Q&A: How pediatricians can talk to parents about firearm ownership, storage
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Key takeaways:
- Surveyed parents indicated a willingness to speak to pediatricians about gun ownership and storage.
- Most were also open to hospitals distributing firearm locks.
ORLANDO — Most parents are willing to talk to pediatricians about safe firearm storage, although less than half reported ever receiving such counseling, according to a study presented at the AAP National Conference & Exhibition.
The findings are from a small survey of 84 parents or caregivers of children and young adults aged 8 to 21 who were admitted to a children’s hospital for a suicide attempt or suicidal ideation.
According to Taylor M. Rosenbaum, MD, a pediatric hospital medicine fellow at Baylor College of Medicine and Texas Children's Hospital in Houston, and colleagues, 96% of respondents agreed that it was important for providers to ask about firearm ownership.
The same percentage said it was important for providers to discuss safe firearm storage, and 87% were open to the idea of hospitals distributing firearm locks, although non-gun owners were more likely to say that distributing locks is “very important,” 74% vs. 67%.
Just 46% of respondents said they had ever been asked about firearm ownership in a health care setting, and only 79% of respondents who owned firearms reported storing them safely.
Firearms remain the No. 1 cause of death for children and young adults in the United States and a popular focus of research presented at the AAP conference each year. The AAP has called for guns to be regulated at the same level as motor vehicles.
In a second study presented at this year’s meeting, researchers reported that laws banning the sale of large capacity magazines reduced deaths in mass shootings involving children by 91% — the only form of legislation associated with reduced mortality in pediatric mass shootings.
Another study showed that firearm injuries were associated with more complications, a higher risk for death and longer hospital stays than penetrating or blunt trauma injuries; and a fourth study reported that only around 24% of caregivers recognized that suicide was the top cause of firearm-related deaths in their state.
We asked Rosenbaum about her study, and for some tips on how to talk to parents about safe firearm storage.
Healio: Is it common for pediatricians to talk to patients and caregivers about gun ownership and storage?
Rosenbaum: Previous studies have shown that pediatricians’ discussions about firearm safe storage with their patients’ families increase the likelihood of families practicing safe storage at home. However, unfortunately, previous studies have also shown that pediatricians — both on the inpatient and outpatient setting — are not universally screening for firearms ownership or storage practices. Our study shows that only around half of all caregivers of youth admitted to the hospital for suicidal ideation or attempt were screened for firearm ownership.
Healio: Did it surprise you that such a large proportion of parents or caregivers indicated a willingness to talk about gun ownership and storage?
Rosenbaum: I was surprised that families were not only so willing to have these conversations but also felt that these conversations were very important. I also was surprised that almost 60% of caregivers who own firearms said they would follow their health care team’s advice to remove the firearms from the home for the safety of their child with self-harm, and none of these caregivers would be offended by this advice. I think often pediatricians shy away from conversations about firearms and safe storage for fear of causing controversy, so I was happy to see that caregivers want to have these conversations.
Healio: Is the study large enough to make the findings generalizable to other hospitals or practices? Do you envision that the results would be different in other places?
Rosenbaum: A limitation of this study is that it is a single-center study, and thus, it is hard to know if the results are generalizable. However, I would not be surprised if most caregivers of youth with suicidality would welcome conversations about firearm safe storage guidance, because previous studies have shown that after a youth suicide attempt, caregivers are most interested in learning how to keep their children safe from future attempts, which firearm safe storage guidance directly does. Additionally, because Texas has the most firearms out of all states in the nation, it is more likely that these results reflect many other states with high firearm ownership.
Healio: What is the clinical message here? Are these results a clear sign that pediatricians should be asking all of their patients’ caregivers about gun ownership and safe storage? What should they say?
Rosenbaum: From our study, we now have action-based items to better care for youth hospitalized for suicidal ideation or attempt. Pediatricians should be screening caregivers of youth with suicidal ideation or attempt for firearm ownership, providing guidance on firearm safe storage and, if possible, distributing free firearm locks. Although our study focused only on caregivers of youth with suicidal thoughts or actions admitted to the pediatric hospital medicine service, we recommend all pediatricians — including pediatric emergency medicine physicians, pediatric hospitalists and primary care providers — screen these caregivers for firearm ownership and provide storage guidance, especially because our study shows that these caregivers are inconsistently screened. We still need to research if caregivers of all hospitalized children would welcome these conversations.
I help teach a workshop on how to have these conversations with families, and we have the following suggestions for approaching firearm safe storage discussions: First, focus on storage rather than ownership. Ask, “How do you store your firearms at home?” rather than “Do you own firearms?” Second, use the word “firearm” instead of “gun.” Third, bundle it with other safety topics — discuss it with other lethal mean restrictions like locking up medications, knives, scissors, etc. Fourth, the focus of these conversations should be safe storage — locked, unloaded and stored separately from ammunition. And fifth, use HIPAA-compliant stories to drive the point home.
References:
- Cafferty R, et al. Abstract P2.D076. Presented at: AAP National Conference and Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
- Emengo P, et al. Presented at: AAP National Conference and Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
- Nofi CP, et al. Abstract P2.P313. Presented at: AAP National Conference and Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
- Parents open to firearms counseling from doctors; Ensuring secure storage remains a challenge. https://www.eurekalert.org/news-releases/1058533. Published Sept. 27, 2024. Accessed Sept. 30, 2024.
- Rosenbaum TM, et al. Abstract 03231. Presented at: AAP National Conference and Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
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Rosenbaum TM, et al. Abstract 03231. Presented at: AAP National Conference and Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
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