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Guns in the Home: An Opportunity for All Pediatricians to Help Prevent Firearm Injuries

Sanghee Suh, MD
February 5, 2018

On a Saturday night in Northeast Philadelphia not long ago, a 3-year-old boy was shot unintentionally by his older brother after he found an unlocked and loaded gun in the home. The younger boy was rushed to the nearest emergency room, where he was intubated and remained comatose in the intensive care unit.

As a first-year resident at the hospital, I spoke with his mom. Through her tears, she described the echoing gunshot she heard from the kitchen and the terrifying silence that followed. In the context of her sorrow, I began to understand the need for greater commitment to promoting firearm safety in the home to help prevent these tragically common injuries.

​On a single day in the United States, according to a recent Pediatrics study, an average of 19 children die or are treated in an emergency department for a gunshot wound. Child deaths from firearms surpass casualties from influenza and pneumonia, heart disease, and congenital anomalies. In fact, the most recent federal statistics show it's the third leading cause of death among U.S. children. 

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"The American Academy of Pediatrics states that the absence of guns in homes is the most reliable and effective measure to prevent firearm-related injuries in children.

While they have similarly devastating effects on families, however, the mechanism of firearm injuries generally fall into three distinct categories:

  • Unintentional injuries. These represent a relatively small fraction of all firearm injuries but frequently are fatal or cause permanent disability. Research shows that unintentional firearms injuries often result from siblings or friends having access to loaded firearms in the home. It's also been shown that children have the ability to pull the trigger on a handgun as early as age 3.
  • ​Homicide. Recent national data identify homicide as the most common firearm-related injury among children. If there is a firearm in the home, the risk of homicide can triple.
  • Suicide. Having increased steadily over the past 15 years, suicide is the second most common firearm-related injury among young people. Studies show most suicidal children spend less than 10 minutes deliberating their choice. While mental health screening is essential in any well child visit, it also is important to realize that triggers to impulsive behavior may not be predicted. The presence of one or more guns in the home is associated with a 5-fold increased risk of suicide.

The American Academy of Pediatrics states that the absence of guns in homes is the most reliable and effective measure to prevent firearm-related injuries in children. For families with firearms in the home, providers can offer counseling on safe storage while offering free or discounted locks.

"Pediatricians are in a unique position to approach the discussion on gun safety as an expert in child development."

Still, with firearm owners in 1 out of 4 households, there remains a sense of hesitancy when it comes to asking about firearm storage at pediatric clinic visits. This may be blamed in part on a number of barriers that have been identified. These include a lack of training, lack of time, and a low expectancy that counseling would be effective.

There also remains a lack of research because the Dickey Amendment has prevented the Center of Disease Control and Prevention from funding research related to firearm control for more than 20 years. The few studies that are available, however, show counseling parents about firearm safety does work to help prevent firearm injuries in children. 

The 3-year old boy whose mother I talked with after he was shot survived, but he spent months in the intensive care unit.  Looking back, I imagine how routine screening and counseling for firearms exposure might have helped prevent his brother from ever coming across that loaded, unlocked gun.

​Approaching loaded firearms in the home as a public health threat to children, the same as other hazards such as open electric sockets, begins at each well-child visit.  Pediatricians are in a unique position to approach the discussion on gun safety as an expert in child development. There's no question we can be a powerful part of the solution.​

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The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

​​​Ab​out the ​​Author

 ​Sanghee Suh, MD is a third-year pediatrics resident at St. Christopher's Hospital for Children and a member of the AAP's Section on Minority Health, Equity and Inclusion. She plans to complete her cardiology fellowship at Columbia University Medical Center. ​

Contributing ​​Author​s

Daniel R. Taylor, DO, FAAP, a member of AAP's Council on Injury, Violence and Poison Prevention, is an Associate Professor of Pediatrics at Drexel University College of Medicine and a general pediatrician at St. Christopher’s Hospital for Children. At St. Christopher, he co-directs the Reach Out and Read program and directs the homeless healthcare for children initiative. Dr. Taylor is the founder of the Children’s Advocacy Project of Philadelphia (, an online directory to help providers, child advocates and families find resources in their community to help address social determinants that can affect children’s health, safety, and long-term outcomes.​

Katie McPeak MD, FAAP, an Associate Professor at Drexel University College of Medicine, is medical director of the Center for Urban Child at St. Christopher's Hospital for Children in Philadelphia. ​