After violent attacks on children, more calls for controls

The spate of violent attacks that killed one child and injured 20 others in Pennsylvania this week is bound to create repercussions far beyond the immediate needs of the survivors and their families.

Violent incidents like these can instill fear and anxiety among witnesses and the broader community that over time can breed more bloodshed, said Joel Fein, an emergency room doctor and codirector of the Violence Prevention Initiative at Children's Hospital of Philadelphia.

The first victim, Jamara Stevens, 11, was killed Saturday when her 2-year-old brother accidentally shot her with a cocked .357-caliber revolver that he had found on top of the refrigerator in his West Philadelphia home.

The next afternoon, Kashie Crawford, also 11, was playing basketball on a Gratz Street playground with friends when he was caught in cross fire between strangers and shot in the back. He is recovering at St. Christopher's Hospital for Children.

Then, Wednesday, 19 teenagers were stabbed in a Pittsburgh-area high school by fellow student Alex Hribal, 16, who went on an inexplicable rampage. Three victims were seriously wounded and one is in critical condition.

"These events happened so closely together that you can't help juxtapose them in your mind," said Fein.

As brutal as the attacks were, several emergency care pediatricians said that if Hribal had been wielding guns instead of knives, the outcome would have been more deadly.

While the general public is deeply divided over gun control, the medical community largely is not.

The American Academy of Pediatrics, for example, advocates for stronger gun laws, including mandatory background checks on all firearm purchases and a ban on high-capacity ammunition magazines.

But rather than get mired in arguments, pediatric trauma specialists say the public should work to better protect children and help heal those who have been traumatized.

"I think there should be stricter gun laws and policies," said Denise Dowd, a pediatrician at Children's Mercy Hospital in Kansas City, Mo., and one of the primary authors of the academy's policy statement calling for stronger firearms control. "But really, what parents need to know is that little kids are curious and big kids are impulsive, and you can't educate them out of it."

Biologically, she said, a child's brain is not sufficiently developed to exercise restraint.

"You can teach a child how to safely cross the street," she said. "You can train them to stop and look right and left and right again. But they don't apply what they've learned at the time of risk. In a park, playing soccer, everyone's revved up. A ball gets kicked into the street. They run to get it. They don't have prefrontal cortexes - the thing that applies the brakes."

Fein suggested the focus should be on making sure that if firearms are present in a home, they are kept locked, unloaded, and out of children's reach. It is also essential to provide psychological and emotional support to those who have been traumatized to help them feel safe again.

"If they don't," Fein said, "they may develop traumatic stress and react in a way that eventually may hurt someone else."

There are multiple programs in Philadelphia, run by nonprofits, the city, and hospitals, Fein said. These include Every Murder Is Real, Healing Hurt People, and Don't Fall Down in the 'Hood.

Often, he said, those who commit violence have been exposed to trauma early in childhood. "We have an obligation to understand what that does to people," he said. That understanding "doesn't condone the behavior," but helps caregivers and law enforcement do their jobs more effectively.

Dowd similarly noted that children who live in neighborhoods where violence is endemic are more prone to "toxic stress."

"The biology of survival, when confronted with a threat is to fight, run away, or freeze," she said. "When the stress response in kids is activated over and over again, it bathes their brain in stress hormones. Their adrenal glands are always going."

The effect, she said, is that they become hyperaware and overreact to any hint of harm.

"It takes a lot of thought and energy to protect our children," said Fein, "But that's what needs to be done."

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