AAP Voices Blog

I recently saw a 10-year-old boy in my clinic in Houston who came in for an evaluation for possible Attention-Deficit/Hyperactivity Disorder and learning difficulties. His chattiness was notable from the beginning of the visit, and he spoke at length about his experiences during 4th grade—the great friendships he made, the struggles he had at times keeping up in class and completing his work, and different teacher quirks he picked up on.

The boy told me that for the coming school year, he will be attending 5th grade someplace new--an intermediate school with only 5th and 6th graders. I asked if he was looking forward to 5th grade. He quickly replied that he was excited about exploring the new school, getting a new set of teachers, and getting a locker. But then he hesitated, a look of apprehension crossing his face.

“What are you afraid of?” I asked, knowing that this is the time of year when anxiety sets in for many students. They think about how hard they have to work to accomplish what their peers seem to achieve effortlessly. Sometimes, they question whether they have what it takes to get through another academic year.

His answer stunned me.

“I’m afraid someone is going to bring a gun to school and kill everybody,” the boy said.

His reasoning was this: “Sometimes kids get bullied, and no one knows about it. Or sometimes they get mad because things are hard, and they don’t know what to do. Then, one day, they come to school and say, ‘Hi Miss. So-And-So,’ and they take a gun out and just start shooting everybody—bang! Bang! Bang!

“I’m scared,” he continued. “I don’t want to be shot dead at school. I don’t know where to hide. I can’t run very fast. I asked my mom if I can stay home, but she says I have to go to school.”

Mom sat in a chair behind him, tears in her eyes, sorrow on her face—pleading silently for some other reality for her precious son who has already had to overcome so much.

This is a child who was born at 34 weeks, who was found to have a chromosomal abnormality at 18 months, and who was so behind developmentally that mom was told early on to “not expect much.” He almost did not wake up from anesthesia after a procedure and is suspected to have a mitochondrial disorder that leaves him weak and fatigued by the end of the day. He has a history of chronic migraines. He used to require oxygen by nasal canula (even at school). He needed a G-tube because of gastroparesis and had to have a nurse come with him all day to school for 1st and 2nd grade to administer feeds. In addition, he has recurrent infections due to hypogammaglobulinemia.

Despite these setbacks, defying all negative prognostication, he managed to “hold his own” in a mainstream 4th grade class this past year. His only pull-outs were for reading and math—no oxygen, no G-tube, no nurse, no nothing.

And now his greatest fear is being shot to death at school.

“He should be afraid of tests, cafeteria food, girls—not being shot to death at school.”

He should be afraid of tests, cafeteria food, girls—not being shot to death at school.

I sat there feeling embarrassed and ashamed.

Embarrassed that I had no solution to this unfathomable problem—no axiom to allay his anxiety, no 6-step plan to enact change, no “Don’t-worry-because-the-adults-in-this-world-know-what-they-are-doing-and-are-going-to-fix-it-and-keep-you-safe” type solution.

Ashamed that these are the present-day circumstances our children are living in, and the legacy we will leave them if we do not take serious action to stop the disastrous, current course set by unprecedented and unbridled gun violence.

“What do you do when you are scared?” I asked.

“I pray,” he said. “That’s all I can do.”

As pediatricians, what else can we do?

​​As gun violence continues to permeate children’s lives, affecting them beyond the devastating physical injuries, we can add our voices in the search for solutions. We can support American Academy of Pediatrics gunsafety priorities, such as common-sense firearm legislation, safe firearm storage, violence prevention research, and ensuring children and their families access to appropriate mental health services, particularly to address the effects of exposure to violence.

We can admit to our frightened young patients, worried about being shot as the new school year begins, that we haven’t found a “cure” for gun violence yet. But as their pediatricians, we won’t stop looking for ways to help keep them safe from it.