox combinations or where the keys are kept.

• Encourage parents to ask about guns in the home of places their child/teen may visit

            40% of unintentional injuries happen at a friend’s home.⁵

Let’s work together to prevent injuries and death due to firearms in Georgia!

References

1. Centers for Disease Control and Prevention & NC for IP and C. Injury prevention and control: Data & statistics (WISQARS), key injury and violence data. 2021. Accessed March 1, 2021. https://www.cdc.gov/injury/wisqars/index.html
2. Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2018;379(25):2468-2475. doi:10.1056/nejmsr1804754.
3. Azrael D, Cohen J, Salhi C, et al. Firearm Storage in Gun-Owning Households with Children: Results of a 2015 National Survey. J Urban Health. 2018 Jun;95(3):295-304. doi:10.1007/s11524-018-0261-7.
4. Hemenway D, Solnick SJ. Children and unintentional firearm death. Injury epidemiology. 2015;2(1): 26.
5. Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005;293(6):707-714.
6. Miller M, Azrael D, Hemenway D, Vriniotis M. Firearm storage practices and rates of unintentional firearm deaths in the United States. Accident; analysis and prevention. 2005;37(4):661-667.
7. Kellermann A, Rivara F, Somes G, et al. Suicide in the home in relation to gun ownership. N Engl J Med. 1992;327:467-472.
8. Brauer J. U.S. firearms: Year-to-date sales exceed all of 2019. http://smallarmsanalytics.com/v1/pr/2020-11-02.pdf Published: Sept 1, 2020. Accessed March 1, 2021.
9.  “Alarming” spike in deadly unintentional shootings by kids as gun sales soar during lockdowns.” CBS News. Published May 8, 2020. Accessed March 1, 2021. https://www.cbsnews.com/news/unintentional-shootings-guns-kids-sales-coronavirus-lockdowns/
10. Spiking Rates of Gun Purchases During COVID-19 Pandemic Put Youth at Risk. Children’s Hospital of Philadelphia Research Institute: Center for Injury Research and Prevention. Published: June 4, 2020. Accessed March1, 2021. https://injury.research.chop.edu/blog/posts/spiking-rates-gun-purchases-during-covid-19-pandemic-put-youth-risk#.X76q1KpKjEZ
11. Hill RM, Rufino K, Kurian S, Saxena J, Saxena K, Williams L. Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID-19. Pediatrics. 2021 Mar;147(3):e2020029280. doi: 10.1542/peds.2020-029280. Epub 2020 Dec 16. PMID: 33328339.
12. Children’s Healthcare of Atlanta Trauma Registry Database 
13. Georgia – Gun ownership by state in America – statistics and rates – CBS News. Published July 23, 2020. Accessed January 20, 2021. https://www.cbsnews.com/pictures/gun-ownership-rates-by-state/34/
14. KF, Morris CR, Akbar T, et al. The Relationship Between Parents’ Reported Storage of Firearms and Their Children’s Perceived Access to Firearms: A Safety Disconnect. Clin Pediatr (Phila). Published online 2020. doi:10.1177/0009922820944398
15. Senturia YD, Christoffel KK, Donovan M. Gun storage patterns in US homes with children: A pediatric practice-based survey. Arch Pediatr Adolesc Med. 1996;150(3):265-269. doi:10.1001/archpedi.1996.02170280035006
16. Farah MM, Simon HK, Kellermann AL. Firearms in the home: Parental perceptions. Pediatrics. 1999;104(5 I):1059-1063. doi:10.1542/peds.104.5.1059
17. Garbutt JM, Bobenhouse N, Dodd S, Sterkel R, Strunk RC. What Are Parents Willing to Discuss with Their Pediatrician About Firearm Safety? A Parental Survey. J Pediatr. 2016 Dec;179:166-171. doi: 10.1016/j.jpeds.2016.08.019. Epub 2016 Sep 14. PMID: 27639529; PMCID: PMC5123916.
18. Firearm-Related Injuries Affecting the Pediatric Population. Published online 2012. doi:10.1542/peds.2012-2481. 
19. Barkin SL, Finch SA, Ip EH, et al. Is Office Based Counseling About Media Use, Timeouts, and Firearm Storage Effective? Results from a Cluster-Randomized, Controlled Trial. Pediatrics. 2008 Jul;122(1):e15-25. doi:10.1542/peds.2007-2611.

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