Keeping Kids Safe From Gun Injury Is a Universal Goal

Hansa Bhargava, MD: Hi. I am Hansa Bhargava, a practicing pediatrician and senior medical director at Medscape and WebMD. Although gun-related violence and injury has long been a key concern for the American Academy of Pediatrics (AAP), the February 14, 2018, shooting at Marjory Stoneman Douglas High School in Parkland, Florida, has dramatically increased national interest. I am delighted to be speaking with Dr Colleen Kraft, the president of the AAP, about this issue and the AAP's efforts to advance legislative changes. Colleen, welcome.

Colleen A. Kraft, MD, MBA: Thank you.

Bhargava: Let's get to it. We have had many mass shootings in this nation; some experts say that the number of mass shootings has tripled over the past few years.^[1] What's different about this shooting? Do you believe that the teen survivors from Parkland have the potential to move the needle?

Kraft: When we look at any issue [that we wish to] change, we harken back to Julius Richmond's theory of social change. To enact change, Richmond said that you need the social strategy, you need the political will, and you need the science.^[2] These kids at Parkland have given us a new social strategy. They have come out and said, "No more. Enough. No gun violence. We want to be safe at school."

Bhargava: It is wonderful when children can be so active in advocating for something that is this important.

Kraft: Absolutely. We stand behind them as pediatricians because they are doing what the adults should have been doing with this issue all along.

Bhargava: Why does the AAP believe that gun legislation is a health issue? I am going to play devil's advocate: Quite a few people believe that we, as pediatricians and physicians, shouldn't be in this space.

It's the homicides and the suicides that hurt our children, at the rate of 74 deaths or injuries a day. If we had an infectious illness that did that, we would have a vaccine by now.

Kraft: Let's talk about gun safety because gun safety is something we can all coalesce around. Whether you are someone who doesn't have guns in the home or someone who hunts to feed your children and guns are part of your culture, we all want to keep our children safe.

We know that even though the mass shootings bring about all of the media attention, it's the unintentional injuries, it's the homicides and the suicides, that hurt our children, at the rate of 74 deaths or injuries a day.^[3] If we had an infectious illness that did that, we would have a vaccine by now. [Editor's note: Since this interview was recorded, WISQARS has updated its nonfatal gun injury data through 2016. Based on this, the average number of daily injuries and deaths by guns for ages 0-21 has increased to 78.]

Let's keep the lens on children and safety because we all love our children and none of us wants to see our children hurt. We know that as pediatricians, we are trusted advisors to families and we can help to keep their kids safe whether they are gun owners or not.

Bhargava: Yes, we all want our children safe. It doesn’t matter where you live—in cities, in rural areas, what state you live in—that is something that unifies us.

One study found that more than a million kids in the United States live in homes with loaded and unlocked firearms.^[4] Yet, many clinicians may not have the time or the expertise to educate families on gun safety. What resources does AAP offer for these busy clinicians to use in practice?

Kraft: This is a big pediatric safety issue, and this is really where the AAP is beginning to expand and consolidate its resources. Right now, on our site we have an article on gun safety and violence prevention, something that's a great resource for parents.

But what don't we know about gun safety and our children? For example, what is the impact of trigger locks on gun safety? Do parents use them? Do they help to prevent unintentional injuries? How about safe storage and gun safety cabinets? Are they used? The answer is, we don't know.

We haven't been able to do the research. The AAP wants to be part of this answer and thus has started a gun safety and violence prevention initiative. We will be bringing together researchers in gun safety from across the United States, holding a summit, looking at what we know in safety research, finding the gaps, and deciding how we can use this information to further research and incorporate it into messages that we give to our parents and families.

Bhargava: The AAP has always taken a strong interest in advocating for children, and part of our job as pediatricians is to advocate for children publicly, in communities, and legislatively. What would you say to the front-line physicians and caregivers who speak to families every day, to help prevent another tragedy like Parkland?

Kraft: We pediatricians are trusted by our families and we can talk with these families about safety. Particularly with gun safety, you want to know your families. Ask how the families keep guns safe. They need to know that you are supportive of what they do regardless and that you're a trusted resource for strategies that will keep their kids safe from guns, from violence, and from other areas that may be troublesome for them.

Bhargava: As a practicing pediatrician yourself and one who has practiced in many parts of the nation, what is the most effective way to talk with parents about this? How have you done it yourself?

Kraft: That's a great question. Much of this is about knowing your families. When I worked in southwestern Virginia, most of my families had guns in the home, so I didn't even have to ask that question. What I did ask them was, "How do you keep your children safe from the firearms in your home?" Sometimes, parents would tell me that they kept them locked up, or they might not have had an answer. Many parents came back and said, "I am so glad you asked about that because now I can tell you how I keep my children safe in our home, how we keep our firearms locked and keep ammunition away from where the guns are located. Now, when my children go to their friends' houses, I ask those parents, 'How do you keep your kids safe?'"

Bhargava: Sounds like you got a lot of positive feedback. Did you ever get any negative feedback for asking the question?

Kraft: I've never had negative feedback for asking the question because it is in the context of a trusting relationship. Our parents and families know that we really just want to keep their kids safe. We know that they own guns. They want to prevent unintentional injuries. They want to prevent suicides and homicides just as everyone else does.

Bhargava: Thank you for that important information. Thank you for being here, and congratulations for all the work the AAP is doing in this area.