Sanjivan V. Patel, MD, FAAP
(Patel Sanjivan, MD, FAAP is Chairman of the Department Of Pediatrics and Director of Newborn services and NICU at Wyckoff Heights Medical Center.
Nguyen-Thao Tran, DO, PGY2 is a Pediatric resident at Wyckoff Heights Medical Center)
Gun violence is recognized as a public health crisis with devastating effects on children, adolescents, and young adults. Death caused by firearms is the third most common cause among children aged 1 to 17 years (1). Furthermore, the United States leads the industrialized world in youth homicide and suicide rates (2). What are the circumstances surrounding firearm-related injuries and deaths in children, and what exactly are we as Pediatricians doing to combat this crisis?
According to data from the Centers for Disease Control and Prevention (CDC) from 2002 to 2014, approximately 1,300 children die and 5,790 are hospitalized for gunshot wounds each year in the United States (1, 2). Nearly half of these were due to homicides where younger children were bystanders in a violent conflict between intimate partners. One-third of firearm-related injuries among adolescents and young adults are triggered by relationship problems with family, friends, or intimate partners. Underlying mental health factors such as depression, developmental, and behavioral problems are also key contributors. The remaining deaths were due to unintentional firearm deaths which are frequently due to unsafe storage of guns (1, 2).
In response to the rising youth violence prevention movement, the AAP issued guidelines and recommendations stressing the importance of Pediatricians becoming familiar with Connected Kids: Safe, Strong, Secure (2, 3). This nationally-accepted program is a comprehensive effort by the AAP that serves as a primary care violence prevention protocol. It serves as a clinical guide, provides 21 information brochures for parents and patients, and offers training materials that are accessible online for healthcare providers.
As Pediatricians we routinely have front-line access to our young patients with co-morbid mental health problems and those with involvement in high risk or violent behaviors (2). It has been shown in a randomized, controlled study by Barkin et al that when pediatricians take the time to discuss gun issues during clinical care visits, patients and their families follow-through with their pediatrician’s recommendations on gun safety (3, 4).
The implementation of this anticipatory guidance and screening during routine health maintenance examinations touches on the importance of fostering resilient factors “that enable children and young adults to adapt successfully to stress, including exposures to violence (2).” It is essential to note that when we take the time to advocate and provide support for early parenting behaviors in areas that help their child build interpersonal skills, peer relationships, staying safe, healthy dating, bullying prevention, firearms and media violence, and mental health, among other topics; children develop greater resilience early-on and more successfully, safely, effectively, and healthfully navigate and handle conflicts.
The AAP encourages pediatricians to routinely ask questions to screen for firearms in the home of their patients. If present, we should counsel regarding safe gun storage (storing the unloaded gun in a locked safe, storing ammunition separately, etc.) or gun removal. An adolescent’s access to firearms is usually obtained illegally through a family member or friend. A recent cross-sectional study by Timsina et al found that the National Instant Criminal Background Check System (NICS) by itself does not decrease gun-carrying behaviors in adolescents. However, they found that in states where universal background checks on all gun purchases are combined with the implementation of NICS, there is a reduction in adolescents having access to guns (6). Our purpose as Pediatricians is to educate and ensure the safety as well as the health of our children and to not infringe on the Constitutional right to bear arms (5).
Overall, youth morbidity and mortality due to firearms is preventable with Pediatricians’ collective efforts to educate and advocate. We need to educate and advise our patients on gun safety. We need to advocate at the federal level for policies and legislation on violence prevention and mental health surveillance and resources that is pro-child health and safety (5).
References:
- Fowler KA, Dahlberg LL, Haileyesus T, et al. Childhood Firearm Injuries in the United States. Pediatrics. 2017; 140(1): e20163486.
- American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. Role of the Pediatrician in Youth Violence Prevention. Pediatrics 2009;124;393.
- Palfrey JS, Palfrey S. Preventing Gun Deaths in Children. NEJM 2013;368;5.
- Barkin SL, Finch SA, Ip EH, et al. Is office-based counseling about media use, time-outs, and firearm storage effective? Results from a cluster-randomized, controlled trial. Pediatrics 2008l;12(1)2:e15-e25.
- Jones N, Nguyen J, Strand NK, et al. What Should Be the Scope of Physicians’ Roles in Responding to Gun Violence? AMA Journal of Ethics 2018; 20 (1):84-90.
- Timsina LR, Qiao N, Mongalo AC, et al. National Instant Criminal Background Check and Youth Gun Carrying. Pediatrics. 2020;145(1):e20191071.