American Academy of Pediatrics has advised pediatricians for years to talk to families about firearm safety in the home. But a new study suggests that most pediatricians do not bring up the subject, and about a third of parents would ignore or even take offense to advice on guns.
Researchers at the Washington University School of Medicine in St. Louis surveyed more than 1,200 parents in pediatricians’ waiting rooms in Missouri and Illinois and found 50.2 percent of the children spend significant time in households with guns, according to the study, published today in The Journal of Pediatrics
Approximately 36 percent of respondents said they had firearms in the home and an additional 14 percent reported their child was frequently in the home of relatives or friends with firearms, according to the study. Though most parents were open to discussions about gun safety with their pediatricians, a significant minority or approximately one-third of parents said they did not want to be asked whether they had a gun, and would ignore or even take offense to advice to remove guns from the home, researchers found.
Only 13 percent of parents reported their pediatrician asking them about household firearm access.
“Guns are an emotional topic,” said Dr. Jane Garbutt, lead author of the study and a professor of pediatrics at Washington University School of Medicine. “Our work suggests this type of conversation doesn’t happen enough. But we need to find a way for doctors and patients to have this discussion to keep kids safe.”
The study also suggests there’s room for improvement when it comes to firearm safety at home. Of parents who owned guns, 22 percent reported keeping their firearms and ammunition in the same location, and about a quarter said they kept at least one firearm loaded inside the home. Of those with a loaded firearm inside the home, 14 percent admitted it was potentially accessible to children.
Overall, three-quarters of respondents - including 71 percent of gun owners - said they thought pediatricians should discuss safe storage of firearms with parents, but only about 13 percent report having had such a discussion with their child’s doctor. Less than 1 percent of respondents said their child’s pediatrician was a significant source of firearm safety information.
Firearm-related incidents continue to pose a significant threat to child and adolescent health. In 2013, more than 6,000 children were hospitalized due to firearm-related incidents and 2,465 died, according to the U.S. Centers for Disease Control and Prevention
These statistics have made screening for children’s access to firearms and discussing firearm safety with parents an important part of the American Academy of Pediatrics' violence prevention recommendations. The AAP encourages physicians to give parents guidance about the health hazards of firearms - even as discussing gun safety in the doctor’s office has become an increasingly contentious legal and political issue.
“It can be uncomfortable to talk about gun safety, just as it can be uncomfortable to talk about drug use, vaccines, or STDs,” said Dr. Judith Schaechter, a pediatrician and member of the AAP Council on Injury, Violence and Poison Prevention. “But if you do it in a respectful way - one that puts the child’s health and safety at the center of the conversation - I think families are actually very receptive.”
According to the study’s authors, there may be a number of reasons that more pediatricians aren’t having these conversations, including lack of time or training, fear of offending parents, and feeling that counseling would be ineffective.
New legislation has also impeded some physicians from bringing up firearms with patients. In 2011, Florida passed the Firearm Owners Privacy Act, which prohibits doctors from asking patients about whether they have a gun in the home. The law has subsequently been challenged by a number of professional organizations, including the AAP, and is currently the subject of a protracted legal battle. Since Florida passed its law, a dozen other states have introduced similar legislation.
One path forward may be for physicians to counsel patients about gun safety generally instead of directly questioning parents about whether they have guns in the home. According to the study, parents were more amenable to hearing messages about how to safely store firearms than they were to inquiries into whether they personally had firearms.
“We need to make it about hazard avoidance,” Garbutt said. “We need to place firearms in the same domain as medications or household poisons, and discuss them as we would other dangerous things in the home. The message from pediatricians has to be, 'Lock it up. Keep it away from your child.'”