PEDIATRICIANS AND emergency department physicians are alarmed at the growing number of children, mostly adolescents, who are taking their lives with firearms. While mass school shootings like the attack last February that killed 17 students and staff members at Marjory Stoneman Douglas High School in Parkland, Florida, generate headlines and public debate about the easy availability of firearms, suicides by gun claim far more children's lives.
Gunshot wounds annually kill nearly 1,300 children ages 17 and younger, according to a study published in July 2017 in the journal Pediatrics. Of this total, 38 percent – nearly 500 kids – died by suicide, according to the research, while 53 percent lost their lives in homicides. Researchers studied gunfire deaths of children ages 17 and younger from 2002 to 2014. Researchers found that child firearm suicide spiked by 60 percent between 2007 and 2014. Gunshot wounds are now the second leading cause of trauma death for juveniles in the U.S., after car accidents. Firearm injuries are now the second leading cause of death for children age 10 and older and teens (up to age 19) in the U.S. after motor vehicle fatalities, says Dr. M. Denise Dowd, a pediatric emergency physician at Children's Mercy Kansas City in Kansas City, Missouri.
"Suicides (by juveniles) are at epidemic proportions," Dowd says. "It's an emergency. If this was an infectious disease, it would be on the news constantly until we got a handle on it." On any given day, between two and eight patients are in her hospital's emergency department being treated for "suicidal ideation," meaning they have attempted suicide or are contemplating it, Dowd says.
The number of children who took their lives with a gun has continued to rise in recent years; 633 children killed themselves with a firearm in 2016, according to the CDC. Accidental firearm deaths trail far behind homicides and suicides as a cause of death for children. In 2016, 53 youngsters died in connection with a firearm accident, according to the CDC.
Using a firearm is far more lethal than other methods of suicide. About 90 percent of people who attempt suicide using a firearm succeed, according to the Center for Injury Research and Prevention at the Children's Hospital of Philadelphia Research Institute. By contrast, people who attempt to jump to their deaths or who use poison die 34 percent and 2 percent of the time, respectively, according to the institute. "These deaths are preventable. If a kid comes into the ER after trying to commit suicide by almost any other way, I can usually save (him or her). Not so with gunfire injuries," says Dr. Megan Ranney, an associate professor of emergency medicine at the Alpert Medical School at Brown University in Providence, Rhode Island. She is also the chief research officer for the American Foundation for Firearm Injury Reduction in Medicine, a group funded by the National Institute of Child Health and Human Development to research and reduce firearm injuries.
The widespread availability of firearms, the natural curiosity, and impulsivity of young children and adolescents and the widespread lack of supervision of kids in homes where adults keep unsecured firearms create "a perfect storm for tragedy," Dowd says. A raft of research supports her analysis:
There are more firearms in the civilian U.S. population than there are people, according to the 2017 iteration of the Small Arms Survey, a report put together by the Graduate Institute of International Development Studies in Geneva. There are more than 393 million firearms in the U.S., which has a population of about 326 million people. This number includes handguns, shotguns, and rifles, including high-powered military-grade firearms capable of shooting large numbers of rounds at high velocities. In a 2018 Gallup poll, 43 percent of U.S. households reported owning at least one gun. Only about one-third of handguns in U.S. homes are kept locked and loaded, according to the Children's Hospital of Philadelphia Research Institute. Many parents who keep firearms in their homes mistakenly believe their kids don't know where they keep their guns, research suggests. Given the ubiquity of guns in the civilian U.S. population, and the fact young kids often visit homes of playmates, "the chances of a child being in a home (even if he or she lives in a household without a firearm) are almost 100 percent," Dowd says.
Whatever their level of intelligence, adolescents are prone to make bad, impulsive choices because the brains of young people aren't developed the way those of adults are, research suggests. The rational part of a teenager's brain isn't fully developed until he or she is 25 years old, according to Stanford Children's Health. Adults think with their prefrontal cortex, the brain's rational section, but teenagers process information with the amygdala, the emotional part. Many teenagers who try to commit suicide hadn't necessarily been suffering from depression, but try to take their lives in a moment of impulsiveness, Ranney says. When youngsters have easy access to a firearm, the consequences of their impulsive choices can be deadly. A temporary setback like a breakup can cause an adolescent to feel he or she wants to die, Ranney says. She recalls breaking the news to the parents of a teenager who fatally shot himself after a breakup about a decade ago. "I will never forget it," she says.
Nearly 40 percent of parents erroneously believe their kids aren't aware of where in their household they store their guns, according to a research review article published in Hospital Pediatrics in June 2017. In addition, 22 percent of parents wrongly believe their kids have never handled guns kept in the house, says Dr. Monika K. Goyal, the senior author of the review article. She's an assistant division chief and director of academic affairs and research in the Division of Emergency Medicine at Children's National Health System in the District of Columbia. Teaching young children who are naturally curious to stay away from a firearm in the house shouldn't be counted on to keep kids safe, Dowd says. She dismissed the National Rifle Association's Eddie Eagle GunSafe Program, which aims to educate kids to stay away from guns, as ineffective. She compared trying to teach a young child to stay away from firearms to teaching him or her to stay out of the street. "You can train a 4-year-old to cross the street safely," Dowd says. "If you put that child in a park with no fence by a busy street, would you be OK not keeping your eye on that child? Kids don't apply what they learn at the time of risk, whether it's from excitement or curiosity," she says. Eric Lipp, national manager of the community outreach department at the NRA, says the organization hears regularly from parents, educators and law enforcement officers who report that a child who was educated about gun safety by the Eddie Eagle program, which is geared toward kids in the pre-kindergarten to fourth grade age range, alerted an adult after seeing a firearm. The governors of 26 states and 25 state legislatures have signed proclamations or resolutions recommending that the education program is used in their respective school systems, Lipp says.
An increase in firepower is also contributing to the uptick in suicides, says Dr. Michael P. Hirsh, chief of the division of pediatric surgery at UMass Memorial Children's Medical Center in Worcester, Massachusetts. In the 1980s, many firearm injuries sustained by juveniles were caused by revolvers that their parents kept in their homes, he says. "Now the ordinance is much more impressive," Hirsh says. "Almost all the injuries now are caused by (more powerful) semiautomatic weapons." Such weapons cause greater damage in the body, he says. "If you have an unsecured weapon in the home and an inquisitive toddler or depressed teen and they shoot themselves or someone else, that's not an accident or fate," he says. "It's a predictable injury."
The best way to shield kids from gunfire injuries and deaths is to not keep a firearm in the home, according to the American Academy of Pediatrics. The association cites research which suggests that keeping a gun in the home increases one's risk of being a victim of suicide and homicide. If parents keep a firearm at home, they should lock it somewhere that's secure, with ammunition stored separately. Parents should also ask the parents of their child's playmates if they have an unsecured gun in their home, according to the academy. "Just as you'd ask about pets, allergies, supervision and other safety issues before your child visits another home, add one more important question: Is there an unlocked gun in your house?" the academy advises.
The NRA disagrees with the assessments of many pediatricians regarding the dangers of firearms in the house pose to children. In November, the NRA issued a tweet advising physicians to stay away from the issue of guns: "Someone should tell self-important anti-gun doctors to stay in their lane." Many physicians responded with tweets, using the hashtag #ThisIsMyLane, describing deaths and injuries caused by gunfire and saying gun policy is their lane. "We spend a lot of our time talking about accident prevention, the importance of using bike helmets, car seats and seat belts, water safety measures to avoid accidental drownings," says Dr. Jennifer C. Ho, a pediatrician at CHOC Children's Hospital in Orange, California. "Talking about gun safety is just as important."
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