The appalling toll of children shot in the US

Almost 112,000 US children were admitted to hospital suffering gunshot wounds between 2009 and 2013, prompting paediatricians to describe the situation as “a national public health crisis”.

The term was used more than a year ago, in a June 2017 article in the journal Hospital Pediatrics, discussing the role of paediatricians in reducing gun-related carnage in the United States.

One of the co-authors of the piece, Shilpa Patel, part of the Children’s National Health System, this week is presenting her latest research at the 2018 American Academy of Pediatrics National Conference & Exhibition, in Orlando, Florida, from November 2 to 6.

“Firearm-related injuries are leading causes of unintentional injury deaths in children and adolescents,” she and her colleagues concluded in their 2017 report.

“Children are more likely to be victims of unintentional injuries, the majority of which occur in the home, and adolescents are more likely to suffer from intentional injuries due to either assault or suicide attempts.

Since then, the crisis has, if anything deepened. Presenting the latest analysis, Patel is set to tell conference attendees that figures from the US national hospital emergency-room database, known as the Nationwide Emergency Department Sample, reveal 111,839 emergency department visits for paediatric firearm-related injuries in the four years starting 2009.

She and colleagues found that when admissions were broken down by age, younger children were more likely to sustain unintentional firearm injuries, whereas adolescents were more likely to be victims of firearm-related assault or self-harm.

“Detailed data collection … could inform efforts to prevent firearm-related injuries,” Patel says of her new research. “Our study suggests that effective strategies to prevent firearm-related injury in children should focus on age and intent.”

As the US comes to terms with yet another mass shooting – this one resulting in 11 deaths in a synagogue in Pittsburgh, Pennsylvania – the 15,000 paediatric health-care professionals meeting in Orlando will have the opportunity to hear about new research into children, firearms, death and injury, and discuss ways in which they might effect change where government officials have failed.

“Paediatricians play an important role in firearm-injury prevention,” Patel says. “Paediatricians should continue to counsel families about safe storage of firearms in the home to prevent unintentional firearm-related injuries. Additionally, pediatricians and acute care providers should routinely ask about access to firearms when screening for depression and suicide risks in adolescents and should provide resources on violence prevention.”

While at the federal government level legislation on firearms remains “a contentious and gridlocked issue”, another study presented at the Orlando conference has found that state legislation “may be an opportunity to prevent paediatric deaths from firearms”, says Stephanie Chao, from the Stanford School of Medicine, in California.

Chao, lead author of a paper to be presented at the meeting, says, “Firearm-related injuries are the second leading cause of death among children in the United States, but we found a clear discrepancy in where those deaths happen that corresponds with the strength of states’ firearm legislation.

“In states with lenient laws, children die at alarmingly greater rates.”

Chao and her colleagues found twice as many paediatric firearm deaths in states with the most lenient gun regulations, compared with states where gun laws are strictest.

Further, their study found that states’ strict gun regulations also affect paediatric firearm mortality rates in neighbouring states.

They also found that firearm laws designed to limit access to guns, such as requiring locking mechanisms or storage requirements, were associated with decreased firearm suicide rates among children.

States without such access laws had paediatric firearm suicide rates more than four times as high as those with them.

“Each year, more children die from firearm-related injuries than from cancer and heart disease combined,” Chao says.

“However, each and every one of these deaths is preventable. Our study demonstrates that state-level legislation prevents children from dying from guns.”

Clearly the situation in the US is dire. In another new study, published in the journal JAMA Pediatrics, looks into more than 75,000 teenagers and children who suffered a firearm-related injury between 2006 and 2014.

Co-author Faiz Gani, from the Johns Hopkins Surgery Centre for Outcomes Research, in Maryland, says, “While mass shootings garner significant media and social attention, unfortunately they’re not a good reflection of the actual burden of firearm-related injuries. 

“In our study, we found that for every 100,000 teenagers and children arriving to the emergency department, 11 come for a gun-related injury. In other words, this represents over 8300 children and teenagers each year who come to the emergency department to be treated for a gunshot wound.”

According to a 2017 Pew Research Centre survey, 30% of US adults say they currently own a gun, and another 11% say they don’t personally own a gun but live with someone who does; and the Washington Post reports that there are 393 million civilian-owned firearms in the US.

Given the numbers of guns and gun owners in the US, a startling finding from another new paper presented in Orlando finds many Americans are extraordinarily lax when it comes to safe gun storage.

Further, the study found that most parents and caregivers, including firearm owners, said they were confident their children could distinguish between a real gun and a toy gun – and the children themselves also said they thought they could recognise the difference. Yet when shown side-by-side photos of actual and toy firearms, only 41% of children between ages 7 and 17 identified both correctly.

For the study, Kiesha Fraser Doh, from Emory University School of Medicine, in Atlanta, Georgia, and her colleagues surveyed 297 caregiver-child pairs visiting one of three paediatric emergency departments in the south-eastern US over a three-month period in 2017.

The researchers asked all the caregivers how easily they thought their child could access a real gun. Only 5% believed their child could obtain a gun within 24 hours. However, 14% of the children whose caregivers owned guns and 4% of children whose caregivers didn’t said they could get their hands on one within the same period.

Among the study’s firearm owners, only 34% stored their guns locked, unloaded, and separated from ammunition, as recommended by the American Academy of Pediatrics. And among children who reported having a gun in the home, 53% knew where it was stored and 45% knew where the ammunition was stored.

“One of the most dramatic findings was how easily caregivers and children can confuse real guns with today’s realistic-looking toy guns,” Fraser Doh says. “Especially considering gun owners surveyed were nearly twice as likely as non-gun owners to let their children play with toy guns, safe storage of firearms in homes where children play is critical.”

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