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A ‘compelling call’ for pediatricians to discuss firearm safety

little boy looking at gun

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

Paradoxically, as overall firearm ownership decreased in U.S. households with young children from 1976 to 2016, the proportion of these families who owned handguns increased. This shift in firearm preferences over decades from mostly rifles to mostly handguns coincided with increasing firearm-mortality rates in young children, researchers report Jan. 28, 2019, in Pediatrics.

“Almost 5 million children live in homes where at least one firearm is stored loaded and unlocked,” Kavita Parikh, M.D., a pediatric hospitalist at Children’s National Health System, and co-authors write in an invited commentary. “This study is a loud and compelling call to action for all pediatricians to start open discussions around firearm ownership with all families and share data on the significant risks associated with unsafe storage. It is an even louder call to firearm manufacturers to step up and innovate, test and design smart handguns, inoperable by young children, to prevent unintentional injury,” Dr. Parikh and colleagues continue.

The Children’s commentators point to the “extremely dangerous” combination of “the small curious hands of a young child” and “the easily accessible and operable, loaded handgun” and suggest that pediatricians who counsel families about safely storing weapons tailor messaging to the weapon type and the family’s reason for owning a firearm.

They also advocate for childproofing firearms stored in the home – through free or discounted locks, storing weapons separately from ammunition, and using personalized technology that limits the firearm’s potential to be used by children accidentally. According to a retrospective, cross-sectional study led by Children’s researchers, younger children are more likely to be shot by accident.

“The development of effective safety controls on firearms is not only attainable but could be the next big step towards reducing mortality, especially among our youngest. We as a society should be advocating for continued research to ‘childproof’ firearms so that if families choose to have firearms in the home, the safety of their children is not compromised,” Dr. Parikh and co-authors write.

In addition to Dr. Parikh, the senior author, the Pediatrics commentary co-authors include Lead Author Shilpa J. Patel M.D., MPH, emergency medicine specialist; and co-author Monika K. Goyal M.D., MSCE, assistant division chief and director of research in Children’s Division of Emergency Medicine.

Lenore Jarvis at #thisisourlane meeting

#thisisourlane: Pediatricians call for safer firearm storage, enhanced research funding

Lenore Jarvis at #thisisourlane meeting

The 2-year-old scampered unexpectedly into a room, startling a family member. Thinking the toddler was an intruder, the family member fired, hitting the child in the chest.

In the emergency department at Children’s National Health System, Lenore Jarvis, M.D. MEd, FAAP, emergency medicine specialist, and colleagues tried to save the boy’s life, inserting tubes, transfusing blood and attempting to restart his dying heart via CPR. The Children’s team was unsuccessful and emerged covered in the blood of a boy whose death was heartbreaking and preventable.

Firearm violence is a leading cause of childhood traumatic death and injury,” Dr. Jarvis told attendees of a recent congressional news conference intended to prod the incoming Congress to take more concrete action to prevent firearm violence. She provided snapshots of some of the countless lives of local youths cut short by firearms, including an 8-year-old girl killed on a playground in a drive-by shooting, a 13-year-old young man murdered during a fight, a 15-year-old young woman who committed suicide and an entire family who died from firearm injuries.

“I wish it were not so. But these stories are endless. In our emergency department, the effects of gun violence are frequent, life-altering and personal,” Dr. Jarvis said.

The #ThisISOurLane press conference, convened by U.S. Rep. Robin Kelly, (D-Illinois), included haunting stories by clinicians from across the nation about the devastating impact of firearm injuries on children and youth. According to a retrospective, cross-sectional study led by Children’s researchers, younger children are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm.

“Gun violence is a public health crisis and should be addressed as such. We need to reduce the numbers of suicides, homicides and accidental gun deaths in children,” added Dr. Jarvis, who also is president-elect of the District of Columbia Chapter of the American Academy of Pediatrics.

During the news conference, U.S. Rep. Frank Pallone Jr., (D-New Jersey), vowed that the House Energy and Commerce Committee he chairs this session will move forward languishing bills, including funding the Centers for Disease Control Prevention to conduct firearms violence research.

ambulance

Accident or assault? Pediatric firearm injuries differ by age

ambulance

According to a retrospective, cross-sectional study led by Children’s researchers, younger kids are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm.

An increasing number of children are injured by firearms in the U.S. each year, but the reasons these injuries happen vary. According to a new retrospective, cross-sectional study led by Children’s researchers and presented at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition, firearm injuries vary by the intent of the person discharging the weapon. Younger kids are more likely to be shot by accident, and odds are higher that older youths are victims of an assault involving a firearm. Efforts to protect children from firearm-related injuries should factor in these differences in intent as legislation and policies are drafted, the study team suggests.

Researchers led by Shilpa J. Patel, M.D., MPH, Children’s assistant professor of pediatrics and emergency medicine, reviewed data aggregated in the Nationwide Emergency Department Sample from 2009 to 2013 looking for emergency department visits to treat firearm-related injuries suffered by children and adolescents 21 and younger. They excluded emergency department visits for firearm-related injuries attributed to air, pellet, BB or paintball guns.

Firearm-related injuries are a leading cause of injury and death for U.S. children. Some 111,839 children and youth were treated in emergency departments for firearm-related injuries, or 22,367 per year when averaged over the five-year study period. Nearly 63 percent of these youths were injured by accident; 30.4 percent were victims of assault; 1.4 percent used a firearm to injure themselves. Of note:

  • 89.3 percent were male
  • Their mean age was 18 (67.3 percent 18 to 21; 27.9 percent 13 to 17; 4.8 percent younger than 12)
  • 1 percent were discharged from the emergency department
  • 30 percent had injuries grave enough to trigger hospital admission and
  • 1 percent died from their injuries.

“Children younger than 12 were more likely to be shot by accident. By contrast, we found that the odds of experiencing firearm-related injuries due to assault were higher for youths aged 18 to 21,” Dr. Patel says. “Physicians can play a powerful role in preventing pediatric firearm-related injuries by routinely screening for firearm access and speaking with families about safe firearm storage and violence prevention,” she adds.

Some 52.1 percent of children with firearm-related injuries lived with families whose median household incomes exceeded $56,486.

American Academy of Pediatrics National Conference & Exhibition presentation

  • “Emergency department visits for pediatric firearm-related injury: by intent of injury.”

Shilpa J. Patel, M.D., MPH, assistant professor of pediatrics and emergency medicine and lead author, Gia M. Badolato, MPH, senior clinical research data manager and study co-author, Kavita Parikh, M.D., MS, associate professor of pediatrics and study co-author, and Monika K. Goyal, M.D., MSCE, assistant division chief and director of Academic Affairs and Research in the Division of Emergency Medicine and study senior author, all of Children’s National Health System; and Sabah F. Iqbal, M.D., medical director, PM Pediatrics, study co-author.

Kavita Parikh

Keeping children safe from firearm-related harm

Kavita Parikh

“While this preventable public health crisis occurs in the home, pediatricians who see children in clinic or at hospitals can play a pivotal role in helping to reduce gun violence,” says Kavita Parikh, M.D., M.S.H.S.

A review led by Children’s National Health System researchers presents new insights about pediatric firearm-related injuries. The findings, published May 23, 2017 in Hospital Pediatrics, show that up to 64 percent of U.S. households have firearms, and almost 40 percent of parents erroneously believe that their children are unaware of where weapons are stored. Additionally, about 22 percent of parents wrongly think that their children have never handled household firearms.

According to the Centers for Disease Control and Prevention, firearm-related injuries are leading causes of injury deaths for youths. Younger children are more likely to be victims of unintentional firearm injuries, the majority of which occur in the home. Older adolescents are more likely to suffer from intentional injuries. Homicide by firearm is the second-leading cause of death for 15- to 19-year-olds, and suicide by firearm ranks as the third-most common cause of death for children aged 10 to 19. Estimates suggest that the cost of medical treatment for firearm-related injuries suffered by youths younger than 21 exceeds $330 million.

“While this preventable public health crisis occurs in the home, pediatricians who see children in clinic or at hospitals can play a pivotal role in helping to reduce gun violence,” says Kavita Parikh, M.D., M.S.H.S., associate professor of pediatrics in the Division of Hospitalist Medicine at Children’s National and study lead author. “In the course of providing care, pediatricians can ask patients and their families about children’s access to firearms, can encourage safe storage of firearms in the home and can support research into firearm-related injury prevention.”

The review article provides an overview of the prevalence of pediatric firearm-related injuries around the nation and a summary of legislative efforts and health care-related advocacy efforts to reduce firearm injuries around the nation. It includes research by four Children’s National co-authors who comprise the institution’s newly formed firearm-injury prevention research work group. Alyssa Silver, M.D., Children’s Hospital at Montefiore, is another co-author.

The study team found that about 20,000 children are transported to Emergency Departments each year for firearm-related injuries. Youths aged 12 to 19 make up 90 percent of this total. On average, 20 U.S. children and youths are hospitalized daily for firearm-related injuries. About 50 percent of the children who are hospitalized for firearm-related injuries are discharged with a disability.

The researchers identified regional variations in the percentage of households with firearms, as well as differences in firearm ownership by race and ethnicity. Across a number of surveys, 6 percent to nearly 50 percent of families reported storing firearms safely by using such methods as trigger locks and locked storage containers. There is a mismatch in what parents report — with many saying their child would never touch a firearm – compared with children who tell researchers they handle “hidden” firearms, including by pulling the trigger. One survey of 5,000 fifth-graders and their caregivers living in three metropolitan areas found 18 percent had household firearms. Of this group, African American and Latino households had lower odds of firearm ownership than families of white, non-Latino children. Among these survey respondents, families of white non-Latino children were less likely than families of African American children to use safer strategies for firearm storage.

“While public health interventions have had varying degrees of success in improving firearm safety, the most effective programs have offered families free gun safety devices,” says Monika Goyal M.D., M.S.C.E., assistant professor of pediatrics and emergency medicine at Children’s National and senior study author. “The stark differences in how parents perceive their children would act and the children’s own recollections to researchers underscore the importance of the combination of counseling parents to talk to their children about firearms and instituting safe storage practices for household guns.”

Sabah F. Iqbal, M.D., assistant professor of pediatrics and emergency medicine at Children’s National and study co-author, adds: “Most families are willing to discuss firearm safety with health care providers. It is encouraging that when families receive safety counseling from health care professionals, they store firearms more safely within the home. Pediatricians need to ask children and their families about the presence of firearms in the home. These essential conversations can occur in any medical setting and need to begin before a child begins to walk and explore their own home.”

Screening for access to firearms within the health care setting where youths receive routine care may represent a beneficial strategy, the authors write. A recent survey conducted among 300 adolescents seen in an Emergency Department found that 16 percent reported having a gun in the home and 28 percent said they could access a loaded gun within three hours. About 50 percent of adolescents screened for firearm access said a friend or relative owned a gun.

The study authors also discuss the benefit of “rigorous, well-conducted” research of firearm-related injuries to guide the work of public health agencies, policymakers and pediatricians, as well as supporting state-level laws shown to be effective in preventing firearm injuries, such as universal background checks and firearm identification.

“Rigorous investigations, with the use of validated scoring systems, large comprehensive databases and accurate detailed reporting and surveillance of firearm access and related injury are urgently needed,” Shilpa J. Patel, M.D., M.P.H., assistant professor of pediatrics and emergency medicine at Children’s National, and co-authors conclude. “A collective, data-driven approach to public health is crucial to halt the epidemic of pediatric firearm-related injury.”

Related reading: Pediatric firearm-related injuries in the United States.