Should The Pediatrician Talk To You About Gun Safety?

In 10 years of taking my kids to the pediatrician, I’ve never been asked if I have a gun in the house.

Maybe it’s because I live in Cambridge, where I’m pegged as a left-leaning, kale-consuming, hybrid-driving, yoga junkie (guilty!) whose world view does not include gun ownership. Still, as part of routine children and family health, I like the idea of pediatricians getting more involved in the debate about gun violence since they may be positioned to intervene before disaster strikes.

(agitprop/flickr)

(agitprop/flickr)

In a thoughtful piece in The New England Journal of Medicine, two local pediatricians, Judith Palfrey (Children’s Hospital Boston, Harvard Medical School) and Sean Palfrey (Boston Medical Center, Boston University School of Medicine) make an excellent case for why more doctors should actively consider the prevention of gun deaths in children. In their piece, they cite this 2012 American Academy of Pediatrics statement:

The American Academy of Pediatrics (AAP), recognizing all these vulnerabilities, declared in a policy statement on firearms in October 2012 that “the absence of guns from homes and communities is the most effective measure to prevent suicide, homicide, and unintentional injuries to children and adolescents.”

Causes of Death among Persons 1 to 24 years of age in the United States, 2010. Data are from the Centers for Disease Control and Prevention. (New England Journal of Medicine)

Causes of Death among Persons 1 to 24 years of age in the United States, 2010. Data are from the Centers for Disease Control and Prevention. (New England Journal of Medicine)

The Palfrey’s write:

In the early 1990s, there was a surge of violence and firearm-related deaths. The death rate was so high (nearly 28 of every 100,000 people 15 to 19 years of age)2 that pediatricians joined with other professionals (police officers, clergy, and educators) to find ways to combat the epidemic. Pediatricians began to address the protection of children from gun-related causes alongside the prevention of other types of injuries, poisonings, child abuse, lead toxicity, and infectious diseases.

Screening tools and basic interventions became routine practice through nationally accepted programs such as Connected Kids and Bright Futures. AAP guidelines recommend that when families report the presence of firearms in the house, pediatricians should counsel about gun removal and safety measures (gun locks and safe storage). One mother responded to routine screening questions asked by one of our colleagues, “Why, yes, I have a loaded gun in the drawer of my bedside table.” Until that moment, she had apparently never considered the risk to her child.

Although such screening and counseling are important in general, it is particularly important that children’s health care providers have the opportunity (and time) to discuss the issue of guns with the families of children and young people who have developmental, behavioral, or mental health problems. In the United States, far too little attention is paid to the seriousness of our children’s mental health problems. Families are often left unsupported as they try to protect their children who may be depressed, impulsive, or combative.

However in some states, the pediatricians’ report, there’s been a backlash against pediatrician screening and counseling about guns, even though studies have found that this type of intervention by doctors works:

In a randomized, controlled, cluster-design study by the Pediatric Research in Office Settings network, the intervention group that received specific gun-safety counseling from their doctors reported significantly higher rates of handgun removal or safe storage than did the control group. This study showed that families do follow through on pediatricians’ recommendations about gun safety.

Despite this evidence, in 2011, Florida passed legislation, the Firearms Owners’ Privacy Act, making it illegal for a doctor to conduct preventive screening by asking families about guns in the home — essentially “gagging” health care providers. Under the aegis of the Second Amendment, the First Amendment rights and the Hippocratic responsibilities of physicians were challenged. In response, the AAP’s Florida chapter brought suit, and in June 2012, Miami-based U.S. District Judge Marcia Cooke issued a permanent injunction banning the state from enforcing the law. Governor Rick Scott has appealed the ruling, and similar bills have been introduced in three additional states.

Readers, have you even been asked about guns in your house by the doctor? How did the discussion go?

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  • jimjogs

    Not opposed to being asked this question. If the doc ever did I’d respond, “yes I have a numbers of weapons in my home and all are locked in a 600 pound steel safe lag bolted to the floor and wall and I am the only person with the combination.” Raised two kids to adulthood with this system. Never had a problem. If folks don’t have at least this much common sense perhaps they should not have children.

  • http://www.facebook.com/futo.buddy Futo Buddy

    The only danger is if the doctor makes an electronic record and down the line the insurance companys get involved that would be a real mess

  • Thinkfreeer

    The pediatrician’s opinion on guns is immaterial. It’s NOT a medical issue. As a matter of fact, you should ask your pediatrician or doctor how many lives he or she has been linked to lost lives by medical errors. The rate is about 1000% more than gun murders.

    I enjoy talking to my doctor. He actually works for the state (UMASS Medical). I will not even pause to tell him my gun ownership or use is none of his damn business, if he falls for some state sponsored “medical” gun questions.

  • gossipy

    Instead of placing child-rearing responsibility on medical professionals, police and others, perhaps parenting courses in high school and for pregnant parents would go a long way toward helping to raise awareness where it needs to be. There is so much to think about. There are safety issues around almost every aspect of our lives; water, bicycle, railroad, traffic, guns, drugs, I could go on and on.

    • http://www.facebook.com/futo.buddy Futo Buddy

      They actually teach kids about traffic and water safety and plenty of time on drugs but they have neglected to teach gun safety at all. Heck its even more taboo than sex ed

  • Audrey

    never
    been asked but not opposed to it. Several commentators say if doctors
    ask about seat belts and bike helmets ( docs do) then gun safety isn’t a
    big deal and I agree. Perhaps some of those people that have guns in
    the home will stop and think if they practice gun safety and if not
    start. Nothing like a child’s doctor to put things in perspective for
    you.

  • CircusMcGurkus

    Pediatricians really need to stop trying to be police officers/lawyers/teachers/parents. They need to deal with actual medical health and not tangential potential public health issues unless asked or unless they have reason to be concerned in an individual case. This is true for all doctors. Every single time medical professionals have gotten involved in public policy they have wreaked havoc. They have too much influence and not enough information.

    I know they have good intentions. But, seriously, there is an adage about where that path leads.

  • Kathleen

    I’ve not been asked by my pediatrician, but am all for it (and for the other suggestion regarding prescription drugs). I am asked about seatbelts/booster seats, smoke detectors, smoking and pets, and questions about crib safety and back sleeping when they were infants. All were asked with my child’s safety in mind. Also when my children were starting “play dates” many moons ago, I read an article in a parent’s magazine about asking other parents if they had guns, and if so, were they secured.

  • http://www.facebook.com/people/Kathy-Wnuk/100000450245663 Kathy Wnuk

    Pediatricians have been asking about safety, i.e. “do you wear a seat belt?”, “Do you wear a bike helmet?” for years. Bringing up gun safety is common sense. However, I’ve read that the NRA insisted that this not be a requirement for pediatricians under the Health Care Initiative, and that they got what they wanted.

  • http://www.facebook.com/profile.php?id=1451162950 Jim Brown

    I don’t think I’ve ever been asked, although it’s possible the question might be on a screening form. I don’t think it’s an appropriate question unless they are also going to offer counselling on pool safety (which is a much bigger risk). If the question is asked though, I like the idea of distributing Eddie Eagle gun safety educational materials.

  • Elizabeth

    Yes, my children’s pediatricians ask every year if have gun in our house. We live in Wayand and the doctors office is in Dedham.

  • http://www.facebook.com/futo.buddy Futo Buddy

    As long as they also ask if the kids have helmets for their bikes and if they make the kids wear seatbelts its fine. They should also ask the parents about their storage of prescription drugs since thats now the primary source for children to obtain drugs. Maybe all the pediatricians could distribute Eddie Eagle gun safety education materials to all children they serve. The NRA would provide all the materials for free.

    • Seth

      Considering the pro-violence rhetoric of the NRA it should be generally considered a moral irresponsibility to have them be the ones to educate children on guns.

      • http://www.facebook.com/futo.buddy Futo Buddy

        pro violence? what gun safety curriculum would you perfer? “stop, dont touch it, leave the area, tell an adult” Is what the NRA teaches children do you have aproblem with that? what would you change?