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Ask the Pediatrician: How firearm safety begins at home

Lois K. Lee, MD, MPH, FAAP, American Academy of Pediatrics on

Published in Health & Fitness

Firearm violence has become the leading killer of children and young adults under 24, surpassing deaths from vehicle collisions since 2017. And while daily headlines emphasize news of mass shootings, most firearms-related deaths and injuries are preventable and occur in a familiar place -- at home.

June is National Gun Violence Awareness Month and the American Academy of Pediatrics is not only calling attention to the sobering statistics, but is also offering tools and tips for families, communities and governmental entities to help prevent gun violence. Parents can learn more at HealthyChildren.org.

About 80% of firearm-related suicides take place in the home of a youth or a relative, with the firearm belonging to either the youth or parent or caregiver in 90% of cases. Approximately 40% of U.S. households with children have firearms, of which 15% stored at least one firearm loaded and unlocked, the storage method with the highest risk.

Between 2015 and 2022, there were at least 2,802 unintentional shootings by children 17 years old and younger. These resulted in 1,083 deaths and 1,815 nonfatal firearm injuries, nearly all among other kids. And at least 895 preschoolers and toddlers managed to find a firearm and unintentionally shoot themselves or someone else during this time.

Firearms are pervasive in America but we do have reason for hope. Research has shown us there are effective ways to prevent or reduce the risks of harm, just as our country did to improve motor vehicle safety. This is a public health epidemic that we can do something about, through a combination of regulation, legislation, product design, education and individual steps like securely storing firearms in the home.

Pediatric practitioners are encouraged to counsel families, offer mental health screenings and promote secure firearm storage as part of routine patient visits. As with other consumer products, the AAP supports regulating firearms for safety and notes that national requirements could be established for safe storage, training, licensing, insurance coverage and registration of individuals purchasing firearms.

Extreme risk protection order (ERPO) laws, also known as "red flag laws," which prohibit individuals at risk of harming themselves or others from purchasing or owning a firearm by a court order, are also becoming more common among states.

If there are firearms in the home, evidence shows that the risk of injury or death—both unintentional as well as from an intentional shooting-- is greatly reduced when they are securely stored. This means storing the firearm unloaded and locked away from children, with the ammunition locked in a separate place that youth can’t access. For households who store their firearms loaded, firearm lockboxes and safes can be used so curious children or teenagers at risk for suicide or homicide, can’t access them without an adult. When there are individuals at risks of suicide or homicide in the household, storing firearms outside of the home (e.g. shooting range, firearm seller) is another option.

 

One study demonstrated that if 20% of parents who currently store their firearms unlocked instead stored their firearm and ammunition locked away separately, there would be an estimated decrease of up to 122 pediatric firearm-related fatalities and 201 injuries annually nationwide.

Even when they've been trained not to touch firearms, we know that young children are curious and will often pick up a firearm–and even pull the trigger–if they find it. Make sure, wherever your child is going this summer for playdates and vacation–including the homes of relatives–that you ask about how firearms are secured in the home.

You can frame this as a safety conversation and first talk about food allergies and car seats. And then ask about how any firearms in the home are stored. But also think about your other options if you have concerns about how firearms are stored in the home–perhaps offer to meet at a park or museum or at your house instead.

Ultimately, we will need a multipronged approach to substantially decrease firearm injuries and deaths to U.S. youth. This is a public health epidemic that requires urgent, deliberative action. We must do better – our children deserve it.

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Lois Lee, MD, MPH, FAAP, Chair of the American Academy of Pediatrics Council on Injury, Violence and Poison Prevention, is a pediatric emergency medicine physician at Boston Children’s Hospital and Associate Professor of Pediatrics and Emergency Medicine at Harvard Medical School. Dr. Lee has published seminal research on pediatric emergency medicine, health disparities and injury prevention, including related to firearms. Dr. Lee’s expertise was recognized with her election to the National Academy of Medicine in 2023.


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