Oct. 11, 2016

Half the children in the United States live or spend significant time in homes with guns, according to a study in the September 2016 issue of The Journal of Pediatrics. Researchers at the University of Washington Medical School in St. Louis reached that conclusion after surveying more than 1,200 parents in Missouri and Illinois.

Many of those interviewed acknowledged that their guns were either stored loaded or in the same place as ammunition, and some said their guns were accessible to children. One-quarter said they carried a loaded gun in their purse or car. And although most parents had never discussed firearm safety with a pediatrician or other health care provider, many said they would be open to such conversations. A good third, however, indicated that they did not want to be asked if they owned a firearm and would ignore or be offended by gun safety advice.

The study authors acknowledge that guns have become an increasingly divisive political issue — and, more recently, a legal one — but maintain that doctors and parents need to find a way to have these conversations to reduce child injury and mortality. In 2013, more than 6,000 children were hospitalized for gun-related injuries and nearly 2,500 died.

The American Academy of Pediatrics (AAP) has long recommended that physicians discuss gun safety with parents, but very few actually do, citing lack of time and fear of offending patients. Recent laws in Florida and other states that seek to curb doctors' ability to counsel patients about firearms have added another layer of complexity. Proponents of those laws argue that physicians have no training in firearms and therefore aren't qualified to talk about them. Yet studies have shown that physician counseling can reduce firearm injuries and death. Furthermore, representatives from the AAP and emergency physician groups point out that it doesn't take a lot of training to recommend that guns be kept away from kids.

Kimberly J. Lombard, trauma center injury prevention coordinator at Mayo Clinic's campus in Rochester, Minnesota, agrees that gun safety can be an uncomfortable topic for physicians but one many parents may appreciate if approached properly. Furthermore, emergency providers are uniquely qualified to have such conversations — and their words likely carry more weight — because they actually see and treat gun injuries. The important thing, Lombard says, is to have the conversation before something happens, not after.

She offers these suggestions for initiating a conversation with parents:

• Be nonjudgmental, respectful, and mindful of cultural and religious differences.
• Instead of asking about gun ownership, talk about gun safety in general. Parents tend to be more receptive when firearms are discussed the same way household poisons and medications are — as hazards that should be kept away from children.
• Offer concrete and clear instructions for safe gun storage.

Steve Loomis, Deputy Sheriff for Olmsted County, agrees that the success or failure of firearm discussions often depends on the approach. He says mentioning firearms safety courses sponsored by the Minnesota Department of Natural Resources may be a good way to broach the subject.

He also explains the pros and cons of gun storage options. He doesn't recommend trigger locks because although they can stop unauthorized use, they don't prevent a gun from being stolen or transported without permission. A standup gun safe is best, he says.

"If a person has just one gun for target practice or home defense, it can be kept in a small, relatively inexpensive bedside safe that can be opened in the dark with a fingerprint scanner," he says.

Newer smart guns are integrated with the same kind of recognition technology to prevent unauthorized use, but although that may be the wave of the future, it doesn't make the 300 million or so firearms already owned in the U.S. safer. For now, most parents will need to lock guns up.

Talking to hunters

It's not just children who need protection from guns, though; adults who use them can benefit from safety advice, too. According to data from the Mayo Clinic trauma registry, 58 patients, all male, were admitted for hunting injuries between 2010 and 2015. Many had self-inflicted gunshot wounds.

"These are serious, costly injuries requiring, on average, 6.5 days in the hospital," Lombard says. She says talking gun safety with hunters can be tricky, and an indirect approach is best.

"Don't ask patients if they hunt," she says. "Ask what their hobbies are, what they like to do in their spare time. If hunting comes up, then the conversation has already started. We use the same approach when we have conversations with patients about motorcycle helmets. These discussions are usually well-received because the information is coming from injury experts."

Loomis says there are four main rules when it comes to handling guns — none of them hard to remember or pass along:

• Don't point at anything you're not willing to shoot.
• Keep your finger off the trigger until ready to shoot.
• Handle a gun as if it is always loaded.
• Before shooting, take care of what is behind and to the side of the target.

Both Lombard and Loomis recommend the Department of Natural Resources' hunter safety certification course, which can be taken in person or online. It's required for people born after 1979 who want to purchase a hunting license, but classes are open to anyone age 11 and older interested in gun safety.

For more information

Garbutt JM, et al. What are parents willing to discuss with their pediatrician about firearm safety? A parental survey. The Journal of Pediatrics. In press.

Minnesota Department of Natural Resources. Hunter education and safety classes.