Guns and Kids: What Do We Know About Injuries and Prevention?

Interviewer: Laurie Scudder, DNP, NP; Interviewees: Kavita Parikh, MD; Michelle S. Sandberg, MD


June 21, 2017

A recent review article[1] by Kavita Parikh, MD, and colleagues, published in Hospital Pediatrics, reported on the tragic number of deaths and injuries in children in the United States resulting from firearms. While motor vehicle accidents long held the number-one position as the most common cause of death in children, firearm incidents have just about caught up and now are implicated in 20,000 emergency department visits annually. In an accompanying commentary,[2] Michelle S. Sandberg, MD, and Nancy E. Wang, MD, argued for pediatricians and other clinicians to adopt a stance of pragmatic advocacy that addresses controversies and myths, and uses data to educate families on the strategies most likely to decrease injury and death.

Medscape spoke with Drs Parikh and Sandberg about these papers and their key take-away messages for both hospital and community clinicians.

Medscape: Dr Parikh, could you quickly summarize the key data points in your examination of firearm-linked events in children?

Dr Parikh: The numbers speak volumes. In 2015, there were over 4500 deaths due to firearm violence in children and young adults less than 21 years of age, which was startling. Firearm-related mortality is among the top four causes of injury deaths in our American youth.

Kavita Parikh, MD
Image courtesy of Children's National Medical Center

In our paper, we examined the prevalence of firearms in the homes of children in this country. While that number was variable based on geography, it ranged from 18% up to as high as 64%. Firearms are in the homes of our children and, unfortunately, many parents have a false sense of security about whether their children can or have accessed that firearm. While 40% of parents believe that their child does not know the location of the firearm, and more than 20% of these parents think that the child has never handled a firearm, that is just not the case.

There is a disconnect between what parents believe and what the children and adolescents actually report. When researchers spoke to the adolescents, they very clearly say that they know where the firearms are and that they can access them.

One finding from our review that really stood out to me is from an emergency department survey of 300 adolescents. These investigators found that 28% of teenagers reported that they could access a loaded firearm within 3 hours and added that it would not be difficult. The fact that parents have such a false sense of security about the firearm in the home, and believe that children cannot access them, really stood out at us.

Medscape: Dr Sandberg, your paper detailed what you called three myths of firearm injury and death. What are they?

Michelle Sandberg, MD
Image courtesy of Dr Sandberg

Dr Sandberg: The first myth is that the majority of firearm deaths are caused by mass shootings by the mentally ill. The reality is that mass shootings actually account for less than 1% of all gun homicides. They represent a tiny fraction of firearm deaths. The mentally ill are much more likely to be victims of violence than perpetrators.

The second myth is the belief that a gun in the house makes the household safer. This is a big one, because many people in this country believe that a gun in their house will allow for self-defense. But the statistics show that a gun in the home is 22 times more likely to be used in domestic homicide, suicide, or unintentional shooting than to be used in self-defense. Many people don't know this. So they may buy a gun thinking that it will keep them safer, when, sadly, in reality the exact opposite is true.

The third myth is something Kavita just addressed, which is a parental conviction that their child doesn't know that there is a gun in the home and would not handle the gun. Kavita and her colleagues noted in their review article that about three quarters of children living in households with guns knew where the gun was stored. More than a third reported having handled the gun.

That information is important and, I think, has not been touched upon much in the literature. And so I was just delighted to see this being addressed, because I think it's really important information for pediatricians and families to know about.