#142: Handle with Care: Firearm Safety in the Pediatric Population

May 21, 2025 | By Sam Masur

Audio

Summary:

Firearm Injuries have a significant impact on the wellbeing of our pediatric population, especially after the COVID-19 pandemic. Come and join us with our guest, Dr. Noé Romo for an insightful conversation regarding firearm safety in the inpatient and outpatient setting. In this episode, you will learn how to provide non-judgemental and seamless anticipatory guidance in well-child visits. In addition, you will gain insight in hospital based violence intervention programs and the multidisciplinary approach required in the primary prevention of firearm injuries.

Firearm Safety Pearls

1. As of 2021, firearm injuries have overtaken motor vehicle crashes as the number one cause of mortality in the pediatric population, with the majority being adolescents between 15-19. 
2. The 5 Ls of firearm safety screening are Loaded, Learned, Little (young children), Low (mental health concerns), Locked
3. The 3 pronged approach toward hospital based violence intervention program involves the clinician, social worker to address socio economic as well as mental health factors, and community outreach workers for support and engagement with the community. 

Firearm Safety Notes

Firearm Injury Epidemiology

As of 2021, firearm related injury is the leading cause of mortality in children, in the United States, overtaking motor vehicle crashes.The majority of these injuries occurred in adolescents between 15-19 years old. 

The has been a significant increase in firearm injuries and mortality since 2021. The reason for this increase is two-fold:

• The effects of the COVID-19 pandemic disproportionately affected populations with lower income and socioeconomic minorities. These same complex socio-economic factors contribute to firearm mortality
• There is in increase in legal sales of firearms, leading to an increase in sales of firearms 

Firearm Safety in Outpatient setting

Screening for firearm safety as well as interventions differ between different cultures as well as different areas (rural vs urban areas). Therefore, firearm safety screening and intervention should be universal to everyone as part of anticipatory guidance. 

5 Ls of firearm safety screening:

• Loaded: Is the gun loaded
• Learned: knowledge of proper and safe handling of firearms and firearm safety
• Little: Are there any little children around
• Low: anyone with a history mental health issues
• Locked: Firearms locked with ammunition locked in a separate compartment

Disparities with Pediatric Firearm Injury

• Poverty is associated with increased risk of firearm injury
• Racial and ethnic differences: Majority of kids victimized by firearm related homicides are black and hispanic. Majority victimized by firearm suicide are white
• Males accounted for almost 85% of all firearm related injuries in 2021, with black children accounting for 67% of firearm related homicides, and white children accounting for 78% of firearm related suicides (Roberts, 2023)  

Firearm Safety in the Inpatient setting

When treating a child who is a victim of firearm injury, it is first important to be aware of unconscious biases. The primary goal is prevention of repeat instances of violent trauma, which is the goal of violence based intervention program. 

Hospital based violence intervention programs

This starts with a multidisciplinary approach incorporating Social work, physicians, and community outreach. The goal is to address the medical need, mental health and socioeconomic need, as well as community outreach.

3 Pronged Approach to Hospital Based Violence programs:

• Medical practitioners: provide the acute medical care caused by the violent trauma
• Social Workers: Provide assistance with mental health and socioeconomic factors that could have been attributed to the violent trauma. 
• Community Outreach workers: Providing a sense of comfort to the kids as well as identifying with them. 

Community outreach and social work is extremely important in these intervention programs. In addition to providing support after the trauma, community outreach workers and social workers engage in the community who have not yet been victimized but who are at risk of being victimized. This first line prevention fosters positive relationships with law enforcement.

These hospital based intervention programs provide a good framework with the multidisciplinary approach to violence prevention, but the specifics need to be tailored to the patient population. Understanding the population of the community is important. 

The role of the clinician is to use our voice to promote understanding that firearm and violence injuries is a public health approach and provide a voice to the kids in the community.

Goal

Listeners will incorporate non-judgemental screening and anticipatory guidance for firearm injury and become familiar with the multidisciplinary approach toward hospital based violence intervention programs for primary prevention of firearm related injuries. 

Learning Objectives

After listening to this episode listeners will…  

1. Be familiar with the epidemiology of firearm related injuries and the changes after COVID
2. Feel comfortable incorporating seamless anticipatory guidance regarding firearm safety in the primary care setting
3. Recognize the different racial, gender, and socioeconomic factors involved in firearm violence
4. Learn about the utility of hospital based violence intervention programs for prevention of firearm related injuries
5. Acknowledge the multidisciplinary approach required towards firearm related injury prevention.

Disclosures

Dr. Romo reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Venkataraman V, Romo N, Berk J, Masur S, Chiu C. “#142: Handle with Care: Firearm Safety in the Pediatric Population”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ May 21, 2025.