Protecting Your Child from Serious Injury: Guns

Injuries are the most common cause of death in the U.S. between the ages of 1 and 44 years old, and one of the most common causes of fatal injuries, especially in children, is guns. In this post I’ll discuss why it’s important for every parent to be mindful of the risk of gun violence, and what they can do to reduce that risk for their children.

Scope of the Problem

Though it has been highly politicized, gun violence is a public health issue. Guns are now the leading cause of fatal injury in the US, more common than motor vehicle collisions. Here are the numbers:

In 2017 in the US, 486 people died of unintentional gun injuries, 23,854 people committed suicide with a gun, and 14,542 people were intentionally killed by gun injuries. About 10% of these deaths occur in children. Among US adolescents 15-19 years old, gun homicides are the second leading cause of death; gun suicides are the third (1). For every child who dies by a gun, hundreds more are injured. Over 7000 children were hospitalized for gun injuries in 2009 (3). In 2010, 15,576 children were treated for gun injures in US Emergency Departments, and 1,970 of them died (1). Of those children who are hospitalized and live, about half will be discharged with a disability.

This appears to be a uniquely American problem. Forty-nine times as many young adults die by guns in the US compared to other high-income countries. In fact, for every 10 children under age 15 killed by guns globally, 9 live in the US (2). This is not a reflection of our rates of mental illness, as gun interest groups try to claim. Other countries with similar rates of mental illness and stricter gun laws have significantly lower rates of gun deaths than the US. This year, there will be more than 35,000 people who die from gun injuries in the US, including about 3000 children. Today, 7 children in the U.S. will wake up ready for a normal day, and be shot and killed.

Risks of Gun Ownership

Despite these stark statistics, many parents keep guns in their homes, often times in the belief that doing so makes them safer. The evidence paints a different picture. Guns in the home increase the risk of homicide by 300% and suicide by 500% (19, 20), and are 22 times more likely to be used in domestic homicide, suicide, or an unintentional shooting than to be used in self-defense (8). Carrying a gun during an assault increases the risk of being shot by 400% (21). Keeping a gun in your home may make you feel safer, but it will put your family at increased risk of injury.

Perhaps the greatest risk of gun ownership is the risk of youth suicide. Multiple studies have found that adolescents’ risk for suicide increases as their access to guns does (11-16), even for adolescents without prior psychiatric diagnoses. The risk for suicide is even greater when guns are stored loaded (17, 18). We know that suicides in children are typically impulsive, and more likely to be successful when they have easy access to lethal weapons: 90% of suicide attempts with guns are successful, compared to less than 5% of suicide attempts using less lethal means, like medications or sharp objects (9, 10). The risk for unintentional injury and suicide in children is reduced by 73% when guns are kept locked, and by 70% when they are kept unloaded (28). Therefore, if we reduce children’s access to guns, we can reduce their risk for death.

Gun Storage Practices

Unfortunately, many gun owners continue to underestimate the dangers guns pose, and do not store their guns safely. Less than 50% of parents of kids 4-12 years old store their guns safely (locked and unloaded) (25), and only 6% of parents of fifth graders store their guns safely (26). A national random sample of gun-owning parents of kids under 18 found that 21.7% of parents stored a gun loaded, 31.5% stored it unlocked, and 8.3% stored at least one gun unlocked and loaded (27).

Parents may store their guns unsafely because they don’t think their children are likely to find or touch them. They are wrong on both counts. Although 75% of parents think their children would not touch a gun (25), this myth was shattered by the terrifying 2001 study, “Seeing is Believing”, in which a majority of children handled a gun they found in a room, and 50% of them pulled the trigger (23). Teaching children about gun safety seemed to have no effect on their natural curiosity and inclination to explore the world around them. This study was recreated and filmed as part of an ABC 20/20 special, “Young Guns”, that is viewable on YouTube, and is harrowing to watch. In a survey of children under age 10 living with guns, 73% knew where their parents’ guns were kept, and 36% admitted to handling the weapons. Meanwhile, 39% of those children’s parents incorrectly thought their children didn’t know where their gun was stored, and 22% incorrectly thought their child had never handled their gun (22, 24). Clearly, we need to find ways to improve gun storage practices.

Recommendations for Parents

The most effective way to reduce your child’s risk of injury, from infancy through adolescence, is to remove any guns from the home. This is especially important if your child has a history of depression, which increases the chance that they might have a moment of suicidal impulsivity, in which case the difference between life and death may come down to whether or not there is a gun nearby.

If your family hunts, or shoots recreationally, consider keeping your guns stored outside the home, in a storage locker.

If for whatever reason you must keep a gun in the home, make sure to always keep it locked, unloaded, and disassembled, with the ammunition stored locked in a separate location. Storing guns safely most of the time is not good enough; because your child only has to handle a gun once to cause irreparable consequences.

Whether you own a gun or not, be sure to ask about guns in any homes your child visits. If you can, avoid taking your child to a home where there are any guns that are not stored safely locked, unloaded, and disassembled, with the ammunition stored separately. Remember that even toddlers can pull triggers on guns, and even in the thirty seconds it takes to check a text message on your phone, your child could find a gun and shoot it, if it is not stored safely.

References:

1. Centers for Disease Control and Prevention. Injury prevention and control: data and statistics (WISQARS) National Center for Health Statistics system. Available at: www.cdc.gov/injury/wisqrs/index.html. Accessed 3/30/19.

2. Grinshteyn E, Hemenway D. Violent death rates: the US compared with other high income OECD countries, 201. Am J Med. 2016; 129(3):266-273

3. Leventhal JM, Gaither JR, Sege R. Hospitalizations due to firearm injuries in children and adolescents. Pediatrics. 2014; 133(2):219-225

4. Centers for Disease Control and Prevention. Leading causes of death reports: 1981-1988.

5.  DiScala C, Sege R. Outcomes in children and young adults who are hospitalized for firearms-related injuries. Pediatrics. 2014; 133(2):219-225

6. Spitzer SA, Staudenmayer KL, Tennakoon L, Spain DA, Weister TG. Costs and financial burden of initial hospitalizations for firearm injuries in the United States, 2006-2014. Am J Public Health. 2017; e1-e5

7. Corso PS, Mercy JA, Simon TR, Finkelstein EA, Miller TR. Medical costs and productivity losses due to interpersonal and self-directed violence in the United States. Am J Prev Med. 2007; 32(6):474-482

8. Kellermann AL, Rivara FP, Rushforth NB, et al. Gun ownership as a risk factor for homicide in the home. N Engl J Med. 1993; 329(15):1084-1091

9. Elnour AA, Harrison J. Lethality of suicide methods. Inj Prev. 2008; 14(1):39-45

10. Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2003; 42(4):386-405

11. Miller M, Hemenway D. The relationship between firearms and suicide: a review of the literature. Aggress Violent Behav. 1999; 4(1):59-75

12. Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma. 2007;62(4):1029-1034; discussion 1034-1035

13. Kung HC, Pearson JL, Wei R. Substance use, firearm availability, depressive symptoms, and mental health service utilization among white and African American suicide decedents aged 15 to 64 years. Ann Epidemiol. 2005; 15(8):614-621

14. Wiebe DJ. Homicide and suicide risks associated with firearms in the home: a national case-control study. Ann Emerg Med. 2003; 41(6):771-782

15. Miller M, Azrael D, Hepbrun L, Hemenway D, Lippmann SJ. The association between changes in household firearm ownership and rates of suicide in the United States. 1981-2002. Inj Prev. 2006;12(3):178-182

16. Miller M, Hemenway D, Azrael D. Firearms and suicide in the northeast. J Trauma. 2004; 57(3):626-632

17. Brent DA, Perper JA, Moritz G, Baugher M, Schweers J, Roth C. Firearms and adolescent suicide. A community case-control study. Am J Dis Child. 1993; 147(10):1066-1071

18. Brent DAPJ, Perper J, Moritz G, Baugher M, Allman C. Suicide in adolescents with no apparent psychopathology. J Am Acad Child Adolesc Psychiatry. 1993; 32(3):494-500

19. Kellermann AL, Rivarra FP, Somes G, et al. Suicide in the home in relation to gun ownership. N Engl J Med. 1992; 327(7):467-472

20. Bailey JE, Kellermann AL, Somes GW, Banton JG, Rivara FP, Rushforth NP. Risk factors for violent death of women in the home. Arch Intern Med. 1997; 157(7):777-782

21. Branas CC, Richmond TS, Culhane DP, Ten Have TR, Wiebe DJ. Investigating the link between gun possession and gun assault. Am J Public Health. 2009; 99(11):2034-2040

22. Parikh K, et al. Hosp Pediatr. May 23, 2017, http://hosppeds.aappublications.org/content/early/2017/05/19/hpeds.2016-0146

23. Jackman GA, Farah MM, Kellermann AL, Simon HK. Seeing is believing: what do boys do when they find a real gun? Pediatrics. 2001; 107(6):1247-1250

24. Baxley F, Miller M. Parental misperceptions about children and firearms. Arch Pediatr Adolesc Med. 2006; 160(5):542-547

25. Farah MM, Simon HK, Kellerman AL. Firearms in the home: parental perceptions. Pediatrics. 1999; 104(5 pt 1):1059-1063

26. Schwebel DC, Lewis T, Simon TR, et al. Prevalence and correlates of firearm ownership in the homes of fifth graders: Birmingham, AL, Houston, TX, and Los Angeles, CA. Health Educ Behav. 2014; 41(3):299-306

27. Johnson RM, Miller M, Vriniotis M, Azrael D, Hemenway D. Are household firearms stored less safely in homes with adolescents? Analysis of a national random sample of parents. Arch Pediatr Adolesc Med. 2006; 160(8):788-792

28. Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005; 293(6):707-714