A 12-year-old boy with a gunshot wound (GSW) to the chest is wheeled into the trauma bay, unresponsive, pulseless and undergoing CPR and subsequently dies. The patient’s 6-year old brother found their father’s gun while playing and pointed it at him. The parents now face the shattering loss of their older son and also the psychological impacts for their younger son, the second victim. Tragedies such as this have become too familiar for emergency departments across the US as the number of pediatric firearm deaths continue to climb annually
Firearms are the second leading cause of pediatric death in the US taking the lives of over 1,700 and injuring more than 6,500 children and teens (ages 0-17) in 2019.1 Homicide accounted for a majority of these deaths, but 40% were from firearm-assisted suicide and 5% from unintentional injuries. Middle schoolers and high schoolers in the US are now more likely to die from a gun than from any other cause, including motor vehicle collisions.2 Additionally, 4.6 million children in the US live in a home with at least one unlocked and loaded gun, double the rates of firearm exposure from a decade earlier.3 Access to an improperly stored firearm in the home increases the risk of both pediatric unintentional firearm injury and firearm assisted-suicide (by 2-5x).4-7
As of June 14th 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. This year of 2018 has been especially deadly for children, with 547 firearm deaths this year. Thus more children died from firearm injuries this year compared to influenza deaths despite frequent media reports about influenza death compared to firearm injuries.
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
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)