A public health crisis: Gun violence and children

We are facing a firearms epidemic. Almost every day, there are stories in the news about children and adolescents who are injured or killed by firearms. While approximately 20,000 children between ages 1 and 19 die of all causes annually, firearms account for just over 8 percent of all child deaths. Many of these fatalities could be prevented, but we are not doing enough to address this public health crisis at the state, provider, or parent level.

The shooting in Las Vegas that left 59 people dead, almost 500 wounded, and tens of thousands of people with the psychological distress from being present at the scene during and after the massacre has once again raised the issue of what can be done about guns in this country. "The solution lies in not just focusing on Las Vegas and the hundreds of other mass shootings that have occurred in the United States in the last 14 months, but rather to underscore that on average almost 100 people die each day in the United States from gun violence," said an editorial released online from JAMA earlier this week.

When focusing on children and teens, approximately 111,000 emergency department visits nationwide involved children and adolescents injured by firearms between 2009 and 2013, according to research presented by Shipa Patel, MD, of George Washington Medical School, at a recent American Academy of Pediatrics meeting.

Patel reviewed regional data on shootings and emergency departments and compared them based on the Brady Gun Law Score, a measure of the strength of the laws for each state. The score includes background checks and limits on open carry assault-style weapons. Essentially, he found that in the Northeast, where there are stricter gun laws, fewer children were shot and taken to emergency departments. Over three-quarters of the shootings were accidental, involving older teens, with more than 90 percent treated at urban hospitals, he found. Stricter gun laws thus appear to result in a safer environment for our young people.

Nationally, shootings resulted in 1,670 child deaths per year from 2009-2013. One missed opportunity to decrease those deaths was highlighted in a follow-up paper presented in the same session, which indicated that although pediatricians routinely counsel families about bicycle safety and wearing helmets, only about one-third of pediatricians counsel families regarding firearms. In 2012, 135 children died in bicycle accidents, with the majority not wearing helmets. For every child killed riding a bicycle, there are 12 killed by firearms.

Several years ago, there was a law in Florida banning physicians from discussing this issue with families. While that was overturned, it did tend to suppress any discussion of gun safety in the home.  Firearm safety is clearly a public health issue, and parents need to be aware and informed about how to keep their children safe.