Many children live in houses with guns, but pediatricians often don鈥檛 feel comfortable discussing gun safety with parents 鈥� even though most parents say they would welcome that conversation.
That鈥檚 a key finding from a study published Wednesday in the Journal of Pediatrics. It comes as some state legislatures and doctors tussle over proposals restricting what doctors can say to patients about firearms, and as doctor groups increasingly push physicians to treat gun violence as a public health concern.
The paper is based on a survey of about 1,200 parents in the area surrounding St. Louis. Parents visiting their pediatrician鈥檚 office filled out a questionnaire asking whether they owned firearms, whether their children were regularly exposed to guns and how they would react if the pediatrician brought up the question of firearm safety for children.
Based on the surveys, the researchers concluded that more than a third of children lived in houses with guns, while another 14 percent were regularly in houses that had them. About 77 percent said their pediatricians didn鈥檛 ask them any questions about gun safety. But, at least when it comes to safely storing guns, three-fourths of parents said the doctor should offer some advice. Parents who owned guns were less likely to want pediatricians discussing gun safety.
鈥淎 lot of children die every year because of needless injuries 鈥� because of their curiosity. Pediatricians are not firearm safety experts for the most part, but they are experts on childhood development,鈥� said Jane Garbutt, a professor of medicine at Washington University in St. Louis and the paper鈥檚 lead author. 鈥淧arents look to their pediatricians as their most trusted source of information about a lot of things.鈥�
The research comes while states debate what physicians can or should say to patients about firearms. A Florida law, which bans doctors鈥� inquiries about guns, is currently facing 鈥� including , , Oklahoma and Virginia 鈥� have considered similar laws, though none passed.
Such legislation, which is supported by the National Rifle Association, has attracted criticism from groups like the聽 and the , which say such measures limit physicians鈥� First Amendment rights and interfere with the appropriate practice of medicine.
The all pediatricians screen for whether families have guns in their homes and, if the answer is yes, says doctors should advise parents to remove the guns. 鈥淯nintentional injury is a real concern,鈥� said Judith Schaecter, chairwoman of pediatrics at the University of Miami, a member of the AAP鈥檚 Council on Violence, Injury and Poison Prevention and one of the doctors challenging Florida鈥檚 law. She was not involved in the study.
The NRA did not immediately respond to requests for comment on this study, but the organization has previously argued that families visiting the doctor are looking for medical advice, and that physicians asking about guns intrudes on patient privacy. the Florida law argue it is trying to 鈥減revent harassment and discrimination.鈥�
This study suggests the issue is more complicated, Garbutt said, and that there are ways pediatricians can appropriately inquire about gun safety without alienating patients. For instance, when a child starts to crawl, pediatricians want to ask about whether they are ever in contact with potentially hazardous materials, like prescription medication and toxic cleaning supplies. It would be easy, she said, to add firearms to that list 鈥� grouping them with materials that may be risky without explicitly asking parents about gun ownership.
鈥淵ou don鈥檛 have to ask directly about firearm ownership. You鈥檙e just asking about a firearm as a hazard,鈥� she said.
And the study finds such questioning could bring benefits. Of survey respondents, about one in five kept their guns and ammunition together. And a quarter stored firearms loaded, which increases the odds of injury if children find them while playing, Garbutt noted. 聽More people are getting guns because they want them for protection, she said. That means they鈥檙e more likely to keep them readily accessible, where聽children could also find them.
That underscores the need for a thoughtful approach, said Eric Fleegler, an assistant professor of pediatrics and emergency medicine at Harvard Medical School, who has researched gun safety and pediatric care but wasn鈥檛 involved in the study.
鈥淵ou need to be sensitive to the needs of our patients,鈥� Fleegler said. 鈥淵es, we are talking about something that some people may feel uncomfortable with, but then again, there are some patients who don鈥檛 want to talk about immunizations. There are people who don鈥檛 want to talk about domestic violence, who don鈥檛 want to talk about sex, etc. It鈥檚 up to the pediatrician to find out a way to balance this.鈥�
One Second Amendment advocacy group questioned the findings. Because the survey is based mainly on the St. Louis area, it shouldn鈥檛 be generalized to the rest of the country, said Timothy Wheeler, director of Doctors for Responsible Gun Ownership, which is operated by the Second Amendment Foundation.
But Garbutt and Fleegler noted that even though the survey isn鈥檛 based on a nationally representative sample, other demographic elements 鈥� like the number of people owning guns 鈥� mirror the rest of the country. That, they said, makes it easier to draw conclusions from it.
Pediatricians, meanwhile, appear skittish. Anecdotally, Garbutt said, many said they didn鈥檛 feel comfortable discussing gun safety. That聽may be because they are afraid of offending patients, or don鈥檛 know how to approach the conversation, she said. And controversies like that over the Florida law may play a role, Fleegler noted.
鈥淭he presence of these laws really dampens people鈥檚 willingness to have these conversations,鈥� he said.
Meanwhile, there needs to be further investigation when it comes to how doctors should handle these conversations, said David Hemenway, a professor of health policy at the Harvard School of Public Health. He is also the director of the university鈥檚 Injury Control Research Center, and was not involved in the study. Right now, he added, there isn鈥檛 a general sense of how doctors should best approach discussing gun safety.
That matters, Garbutt said. The absence of productive conversations keep children at serious risk.
鈥淭here are a lot of risks for children in terms of their chance to come across a loaded firearm. What we know from other studies is if they can find it, they will, and if they find it, they will play with it,鈥� she said. 鈥淧arents who have a gun in the home need to make absolutely sure it鈥檚 not accessible to their children.鈥�