Firearm Injury Prevention: A Conversation for Every Parent – PediaCast 598
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Description
Drs David Kling, Vanessa Ng, and Nichole Michaels visit the studio as we consider the prevention of firearm-related injuries in children and teenagers. Guns kill more kids in America than any other cause, including car crashes, poisoning, and cancer. Most of these deaths are preventable… tune in to learn how!
Topic
Preventing Firearm-Related Deaths in Kids and Teens
Guests
Dr Vanessa Ng
Pediatric Anesthesiology
Nationwide Children’s Hospital
Dr Nichole Michaels
Principal Investigator
Center for Injury Research and Policy
Dr David Kling
Pediatric Emergency Medicine
Nationwide Children’s Hospital
Links
Firearm-Related Injuries and Deaths in Children and Youth: Injury Prevention and Harm Reduction (AAP Policy Statement)
Firearm-Related Injuries and Deaths in Children and Youth (AAP Technical Report)
Pediatric Firearm Injury Mortality Epidemiology (Pediatrics)
Firearms Injuries Involving Young Children in the United States During the COVID-19 Pandemic (Pediatrics)
Epidemiology of Pediatric Firearm Injuries in the United States: The Progression of Gunshot Injury Rates Through the Coronavirus Disease 2019 Pandemic (Journal of Pediatric Orthopedics)
Racial and Ethnic Disparities in Pediatric Firearm Deaths Persist in 2022 and 2023 (Injury Epidemiology)
An epidemiological study of unintentional pediatric firearm fatalities in the USA, 2009–2018 (Injury Epidemiology)
Unintentional Firearm Injury Deaths Among Children and Adolescents Aged 0–17 Years — National Violent Death Reporting System, United States, 2003–2021 (CDC Morbidity and Mortality Weekly Report)
State Gun Laws and Pediatric Firearm-Related Mortality (Pediatrics)
Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths (JAMA Pediatrics)
Characteristics and Precipitating Circumstances of Preteen and Teen Suicide Who Died by Firearm in the United States, 2012-2021 (Journal of the American Academy of Child and Adolescent Psychiatry)
Gun Violence Archive (near real-time counts of firearm injuries and trends in the USA)
Everytown for Gun Safety (Community plans to end gun violence)
Firearm Violence Prevention (AAP Advocacy)
Agree to Agree (Ad Council Initiative)
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast is brought to you by the Center for Injury Research and Policy and by Pediatric Emergency Medicine at Nationwide Children's Hospital.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast. We are a pediatric podcast for moms and dads.
This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 598.
We're calling this one Firearm Injury Prevention, a conversation for every parent. I want to welcome all of you to the program. We're so happy to have you with us.
So, we have a really, really important episode for you this week as we consider firearm-related injuries in children and teenagers. And it's important because gun injuries are the leading cause of death for kids and teenagers in America between the ages of 1 and 17. So just let that sink in for a minute.
More kids and teenagers die from firearm-related injuries than from any other cause, including car crashes, cancer, poisonings, overdoses, drownings, and heart disease. And here's the most important point. Most of these tragic deaths are entirely preventable.
So, on this episode of PediaCast, we're going to talk about what firearm injuries look like in kids, why risk has increased, and most importantly, what families, clinicians, and communities can do to keep kids safe. And just right out of the gate, we're not talking about gun control here. We're not saying, oh, we need to get rid of firearms to keep kids safe.
You know, it is an important part of the United States of America to be able to own firearms. How can we do that responsibly? How can we do that safely so that our kids and teenagers do not suffer injuries or death because of having a firearm in the home?
Of course, in our usual PediaCast fashion, we have a terrific panel of guests joining us in the studio for the conversation. Dr. Vanessa Ng is a pediatric anesthesiologist at Nationwide Children's Hospital. Dr. Nichole Michaels is a principal investigator with the Center for Injury Research and Policy. And Dr. David Kling is an emergency medicine physician at Nationwide Children's Hospital. I do want to remind you the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
If you're concerned about your child's health, be sure to call your health care provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at PediaCast.org. So, let's take a quick break.
We'll get our experts settled into the studio. And then we will be back to talk about the prevention of firearm-related injuries and deaths in children and teenagers. It's coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Dr. Vanessa Ng is a pediatric anesthesiologist at Nationwide Children's Hospital and an assistant professor of anesthesiology at The Ohio State University College of Medicine. Dr. Nichole Michaels is a principal investigator with the Center for Injury Research and Policy at Nationwide Children's and an associate professor of pediatrics at Ohio State. And Dr. David Kling, he is an emergency medicine physician at our hospital and an assistant professor of pediatrics at Ohio State. All three have a passion for preventing the tragedies that are firearm-related injuries in children and teenagers. That is what they're here to talk about. But before we dive in, let's offer a warm PediaCast welcome to our guests.
Thank you all for stopping by the studio today.
[Dr Vanessa Ng]
It's a pleasure to be here.
[Dr Nichole Michaels]
Thanks so much for having us.
[Dr David Kling]
Hi, yes, happy good morning.
[Dr Mike Patrick]
Yeah, I am so glad that all of you are here today. We have a really important episode this week. And, Vanessa, if you could start us off, what do we mean when we talk about pediatric firearm-related injuries?
And why does the particular definition of that phrase matter?
[Dr Vanessa Ng]
Great question. So, when we talk about pediatric firearm-related injuries, we're referring to any injury or death involving a firearm that affects infants, children, or adolescents, most usually defined as youth under 18, though some studies include young adults up to their early 20s. And these injuries can be unintentional, self-inflicted, or the result of interpersonal violence.
And those can include fatal and non-fatal harm. And this isn't just rare or extreme events that you read about in the news. It includes everyday situations like a child finding an unsecured gun at home, or a teen in crisis acting impulsively, or youth injured in community violence.
And so, the definitions really do matter, especially for healthcare providers and families, because how we define the problem shapes how we respond to them. And, you know, for clinicians, clear definitions guide our research, screening, counseling, and prevention efforts. And for families, it reframes firearm injuries as preventable health and safety issues, just like car seats or safe medication storage, rather than something like a political debate.
[Dr Mike Patrick]
Yeah, absolutely. And so, we're really talking about all comers. Regardless of the cause, if a firearm is involved in an injury or a death, it's going to get counted.
And by having that definition of what we're talking about, we can really look at trends, because we want to be comparing apples to apples, not apples to something else. When we talk about like, well, how many firearm-related injuries were there five years ago versus today? So, like we said, definitions definitely matter.
Nichole, how have pediatric firearm deaths changed over the past 20 years?
[Dr Nichole Michaels]
Great question. So, we've seen a dramatic increase in firearm-related deaths among children over the past 20 years. So, in 2024, there were nearly 4,000 firearm-related deaths in the U.S. among children and adolescents between the ages of 1 and 19 in the U.S. Longer than I've been alive, really, motor vehicle crashes were the leading cause of death for children. But in 2020, we saw a change. And that's the point when firearm-related injuries became the number one cause of death for children between the ages of 1 and 19. So that's a really sobering statistic.
You know, for myself as an injury researcher, it was really, you know, alarming and not something I really expected to see in my lifetime. And it's not something that happens in other high-income countries. It's really a problem in the U.S. Yeah, yeah.
[Dr Mike Patrick]
And more access to firearms than most other countries do. And so that comes into play. But the other thing is that these are all mostly preventable.
Almost every one of them is preventable. And we'll talk more about that because that's really what our focus is going to be on so that we can save some lives. David, what does the current data tell us about firearm injuries in kids and teens?
[Dr David Kling]
Well, as was just discussed, overall, the current data reveals firearm injuries continue to grow. Assault actually accounts for the majority of these injuries or deaths in about 67 percent of cases, followed by unintentional injuries in about 15 percent of cases, and then lastly, self-harm in about 14 percent of those cases. There are also age-specific patterns that show that children under the age of 12 are most affected by unintentional injuries, while those aged 12 to 14 years are typically affected by suicide.
And then lastly, those 15 to 18 years are affected by assault. Additionally, it's important to know and recognize that 50 percent of firearm-related deaths actually occur among Black children. While most fatal injuries occur in the home, and typically about 85 percent of cases actually, and within that, 56 percent of those are in the victim's own home, with firearms typically stored, loaded, and unlocked, unfortunately.
Also, geographic clustering shows that worsening rates in southern states and increasing rates in midwestern states with higher poverty levels correlating with higher firearm-related deaths.
[Dr Mike Patrick]
And Vanessa, can you walk us through the different types of firearm injuries we see in kids? We covered these briefly, but can you expand on them just a little bit?
[Dr Vanessa Ng]
Absolutely. So, just like was mentioned, you know, there's those three main categories. So, a little bit more in-depth.
So, those first ones that we talked about, the unintentional or accidental injuries, which I'm going to go over first, those most involve the younger kids. Typically, it happens at home. And I think I mentioned before, the most common scenario is like, a kid, a child finds a loaded and unlocked firearm, and they're super curious.
They want to know what this is, and they think it maybe is a toy, or it's just something new, and it's interesting. And so, you know, children are found to have really good, you know, developing motor skills, and they pull the trigger, and sometimes it's aimed at themselves, or sometimes it can be aimed at, you know, a sibling, a friend, an adult, someone else that's nearby. And so, these injuries are highly, highly preventable, and they're strongly linked to how firearms are stored.
So, you know, safe storage is such a central prevention strategy in those kinds of situations. And then the second type of injuries, they're most related to suicide or self-harm, and we mentioned those are most often affecting adolescents and teenagers. And so, what's especially important for those parents and clinicians to understand is, you know, a lot of those suicide attempts, and I think my colleagues will speak more to this, are just like, they're impulsive, and they're, you know, they occur during short periods of crisis.
And so, you know, someone's having a really stressful moment, and they know that there's a firearm in the house. They go and get it, and, you know, like, those moments greatly increase the risk of death. And prevention here really focuses on secure storage and seeing those warning signs and having conversations about mental health and sort of preventing that, especially during stressful life events.
And then the third that David mentioned was, are those injuries related to assault or homicide, and those are much more common in the older adolescents and within community violence, and they reflect, you know, some of those broader social factors, inequities, easy access to firearms, and those are, we're talking more like community-level prevention and informed care and intervention programs and that type of thing. And those, and all three of these, in three of these situations, injuries can be fatal, or they can be non-fatal, and both are important, and they matter.
And those non-fatal injuries lead to, you know, long-term physical disabilities, emotional traumas, significant family stress. And so, that's why we're here.
[Dr Mike Patrick]
Nichole, let's focus in on the younger children, so the unintentional shootings where maybe a kid was exploring and, you know, playing with a gun that they found at home. What are some of the most common scenarios that we see surrounding that, and then what are some ways that we can prevent that from happening?
[Dr Nichole Michaels]
Yeah, so to build on what Vanessa was just saying, you know, unintentional injuries, they make up a relatively small proportion of all firearm injuries and deaths among children. But they are somewhat unique, and they, because of the nature of these injuries, they often are a nice segue into talking about this issue without getting overly, you know, political or bogged down by political debate. Shootings among younger children typically fall into two groups.
So, we have the very young children, these are often toddlers and preschool-age kids, who find a gun in the home and often unintentionally shoot themselves. As was said, you know, they're often playing with the firearm, they may mistake the firearm for a toy. And these cases have been documented in children as young as two years old.
So, we're talking about really young kids in these cases. The other group where we see a lot of unintentional firearm shootings is among the later elementary school-age kids and kind of early middle school. And the scenario here is often children who unintentionally shoot themselves or a friend or a relative in the context of kind of showing off the gun.
So, what we see is, you know, kids might be socializing or having a sleepover, hanging out with friends, and, you know, one of the children knows where the family's firearm is stored. And so, they want to show it to the other kids. And often, you know, in these cases, the firearm will go off unintentionally and harm the child or one of the friends that's there with them.
In both age groups, interestingly, a child who shot the gun is nearly always a male. So, you know, something to kind of think about as we think about prevention. And these shootings typically occur at home, and they involve a handgun that's been stored, loaded, and unlocked.
In 2023, my lab published a study, and we were specifically looking at children younger than 15 years of age who unintentionally shot and killed themselves or another child. And when we looked at the data on how the firearm was stored, when that data was available, it was found that more than 90% of the firearms in those cases were stored, loaded, and unlocked. So, there's a clear opportunity for prevention here.
These deaths are highly preventable.
[Dr Mike Patrick]
Yeah, yeah, for sure. And so, you know, making sure that the child doesn't have access to the gun and that the gun and the ammunition are stored separately and you don't have a loaded gun in the house, those are all going to be important things. You know, one thing that I was just thinking about, when I was a kid, you know, toy guns were a thing.
And there are still toy guns out there, and there's water guns. And it seems to me, especially as we consider firearm-related injuries being the number one cause of death in kids pretty much of all ages, that maybe it's time to not have our kids play with guns, that these are something to be respected. We want to teach our kids that they can be dangerous, that they need to be used appropriately, and probably not a great idea to be playing with guns.
That's, you know, my own personal opinion, and I'm sure there will be folks who disagree with that. It is certainly one way to inform our kids that, hey, these things are serious, and that can help prevent injuries too. Now, a lot of folks, when you think about, you know, you hear that firearm-related injuries are the number one cause of death in kids, you know, it's hard, I think, to wrap our brains around that if it's not something that you see or maybe even hear about on a regular basis.
David, can you just comment on working in the emergency room? I mean, you actually see kids who are shot, right?
[Dr David Kling]
Yes, that is very true. I mean, it's something that unfortunately does happen in our own community, and as a result, they do come to our hospital. And, of course, we are prepared for these types of injuries when they do occur.
We have a whole trauma activation process that involves mobilization of multiple people within the hospital, not only the emergency medicine physicians, but the emergency medicine also nurses, as well as trauma surgeons, pharmacists, respiratory therapists. We all come together as a team to evaluate and kind of determine the level of injury related to a firearm and then decide what kind of interventions are necessary. Sometimes these patients just need some simple wound care that can happen in the emergency department.
However, other times these patients need additional resources like activation of massive transfusion protocols and involvement of the blood bank in an emergent situation, as well as emergently going to the operating room for a laparoscopy to look for injuries that need intervention and treatment in the OR setting. And then, of course, the disposition really kind of depends on the level of severity of that injury. So, of course, in nonfatal injuries, some of those patients do get to go home.
However, in more serious nonfatal injuries, they do require long, extended periods of time in the hospital, either in the ICU or on the regular surgical floor.
[Dr Mike Patrick]
And so, you really make a good point there that the headlines that we see, like on TV, it's usually when a death occurs. But we see a lot more actual injuries that don't resolve in death but still cause lots of trauma for families and lots of pain and suffering for the kids involved that don't necessarily make the headlines. But you do see, you know, certainly almost every week at least, you know, we see a kiddo come into the emergency department because of a firearm-related injury.
Vanessa, you know, we always hear about secure storage. And I had mentioned, you know, store the gun and the ammunition in separate locked places. What does safe storage actually look like?
Like, what does the box look like that you would store these things in?
[Dr Vanessa Ng]
So, in general, there's all types of different. So, safe storage, it's like practical everyday steps that families can do to keep, you know, like their firearms secure and, you know, kids from getting into them. And so, it means firearms are like they're locked away, they're unloaded from ammunition, and they're stored separately from the ammunition.
And the goal is just to prevent unsupervised or impulsive access. And so, they literally look like sort of mini security. Like, they're like, they can be metal, and they're like a lockbox or a lock combination.
Oftentimes these days there's like some biometric, you know, lock prevention type of thing. And those are the lockboxes and safes. And then you also have cable locks or trigger locks, which actually kind of wrap around the, you know, trigger, so that you cannot depress it.
And so, there's so many different options. They're available many, many places at, you know, at the fire station, at the hospital. And so, choosing a storage option that fits like a family's sort of like daily life, their routine, and then their access needs are, you know, that's our goal.
And then every once in a while, just like revisiting like how you're storing, you know, your firearms, just as children grow and your circumstances change. And so, I just want to emphasize that, you know, safe storage doesn't mean anything about firearm ownership. It's just adjusting how we store them to match, you know, a family's, you know, situation and maybe their children's developmental stages and current risks.
[Dr Mike Patrick]
In many ways, it's kind of like seatbelts. I mean, I can remember a time when, you know, very few people actually used seatbelts. And then we had public safety drives and really normalized the use of seatbelts.
And now for a lot of us, like you get in a car and you, you know, if you don't put that seatbelt on, something feels off, something feels wrong. So, we've really allowed seatbelts to become a part of our daily life and really safe gun storage. If we're going to decrease the number of deaths in kids and teenagers, that safe storage, we're going to have to embrace that or those numbers.
It's going to be difficult for those numbers to come down, which we certainly want to do. And I think also that families ought to think about risk versus benefit. We do that in medicine all the time.
You know, as we think about treating folks for a particular disease, well, what are the impacts of the medicine going to be? So, we think about risks and benefits all around. And with firearms, you know, folks who do keep a loaded firearm, you know, maybe in the bedside table or something, you know, they're thinking, oh, I need this quickly for safety.
But if you think about what is the real risk of someone breaking into your home versus the real risk of your child getting into the firearm and hurting themselves or killing themselves or hurting or killing someone else, then, you know, that risk-benefit ratio, you know, it's more dangerous for our kids than an intruder actually that happening. So, a lot of things to think about. Beyond the home, what community or policy approaches have been shown to reduce pediatric firearm injuries?
[Dr Nichole Michaels]
So, health education is often our go-to, you know. And as someone who started their career as a health educator, you know, there is a place for education. Education of family members, parents, education of children.
Education isn't enough from an injury prevention standpoint. So, you know, ideally, you know, the education that we're giving to parents and caregivers is paired with the distribution of those safer storage devices, as Vanessa was saying, you know, the trigger locks, the lock boxes. We do know, however, that gun safety education programs that are designed to teach children what to do if they encounter a gun have not really been shown to be effective at changing their behavior or changing their risk of an injury.
So, I try to emphasize to parents that it's really the responsibility of adults to keep firearms out of the hands of children. And beyond that, you know, if we really want to move the needle on firearm injuries and deaths among children, the research shows us that policy change is needed. So, you know, the motor vehicle analogy is a great one.
You know, if you think back to the 80s, there was a lot of drinking and driving going on, right? And so, there was kind of this grassroots movement to not only make that socially unacceptable, but also to get policies put into place that put restrictions on drunk driving. And so much in the same way, you know, the U.S. has a lot of guns. We have more civilian-owned guns than people, actually. And we know that more guns in the home can lead to more firearm-related suicides, homicides, and unintentional deaths among youth as well as adults. So, if we want to prevent firearm-related harms among children, we need to do a better job of storing our guns.
And we know that policies mandate secure storage to prevent children from accessing guns can reduce all forms of firearm-related injury and death. And it's worth noting that Ohio does not currently have any child access prevention laws that require people to store their firearms securely. So really kind of an opportunity for folks to think about if we want to move the needle on this topic.
And last but not least, we need more research on how to prevent firearm-related injuries. For many years, the federal government was restricted from funding research on this topic. And now, even though some of those restrictions have been lifted, research on how to prevent firearm-related injuries really only gets a tiny fraction of the funding that's provided for studying other conditions that impact children.
So those are just kind of some opportunities to make improvements here.
[Dr Mike Patrick]
Yeah, absolutely. As we think about it from the family's perspective, there's a lot that families deal with when firearm injury occurs. So, it's not just the physical injury, but there's a whole burden from, you know, mental health, trying to prevent this from happening again.
There may be disagreements between mom and dad on how we store the firearm. I mean, just lots of things is really a pretty big burden for families. Can you talk more about that?
[Dr David Kling]
Well, first, we definitely have to just at least acknowledge that actually non-fatal injuries occur twice as frequently as fatal injuries. And as, you know, both of them will have impacts on the family, these non-fatal injuries, of course, are a significant number of these injuries and therefore have like one of the largest burdens affecting on these families and the patients themselves. These non-fatal injuries represent kind of a substantial and often underrepresented component of the pediatric firearm injury burden.
For example, through one year after injury, children and adolescent survivors experience actually 117% increase in pain disorders, a 68% increase in psychiatric disorders, and 144% increase in substance use disorders compared to match controls. Interestingly enough, only 14% of patients had psychiatric follow-up or at both 30 days and one year after injury. Kind of suggesting significant gaps in mental health care and areas that we can make improvements on.
Additionally, family members experience significant mental health impacts as well, which parents of survivors have experienced 30% increase in psychiatric disorders. Lastly, the economic burden is also important to mention is quite substantial for both families and the health care system. One study found that total cost of care for all pediatric firearm injuries is approximately $26 million.
And then the mean individual hospital cost for a firearm injury is five times greater than that for a motor vehicle injury.
[Dr Mike Patrick]
Yeah, as we think about both just the injuries and the deaths and how these impact families and how they are preventable, it seems like this is something that would be really important to talk to families about. Vanessa, you know, conversations regarding all of this can feel uncomfortable between providers and parents and families and kids and teens. Why is stigma such a barrier when it comes to talking about this issue?
[Dr Vanessa Ng]
I think it's such an important thing to acknowledge. The discomfort is very real. And stigma is a big part of why these conversations can feel so hard for both families, you know, between friends and families and health care providers.
You know, firearms these days in particular carry a really strong personal, cultural and emotional meaning. You know, some families will say like, well, I went hunting with my family. You know, this is why we have hunting rifles.
It's that if there's something significant, you know, tied to like protection, tradition, identity, and those are big things. And, you know, for other people, they're associated with fear or trauma or loss. And that's incredibly significant as well.
And because of this, you know, discussions can feel very judged. It's, you know, and nowadays there's like this political sort of overtone to them. And sometimes it's intrusive.
People feel like this is their private business. This is, you know, you know, something related to, you know, their rights. And so even when the intent is simply to keep our children safe, there's, you know, this heaviness to it.
And so, a lot of families in particular, they feel they're going to be blamed. They're going to be reported. They're going to get into trouble.
And then on the flip side, clinicians and healthcare providers, you know, they're thinking, oh my gosh, you know, I'm damaging the trust with this family. I'm saying the wrong thing. And so, in the end, the conversation just gets completely avoided altogether.
And so, it's, you know, stigma also affects what people are sharing. You know, what they feel safe sharing. And, you know, parents may hesitate to disclose that there's a firearm in the home and, you know, storage isn't as secure as they really would like.
And teenagers, oftentimes, you know, they're going through so much emotional distress or a very stressful period of time. And so, you know, those things can stay hidden. And, you know, when in reality those things are hidden and not talked about, you know, we're missing these opportunities to make things safer and the community safer.
And our children safer. And I feel incredibly strong about this because in the operating rooms as an anesthesiologist, I see what happens to these children. And it is so terrible at times that it is, you overcome that fear because it is so important.
And I think with something like this as a podcast, we can just talk about it with no judgment. It's just really very much sort of like some facts and things that we see and sort of like this background. We're going to start that conversation, and we can break that stigma of like no one's talking about it.
Well, here we are. We are. We are talking about it.
And so, I think the big thing for hopefully that families and health care providers can take away from this, that it's important to talk about this openly. And, you know, firearm safety conversations work best when they're just framed as routine, respectful, nonjudgmental. It's like seatbelts or safe sleep or wearing a helmet when you're riding a bike.
It should just be we should turn it into something that is just we talk about it every day.
[Dr Mike Patrick]
Yeah. Yeah. You know, when we talk about seatbelts, we aren't saying, oh, you shouldn't drive.
Or if we're talking about safe sleep, we're not saying, you know, don't have a crib. You know, like how do we do this safely? And that's the same thing with firearms.
We're not saying don't have one. How can we keep our kids safe if you do have one? Nichole, a particular family might not have a firearm at home, but it is very likely that they have friends who do have firearms in the home.
What does that conversation look like for families in terms of, you know, amongst themselves, but then also communicating with other families that our kids may be visiting their homes?
[Dr Nichole Michaels]
Yeah. You know, I think the key is really just to kind of normalize these conversations. As Vanessa was saying, you know, normalize asking about firearms in the home.
You know, when you're talking with other parents and caregivers. I know this can feel really uncomfortable at first, kind of awkward. You know, how do I start this conversation?
As a parent myself, you know, I've had these conversations. I know at first, I was very nervous about talking to other parents. You know, what are they going to think?
You know, I'm this, you know, crazy injury lady, you know. But, you know, I think the more that we do it, the more it becomes less uncomfortable. And we also are modeling for other parents.
Right. And so, when we're setting up play dates, I encourage parents to ask about firearms in the home the same way that they might ask about, you know, pets in the home. Or the same way you might tell a parent, you know, hey, my child has a peanut allergy.
You know, just kind of make it part of your routine. So, words that you might use would be, you know, something like, you know, hey, my son is super curious, so I always like to ask other parents. Do you have any guns in your home?
And if so, you know, how are they stored? And if you're a gun owner yourself, you know, it's also important that you have these conversations. So, you might say something like, you know, I know, you know, Johnny's coming over.
Just wanted to let you know that the kids are going to watch a movie. It's rated PG. You know, we have a dog.
He's very friendly. And also, you know, we have a handgun in our home, but we keep it locked, unloaded, and we keep the ammunition stored in a separate locked space. You know, and just, you know, the more that we talk about these things, the more comfortable it becomes and the more normalized it is.
And so, you know, as parents, we are asked to do a lot of hard things when we're raising our kids. And so, you know, this is just one more thing where we can, you know, have these conversations to keep our kids safe.
[Dr Mike Patrick]
Yeah, yeah. So, so very important. David, you know, clinicians often counsel families about this, and we touched a little bit on that when Vanessa was telling us about just conversation surrounding.
What are some challenges that are unique to clinicians? And we, even though this is a parent podcast, we do have a lot of pediatric providers who also, what are some challenges that we as medical providers face? And how can we overcome those in counseling families about firearm safety?
[Dr David Kling]
Very important question to think about and kind of have this conversation. Again, starting the conversation is somewhat the hardest part, and that's the biggest barrier that clinicians face. Beyond that, you know, they feel like counseling families about firearm safety is also very important.
However, there's low rates overall in terms of routine counseling. There's also a lot of concerns about the patient's and parents' receptivity to this conversation. And of course, there's lack of formal training on having these kinds of conversations.
However, recent evidence suggests that these challenges are being addressed through improved tools, standardized approaches, and growing recognition of counseling effectiveness. Only 28% of pediatric clinicians, however, report routinely counseling on secure firearm storage. And just 2% of those clinicians actually offer some type of safety device during well child visits.
This low implementation occurs despite the American Academy of Pediatrics recommendations for anticipatory guidance on this topic. Additionally, patient-slash-parent receptivity kind of varies significantly and presents a key challenge as well. While 66% of parents believe pediatricians should ask about firearms, only 13% actually report having this discussion during their routine visits.
Additionally, firearm-owning parents are sometimes less open to these conversations, with about 14% reporting they would be offended by these kinds of conversations. However, on the flip side, 63% stated they would think it over or follow the advice from a pediatrician. This evolving landscape shows promising improvements in addressing these barriers.
Patient-centered counseling methods using motivational interviewing, emphasizing nonjudgmental, nonconfrontational, apolitical conversations, and demonstrate greater acceptability and efficacy than direct approaches. And some of those key elements of successful screening include maintaining a conversational tone, representing patients' firearm knowledge and respecting it, and using neutral terminology such as firearm rather than gun, and framing discussions around injury prevention rather than limiting ownership.
[Dr Nichole Michaels]
So just to add to that, I think another important thing to kind of keep in mind for clinicians is really considering and being open to why families have guns and why they may have them in an accessible place, right? As we talked about earlier in the conversation, you know, families sometimes have guns in their home for protection because of concerns about safety. And so I think really just taking the perspective that we want to work with families and that we're, you know, it's an open dialogue where we, you know, are trying to understand kind of their perspective and, you know, what their legitimate concerns may be about, you know, having access to their firearm.
[Dr Mike Patrick]
Yeah, yeah. And again, this may be an uncomfortable conversation, especially if you're not used to having this conversation, if it's not a normal part of your script for a well visit as a clinician. But, you know, there are so many things that we can talk about during well visits and that sometimes, you know, we feel like, well, we can't cover everything because there are just too many things to cover.
But this particular issue is so important because it's the leading cause of death across all age groups during childhood and during the teenage years. And so, we really need to prioritize it given how common it is. And yet less than 15% of the time is it actually talked about during well checkup visits.
And that's on us as physicians that we really do, and other pediatric providers as well, that we really do need to bring this up, especially when we have families attention during those well visits.
[Dr David Kling]
Yeah, I just want to also emphasize, like, to your point, you know, there's a lot of topics that are covered during a well child visit. And then if you factor in any other parental concerns that might be brought up during those conversations, it can be very difficult to kind of then weave into this another potentially sensitive topic such as firearms. So, as a clinician that doesn't typically do routine visits, well child visits, and I see people more in an emergent setting, I still think there is room for us to kind of have these conversations and kind of involve them into our typical routine when we see patients in various settings throughout the medical system.
[Dr Vanessa Ng]
And just to go along with David's, you know, sort of line of thought is, you know, I'm an anesthesiologist and I care, the surgeons care, we care. And so we're trying to, you know, implement more things even into like the perioperative, you know, setting because we know that we just, we care and we want to, you know, catch anyone and everyone at any touchpoint with the hospital and offer those, you know, that education, the opportunities, lockboxes, you know, just anything more that will make, you know, our children and the community safe.
[Dr Mike Patrick]
Yeah, yeah, absolutely. There's so many things that are out of our control when it comes to our kids and their health. And there are certainly disease processes that we, you know, may be genetic and there's just not a lot we can do to prevent it from happening.
We can just figure out what's the best way to treat it and manage it and hopefully improve kids' lives who are impacted by those illnesses and diseases. But when we're talking about firearm-related injuries, almost across the board, these are preventable. And so, it is so important to, again, to talk about.
Before we go, David, can you just sum up the main points of preventing these injuries? What do parents need to know to keep their kids safe?
[Dr David Kling]
You know, I think first, overall, we just need to continue having these conversations as a society, as a group. It doesn't matter what you do on a daily basis, what your background is. These are kind of conversations that affect all of us.
And again, to everyone's point, this is preventable. And the key points to remember of how this can be preventable is, one, keep guns locked, keep them unloaded, and keep them in a secure position away from the ammunition as well. And then, of course, when your child is at the appropriate age, also have a conversation with them about gun and firearm safety.
[Dr Mike Patrick]
Absolutely. We are going to have a ton of links over at the show notes. So, if you head over to pdacast.org, this is episode 598. Just check out the show notes for this episode, and we do have a lot of resources for you. Just some examples, we have the American Academy of Pediatrics Policy Statement and Technical Report on firearm-related injuries and deaths in children and youth, and that focuses on injury prevention and harm reduction. We also have Pediatric Firearm Injury Mortality Epidemiology.
So, if you want to know more about the numbers and what this looks like, in what groups are at higher risk for this, we do have an article on that from the journal Pediatrics. Lots of other scientific articles. We also have stuff for families.
Gun Violence Archive. This is a near real-time count of firearm injuries and trends in the USA, if you want to see what's happening now. Every Town for Gun Safety.
This has community plans to end gun violence. We have firearm violence prevention from AAP Advocacy, which is American Academy of Pediatrics. And even the Ad Council has an initiative called Agree to Agree, and we'll put a link to that in the show notes as well.
So, lots of stuff there for you if you head over to pdacast.org. Again, episode 598. So once again, Dr. Vanessa Ng, Pediatric Anesthesiologist, Dr. Nichole Michaels, Principal Investigator with the Center for Injury Research and Policy, and Dr. David Kling with Pediatric Emergency Medicine, all from Nationwide Children's Hospital. Thank you all for stopping by and chatting with us today.
[Dr Vanessa Ng]
Thanks so much, Dr. Mike.
[Dr Nichole Michaels]
Thank you.
[Dr David Kling]
Thank you for having us.
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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. We really do appreciate your support. Also, thanks again to our guests this week, Dr. Vanessa Ng, Pediatric Anesthesiologist, Dr. Nichole Michaels, Principal Investigator with the Center for Injury Research and Policy, and Dr. David Kling, Pediatric Emergency Medicine at Nationwide Children's Hospital. Don't forget, you can find us wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is pdacast.org.
You'll find our entire archive of past programs there, along with show notes, our terms of use agreement, and that handy contact page if you would like to suggest a future topic for the program. Reviews are also helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.
You'll find us on Facebook, Instagram Threads, LinkedIn, X, and Blue Sky. Simply search for PediaCast. A couple of other podcasts to tell you about.
One is PediaCast CME. That stands for Continuing Medical Education. It's similar to this program.
We do turn the science up a couple notches and offer free continuing medical education credit for those who listen. It is Category 1 credit, not only for physicians, but also for nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. It's because Nationwide Children's is jointly accredited by all of those professional organizations, it's likely that we offer the credits you need to fulfill your state's continuing medical education requirements.
Shows and details are available at the landing site for that program, pdacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.
An additional podcast that I host is FAMEcast. This is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. If you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you.
You can find FAMEcast at famecast.org and wherever podcasts are found by searching for FAMEcast. Thanks again for stopping by, and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
[MUSIC]
