Joel A. Fein, MD, MPH, co-director of CHOP’s Violence Prevention Initiative, is an attending physician in the Emergency Department at The Children’s Hospital of Philadelphia.
The Violence Prevention Initiative (VPI) at The Children’s Hospital of Philadelphia frequently fields questions from healthcare providers on how to counsel families about gun safety. As pediatricians, our goal is to keep our patients and families safe and healthy, and this type of counseling fits squarely in our wheelhouse.
Whether you practice in a rural, suburban, or urban area, your patients have a good chance of living or playing in 1 of the 40% of homes where there is a gun. Research has shown that even when parents think that they keep the gun where the child cannot find it, 3 in 4 children (ages 5 to 14) know where it is stored. Further studies have shown that even children who are “taught” not to handle a gun, to parents’ surprise and dismay, will eventually pull that trigger. From the preschooler’s natural curiosity to the adolescent’s vulnerable emotional moments, having access to a firearm is a recipe for tragedy, as news reports too often remind us.
The topic of guns is polarizing, and you may feel uncomfortable bringing it up. Placing this conversation in the context of other anticipatory guidance — about child-proofing a home to prevent falls, poisoning, drowning, or burns — is a way to have an effective conversation about keeping children safe generally. If gun removal is not an option for the family, don’t judge. Instead, talk about safe storage of guns and ammunition and why these maneuvers are so critical. Avoid talking about gun rights and gun control; focus on children and best practices to keep them safe.
If your patient families don’t have guns, it is still likely that their friends or infrequent caretakers do. Empower families to ask about the presence of guns in any home their child will visit and if they are safely secured. I have 3 boys, and before any playdate I gently asked other parents that exact question, letting them know that I feared my highly curious son could find almost any hidden object in an incredibly short time. This was always well received, as I was not passing judgment on the family.
On the VPI website, injury.research.chop.edu/violence-prevention-initiative, you can read more about the issue of gun violence, see counseling tips at different developmental milestones and watch a webinar on counseling families.
Draft bills restricting physicians from asking specifically about gun ownership have been considered by multiple state legislatures and strongly opposed by medical societies such as the American Academy of Pediatrics. Only Florida has passed this type of law, which due to a current injunction, is not enforced. In the case that this does formally pass, Florida HCPs can still provide firearm safety education universally without asking specifically about a gun in the home.