Gun Safety and Violence Prevention

Incorporating Discussions of Firearm Safety and Suicide Prevention into Anticipatory Guidance

Anticipatory guidance is an important component of every well-child visit.

Many pediatric providers may feel uncomfortable in broaching the topics of suicide prevention and firearm safety.  However, in light of the increasing incidence of youth suicide as well as firearm-related suicides, it has become imperative to address these issues as part of routine pre-adolescent, adolescent and young adult anticipatory guidance.

Research has shown that firearm-related anticipatory guidance can be associated with safer storage practices.

FACTS:

1. Firearms are the leading cause of death in children and youth 0 to 24 years of age in the United States.
2. Rates of firearm suicides in US youth 15 to 24 years of age are increasing.
3. Children and adolescents are at an increased risk for suicide when there is a gun in the home.
4. The suicide rate in homes with guns is four times greater than in homes without guns.
5. 40% of child/teen suicides during the past decade involved the use of a firearm.
6. 90% of these suicides by firearm were with guns that the victims accessed at their own homes or from a relative’s home.
7. Anticipatory guidance and lethal means counseling can help youth and families make informed choices about reducing firearm access to decrease the risk of suicide by firearm and firearm deaths in general.
8. Removal of firearms from the home, which is the most protective measure and may be strongly advisable in some scenarios, may not be acceptable or achievable for many firearm-owning families.
9. Clinician-initiated firearm safety anticipatory guidance to patients and families can increase household safe firearm storage behaviors.

WHAT WE CAN DO:

1. Implement interventions that are focused on the individual, household, and community.
2. Incorporate discussion/counseling about individual and household interventions as part of routine pre-adolescent and adolescent anticipatory guidance.
3. Incorporate discussion/counseling about a) the increased risk of firearm injuries and deaths with firearms in the home as well as b) the principles of safer firearm storage as part of routine pre-adolescent and adolescent anticipatory guidance.
4. Incorporate lethal means counseling for patients and families with individuals at risk for self-harm and suicide.
5. In households with firearms, where removal of firearms from the home is not considered a possible option, it is important to discuss the safer storage of firearms in the home, which includes the following:

• Store the firearm unloaded.
• Store the firearm locked.
• Store the ammunition separated from the firearm.
• Store the ammunition locked separately from the firearm.      

6.  Ask about firearms in the homes of relatives and friends where the child(ren) may visit.

REMEMBER!! 

1. Culturally appropriate messaging is important.
2. Firearms have the highest fatality rate (>90%) compared with other methods of suicide.
3. Lethal means counseling in households with individuals at risk for self-harm and suicide should include discussions to prevent access to lethal agents of harm, including firearms and other means.
4. In addition to the primary care office, this type of counseling can occur in the emergency department (ED) or mental health professionals’ offices.

Gary Krigsman, MD, FAAP
NYS AAP Chapter 2 Suicide Prevention Ambassador

Reference: “Firearm-Related Injuries and Death in Children and Youth: Injury Prevention and Harm Reduction” Lois K. Lee, MD, MPH, FAAP, Pediatrics (2022)150 (6): e2022060070

“End Family Fire” Campaign Hopes to Combat Accidental Child Gun Deaths

The nonprofit that helped popularize Smokey Bear and “friends don’t let friends drive drunk” is teaming up with a gun control group to promote safe firearm storage.  See the “End Family Fire” Campaign they have produced.

On May 17, 2018, our newly formed Chapter 2 and 3 Firearm Injury and Gun Violence Prevention Committee met at Cohen Children’s Medical Center.  There were over 30 attendees from both Chapters, including students, parents, residents, and attending physicians.  Jeff Ostreicher from Chapter 2 and Nina Agrawal of Chapter 3 will co-chair this joint endeavor.  Four working groups are planned: Legislative Advocacy, Research and Education, Grassroots, and Media Outreach.  If you would like to help, click Jeff and Nina’s names above to email them.

Resources:

1.  Firearm Safety and Injury Prevention – AAP resource.
2.  Talking to Children about the Shooting – from the National Child Traumatic Stress Network.

March For Our Lives 2018

March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	Drs. Steven Goldstein & Jack Levine
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	March For Our Lives, Huntington
March For Our Lives, Huntington	Steven Goldstein, MD, FAAP
Steven Goldstein, MD, FAAP