Today we are going to talk about a subject that is controversial but shouldn’t be. Let’s start with some facts I think we all can agree on. This comes from a new study about firearm safety in the United States by the Department of Pediatrics at Washington University in St. Louis:
Children and adolescents in the US who live in or visit homes with firearms are at an increased risk of fatal and nonfatal firearm-related injuries, suicide, and homicide. In 2013, 2,465 children and adolescents under 20 years old died from firearm-related incidents, 15,091 visited emergency rooms, and 6,213 were hospitalized. The American Academy of Pediatrics recommends that pediatricians screen patients for the presence of household firearms. For gun owners, the American Academy of Pediatrics advises emphasizing that a home without guns is the safest option and counseling firearm removal for parents of adolescents. Advising safe storage is also encouraged.
Of course, it’s hard to find many “facts” about gun violence in the U.S. when, in 1996, Congress effectively banned the use of federal tax dollars for the CDC and other government agencies to study this important public health issue. The AAP recommends (urges, actually) that pediatricians ask parents about firearms in the house — who owns them, where they are kept, who has access to them, etc. But even follow-through on that recommendation has become difficult. The State of Florida bans physicians from asking their patients about firearms in the home unless the doctor “in good faith believes that this information is relevant to the patient’s medical care or safety, or the safety of others.” The safety of children and family members in the potential case of an accidental shooting is apparently not a relevant consideration, so pediatricians are not allowed to ask in order to dole out anticipatory guidance on firearm safety.
There is no such restrictive and intimidating law about asking about guns in the home in Missouri, so the researchers from Washington University School of Medicine went into pediatricians’ offices and did just that. Among their findings:
- 50% of children in the United States spend significant amounts of time in households with firearms.
- 36% of children lived in homes with guns.
- 14% of children frequently visited the homes of relatives and friends with guns.
Okay, then. Let’s drill down:
- 25% reported keeping a firearm loaded in the home. (14% of them said the firearm(s) was potentially accessible to children.)
- 22% reported keeping firearms and ammunition in the same location.
- 18% carried a gun when leaving the house.
Are pediatricians asking about firearm presence and firearm safety at office visits?
- 75% of parents (71% of gun owners) said pediatricians should advise about safe storage of firearms, 17% disagreed, and 8% weren’t sure.
- 66% of parents (58% of gun owners) said pediatricians should ask about the presence of household firearms, 23% disagreed, and 10% weren’t sure.
- 22% of gun owners said they would ignore advice to not have household firearms for safety reasons and 14% would be offended by such advice.
- Only 13% of parents said their pediatrician discussed firearm safety with them.
My sense is that if this survey was taken in my offices, we’d get similar responses. There are a few reasons why pediatricians might hesitate asking about the presence of household firearms and firearm safety with their patients and parents. First, as a group of healers, we really don’t want to offend anyone; it’s not a good day when we get a patient or a parent mad at what we do or say. Second, I’d venture a guess that most pediatricians in the U.S. do not own guns. (In fact, the majority of Americans (68%) don’t own guns, and the trend is downward.) This makes it hard to relate to those who do. Finally, most of us have a healthy expectation that others respect our privacy. When pediatricians delve a bit too deep, we often get some push-back which should not be surprising. Dr. Dhruv Khullar spoke with the study’s lead author:
“Guns are an emotional topic,” said Dr. Jane Garbutt, lead author of the study and a professor of pediatrics at Washington University School of Medicine. “Our work suggests this type of conversation doesn’t happen enough. But we need to find a way for doctors and patients to have this discussion to keep kids safe.”
Dr. Khullar has an idea:
One path forward may be for physicians to counsel patients about gun safety generally instead of directly questioning parents about whether they have guns in the home. According to the study, parents were more amenable to hearing messages about how to safely store firearms than they were to inquiries into whether they personally had firearms.
“We need to make it about hazard avoidance,” Garbutt said. “We need to place firearms in the same domain as medications or household poisons, and discuss them as we would other dangerous things in the home. The message from pediatricians has to be, ‘Lock it up. Keep it away from your child.’”
Fair enough. We’ll provide some anticipatory guidance about firearm safety — you can take it or leave it — tomorrow on The PediaBlog.