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?

Please follow our community rules when engaging in comment discussion on this site.