Pediatric Hospitalists at the Front Line of Gun Violence Prevention: Every Patient Encounter Is an Opportunity to Promote Safe Gun Storage

Abstract

Pediatric hospitalists have a critical role to play in the prevention of firearm death and injury in children. Gun violence is the second leading cause of death for children and adolescents. 1 Just over half of these deaths are homicide, with the remaining attributed to suicide and unintentional shootings. There are more child deaths from gun violence than child deaths from cancer, heart disease, and lung disease combined. 1 These startling statistics should urge all pediatricians to act, including those invested in the care of hospitalized children. This uniquely American problem is driven, in part, by access to unsecured firearms. In America, 4.6 million children live in a household with at least 1 loaded, unlocked gun. 2 Access to unsecured firearms puts children at risk for unintentional shootings and adolescents at risk for suicide. 3 Responsible storage (keeping guns locked, unloaded, and separate from ammunition) can decrease these risks. 3 The majority of children in gun-owning households are aware of where their parents store the gun, with more than one-third reporting previously handling the gun. 4 We cannot rely on curious children to not find a gun that is "hidden" or to know what to do if they encounter a gun. Educational programs that are focused on teaching children about gun safety do not work. In fact, after completing gun safety training programs, preschool-and school-aged children are just as likely to approach and play with a handgun as those not given the training. 5 Access to a firearm is key modifiable risk factor for adolescent suicide in the United States. 6 Of the adolescents screened in 1 study, .50% reported they had a friend or relative who owned a gun, and 28% stated they could access a loaded gun within 3 hours. 7 Households with locked firearms and separate locked ammunition have an 85% lower risk of unintentional injury and a 78% lower risk of self-inflicted firearm injury. 3 In this month' s issue of Hospital Pediatrics, Monroe et al 8 evaluated the frequency of screening for firearms in the home by inpatient pediatric providers in the academic tertiary care hospital setting. Via retrospective chart review, they found a low rate of documented screening, with an overall rate of 2.94%. The most frequently screened diagnosis was mood disorders, and the most frequent screening provider type was child psychiatrist. Although it is encouraging that children and adolescents with mood disorders are being screened at higher rates, this number is still drastically low at 37.3%. As the authors point out, what is most concerning is that even when screening took place, the conversation often stops there, with no anticipatory guidance or safe storage counseling provided. The authors describe this as a missed opportunity, and we could not agree more. It is past time for pediatricians, including hospitalists, to adopt strategies to incorporate firearm access screening and safe storage counseling into their practice. Every health care encounter is an opportunity to prevent a child' s death or inju...

Firearm screening in pediatric patients

“…The inpatient settings has other advantages as well, as the hospital context provides more resources and providers and there are more caregivers present, thereby allowing these parties to have these important conversations ( 39 ). In addition, hospital pediatric providers are already well versed in safety discussions about tobacco cessation and car seats, and the topic of firearm safety should be treated in the same way ( 52 ). Especially at academic hospitals, pediatric providers can teach trainees about the importance of firearm safety screening and counseling, which can have a lasting impact on the future pediatric workforce ( 52 ).…”

“…In addition, hospital pediatric providers are already well versed in safety discussions about tobacco cessation and car seats, and the topic of firearm safety should be treated in the same way ( 52 ). Especially at academic hospitals, pediatric providers can teach trainees about the importance of firearm safety screening and counseling, which can have a lasting impact on the future pediatric workforce ( 52 ). The goal of this project was to screen all patients presenting to the pediatric emergency department, pediatric floor, and pediatric intensive care unit for the presence of firearms in the home, firearm storage practices, and whether they had previously received any firearm counseling by medical professionals.…”

“…Additionally, even if parents do not agree with the physician's advice, parents said it could help them "think it over" (50). While adolescents may be less willing to talk to their pediatricians about firearm safety, one study found that if their physician asked them about firearms, most adolescents would be willing to discuss it (51). In addition, a study found that with some of the recent firearm-related incidents in the national spotlight, such as mass shootings, there has been an increase in public awareness about the importance of firearm safety, and thus it has become easier for pediatricians to start these conversations (44).…”