AAP Urges Pediatricians to Inform Parents About Gun Safety

Barbara Boughton

October 18, 2012

The American Academy of Pediatrics (AAP) today released a policy statement urging pediatricians to counsel parents about the dangers of allowing children and adolescents access to guns. The statement, an update of a position paper first published in 2000 and reaffirmed in 2004, was published online today in Pediatrics and will appear in the November print edition of the journal.

The AAP statement also advocates strong legislative and regulatory reform aimed at preventing firearm injuries and deaths in children, including the reinstatement of the assault weapons ban and closing the "gun show loophole."

"We are renewing our call to counsel parents on safe gun storage," said O. Marion Burton, MD, immediate past-president of the AAP, in a press conference that occurred in advance of the AAP 2012 National Conference and Exhibition. Dr. Burton noted that the children are safest in a home without guns, but the risk for injury and death is reduced if guns are stored unloaded and locked up with ammunition locked in a separate place.

"Pediatricians routinely offer this kind of safety advice along with other counsel at healthcare intervals," Dr. Burton said.

Counseling parents about safe gun storage became an issue in Florida last year when the state's legislators passed a law forbidding clinicians from asking patients whether they own a gun. The law has since been overturned by the Florida federal courts and is being appealed by the state of Florida and the National Rifle Association (NRA).

The AAP's position paper was not prompted by the Florida case, the group said, and was actually planned before the state's gag law on pediatricians was put in place. "Since 2000, there's been increasingly solid scientific evidence that our previous recommendation to store firearms unloaded and locked really does work to reduce gun injuries to children," said pediatrician M. Denise Dowd, MD, MPH, one of the 2 lead authors of the AAP position statement. The paper was written by the AAP's Council on Injury, Violence, and Poison Prevention Executive Committee, which has 11 additional members.

In 2005, a case-control study published in JAMA showed that storing firearms unloaded and in a locked location with ammunition stored and locked separately significantly reduced the risk for suicide attempts with guns and unintentional injuries from firearms among children and adolescents.

Although studies indicate that counseling children and teenagers about the danger of guns is not effective in preventing injuries or death from firearms, results of a large national randomized controlled trial published in Pediatrics in 2008 showed that brief physician counseling aimed at parents combined with the distribution of gunlocks may be effective in promoting safer storage of guns in homes with children, Dr. Dowd said.

Although firearm-related deaths in children and youths have declined since 1992, the presence of guns in a home is a very real danger to children. In 2010, a total of 15,576 children and adolescents younger than 20 years were treated in hospital emergency departments for firearm-related injuries, and 114 children and adolescents died from unintentional firearm-related injuries in 2009, according to the AAP position paper.

"We know that 90% of the time when an adolescent attempts suicide with a gun, he or she will succeed," Dr. Dowd said. The presence of guns in a home increases the risk for suicide in youth, even in those without a previous psychiatric diagnosis, she noted.

"As an emergency room physician I've seen many gunshot wounds, suicides, and homicides that have resulted from the use of guns by children. These injuries and deaths not only damage children but rip families apart," commented pediatrician Bernard Dannenberg, MD, director of the pediatric emergency department at Lucile Packard Children's Hospital at Stanford in Palo Alto, California.

Dr. Dannenberg noted that conversations with parents about gun safety should be a part of well-child visits. "We counsel parents about everything from nutrition to safe storage of medication, so asking parents about handguns and making suggestions about safely storing them can be part of our job," he said.

Pediatricians routinely ask children and adolescents about private matters, such as sexual activity and sexual orientation, to know whether to provide counsel about safe sex practices, Dr. Dannenberg pointed out. "As long as we ask questions about guns in a nonjudgmental way, it can be part of the conversation during a healthcare visit. It's about creating a safe environment for children.

"It's not the job of a pediatrician to tell people how to live their lives, but to point out safe practices," he said.

Dr. Burton, Dr. Dowd, and Dr. Dannenberg have disclosed no relevant financial relationships.

Pediatrics. Published online October 18, 2012. Full text