A Q&A With Drs. Mark Del Beccaro and Fred Rivara

A child or teen is killed by a firearm every nine days in Washington, and firearms are the third leading cause of injury-related death in our state behind poisoning and falls – and ahead of motor vehicle crashes. In 2016, 3,155 children and teens in the United States died of firearm-related causes.

Most of these shootings occur in or around the home. One out of every three homes with children in the United States has a firearm. Many of these firearms are kept unlocked or loaded.

Children and teens are at the greatest risk of unintentional death, injury and suicide by firearm. Young children are naturally curious. They explore in drawers, cabinets and closets. Some older children and teens view firearms as signs of power. Others struggle with depression and thoughts of self-harm and live in households where firearms may be accessible.

Physicians may not always feel comfortable screening for the presence of firearms in the homes of caregivers or places where the child visits due to lack of training and perceived parent discomfort when discussing the subject.

A 2016 study found that fewer than 15% of physicians regularly ask caregivers screening questions about firearm safety. Yet, with national attention on recent school shootings, ongoing political dialogue and the opportunity to protect families with safe storage, pediatrician interest in discuss the subject with families may be changing.

Seattle Children’s chief medical officer, Dr. Mark Del Beccaro, and Seattle Children’s Research Institute’s investigator Dr. Fred Rivara share valuable information about firearm safety and advice on how providers can discuss this controversial topic with their patients and families.

What are the greatest risks associated with accessible firearms?

Dr. Fred Rivara

Rivara: In Washington, 75% of firearm deaths are suicides. People focus a lot on mass shootings, school shootings and homicides, but there is an especially strong association between having a gun in the home and the risk of suicide.

Accidental shootings with kids are important, but they’re a small proportion of the problem – about 500 fatalities nationwide annually, compared to 38,000 people who die by homicide and suicide.

We know that how someone attempts suicide matters. Of the people who try to commit suicide in Seattle, 93% of those using a gun will die. But only 2% of those who consume pills will die. So restricting access to lethal means is important.

Data indicate that suicide attempts are an impulsive act. For 75% of people who try to commit suicide, the time between when they decide to commit suicide and when they act is one hour or less. If lethal means are not available, people are less likely to make attempts and the attempts they make are less likely to be fatal.

Del Beccaro: Teen emotions are roller coasters. If they’re feeling depressed or bullied, they’re going to quickly pursue an immediate solution. If you can stop them for five minutes, they will potentially come out of the depth of their emotions and will no longer feel like they should end their life.

But with firearms, there’s no chance to change your mind. Once you shoot a bullet, there’s no going back.

Temporarily removing firearms from the home if a family member is depressed, suicidal or abusing drugs or alcohol may save a life. A study of adolescent suicides found that over half were carried out with firearms from the adolescent’s home. More than 75% of the firearms used in suicide attempts and unintentional injuries were stored in the residence of the victim, a relative or friend.

Why should providers address firearm safety in a clinical setting?

Del Beccaro: Protecting children is everyone’s responsibility, especially providers. Practicing safe firearm storage is no different than making a child wear a helmet or a life jacket, putting them in a car or booster seat or childproofing your home.

Practicing safe firearm storage is a proven method to keep kids safe from firearm suicide and unintentional shootings. When firearms are stored locked, suicide by firearm is reduced by 78% and accidental shootings are reduced by 85%.

Rivara: The Second Amendment guarantees people’s right to own guns and potentially have guns in their home, so it’s not a question about whether you should have a gun. But if you’re going to have a gun in your home, consider how you can prevent a tragedy from occurring. Safe storage is the best way to do that.

Why is this a difficult conversation for providers to initiate?

Rivara: There has been some concern over the legality of discussing firearm safety with patients. In 2011, a law was passed in Florida restricting a physician’s ability to ask patients about guns. That law has since been declared unconstitutional because it violated a physician’s First Amendment rights. So, providers should know it is perfectly legal to ask patients and families if they have guns in their home.

Providers are also concerned about offending patients and families. Yet surveys indicate most patients, particularly parents with kids, are perfectly comfortable with their pediatrician asking about guns in the home.

They don’t want their pediatrician to say, “You shouldn’t have guns in the home,” but they are happy to talk about safe storage.

Dr. Mark Del Beccaro

What has research revealed regarding the most effective ways to talk about firearm safety in a clinical setting?

Rivara: Our research has revealed three things:

  1. Context matters: Caregivers feel more comfortable answering firearm screening questions when the questions were asked with other non-firearm safety questions. For example, when providers discuss other injury risks to children during a standard well-child visit, the pediatrician can ask about firearms.

Additionally, it’s important to ask about firearms when caring for adolescents with substance abuse or mental health issues.

  1. Word choice matters: Caregivers strongly preferred physicians use the word “firearm” instead of “gun.”
  2. People want doctors to ask! Caregivers wanted physicians to ask firearm safety questions. Patients appreciate their pediatrician caring about the health and well-being of people in their family.

Should parents talk to their children about firearms?

Del Beccaro: Yes! It’s better to talk about it before a child or teen comes across a firearm at home or somewhere else. Here are some tips on how to do so:

  • Talk with your child about the risk of firearm injury in places they may visit or play.
  • Explain that real firearms can kill or seriously injure people, unlike toy guns or firearms shown on TV, in movies or in video games.
  • Teach your child that if they find a firearm they should leave it alone, leave the room and tell an adult right away. While this training seems to work for some children, it doesn’t work for others. The only guarantee of safety is to lock up firearms.
  • Teach your child to tell an adult right away if they see a firearm in someone’s backpack at school or if they hear someone is going to bring a firearm to school.
  • Talk with your child about firearms and violence. Let them know that strong feelings like fear and anger can be expressed without using weapons.

How can people store a firearm safely?

Del Beccaro: Kids are naturally curious about firearms and may be tempted to play with one if they find it. Locking up firearms is the most effective way to keep them out of the hands of young people.

Here is some information and advice for parents:

  • Store firearms unloaded and locked.
  • Store and lock ammunition in a separate place.
  • Use a firearm safe, lockbox, trigger or cable lock to store firearms. Simply storing firearms out of sight is not safe. Children will find them!
  • Make sure your kids do not know lock combinations or lock box key hiding places. If possible, avoid locking devices that only use keys because children and teens often know where keys are kept.
  • Always lock firearms up, even if your child or teen has had safety training. Teach responsibility by example and keep your firearms safely locked away. Teaching your child about firearms and telling them not to touch a firearm is not enough.
  • Storing firearms in a lock box or safe can prevent theft, a common source of firearms used by criminals.
  • Firearms kept in the home are 43 times more likely to be involved in a fatal unintentional shooting, homicide or suicide than to be used in self-defense.
  • Ask family and friends to use safe storage steps if they own firearms.
  • Temporarily remove firearms from your home if a family member is depressed, suicidal or abusing drugs or alcohol.
  • Safely storing a firearm does not negate your ability to use it for self-protection. Lock boxes with push-button locks make the firearm accessible in seconds. There are various types of safe firearm storage devices on the market. We encourage you to find the storage device that works best for you and your needs.

How can parents keep their children safe at other homes?

Del Beccaro: Before their children visit other homes, parents often ask questions about things like booster seat and seat belt use, allergies and animals. Advise them to add firearm safety to the conversation.

Parents should ask if firearms in the home are stored unloaded and locked and if the ammunition is stored separately. They should also ask about shotguns and rifles, not just handguns.

If parents have doubts about the safety of someone else’s home, they should invite children to play at their home instead.

Many parents feel awkward asking other people how they handle firearm safety. But research shows that 93% of parents, including parents who choose to own firearms, would be comfortable being asked about a firearm in their home.

Parents who are struggling should consider using these words to start the conversation:

  • “Knowing how curious my child can be, I hope you don’t mind me asking if you have a firearm in your home and if it is properly stored …”
  • “Mom, Dad, _________, this is awkward for me and I mean no disrespect. I am concerned Susie will find one of the firearms in your home when we visit. Do you keep them locked up with the ammunition stored separately?”

Where can families get lock boxes and trigger locks?

Del Beccaro: Safe firearm storage devices can be purchased online or at a sporting goods store, firing range or gun store. Firearm owners should decide which features are important to them and find a storage option that works best for their needs. No matter what device they choose, firearm owners should make sure that it meets the California Department of Justice’s safety standards.

Seattle Children’s distributes free lock boxes, trigger locks and cable locks at its Safe Firearm Storage giveaway events hosted periodically around the state.

Learn how to host your own safe firearm storage giveaway event: Safe Firearm Storage Giveaway Event Planning Toolkit.

Available resources: