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JULY 2017 Casey Johnston, MD One of the most memorable patients in my pediatric residency was a teenager who was hospitalized for a multi-drug-resistant bed sore infection. He was prone to bed sores because he was paralyzed from his waist down and areas of high pressure would start to ulcer. I asked more about his life story and he explained that a few years back he and his friend had been playing with a gun and his friend accidentally shot him in the back, ultimately leading to his paralysis. A single bullet had changed the course of his whole life as well as the life of his guilt-ridden friend. Many of us know someone affected by gun violence and if not, we all definitely hear about shootings in the local, national and international news. Gun violence in our youth is a public health crisis that can only be prevented through education and safety measures. Roughly 1 in every 10 deaths in people under 18 years of age is caused by a gun. According to a recent study published in the Journal of Pediatrics, an average of 5,790 children per year in the U.S. receive medical treatment in the emergency room for gun-related injuries (that’s 19 children a day). Sadly an average of 1,297 children die annually from gun-related injuries. More than a third of these deaths were suicides and nearly a quarter of the injuries were unintentional. Boys accounted for more than 80 percent of all child firearm deaths. The number of child deaths from guns is vastly higher than in any other high-income country. In fact, the U.S. accounts for more than 90 percent of all gun-related deaths in children under 14 years of age among high-income countries. Only recently did gun violence research get government funding. There was a federal funding moratorium for 20 years because of lobbying efforts by the National Rifle Association (NRA) after the Centers for Disease Control and Prevention (CDC) found a strong correlation between having a gun in the home and an increased risk of homicide. Congress even passed a budget amendment in 1996 prohibiting federal funds from going toward research that would “advocate or promote gun control.” Individuals such as emergency medicine physician Dr. Garen Wintemute at U.C. Davis have donated their own money and time to researching the problem. Dr. Wintemute gave $1 million of his own savings to gun research. In 2016, U.C. Davis established the country’s fist state-funded firearm violence research center under the direction of Dr. Wintemute. According to the American Academy of Pediatrics (AAP), “The safest home is one without firearms;” however, many parents choose otherwise. In these cases, families who own firearms should safely secure and store them away from children with gun locks and gun safes. Bullets should be stored and locked separately. Even though a child or teenager may be trained on how to properly use a gun, accidents happen and risk-taking teenagers can act impulsively. Children and adolescents are exposed to an exhaustive amount of violence in movies, television and video games, all of which can normalize the handling and use of guns while minimizing the harmful consequences of gun violence. Another important aspect of gun violence is its intersection with mental health. Youth struggling with depression, anger, anxiety and other potential risk factors associated with harming themselves or others should have access to counseling and support. The AAP recommends removal of guns or strict restriction of access to children with significant mood disorders, substance abuse problems, or history of suicide attempts. Healthymendocino.org has helpful information about firearm safety including how parents should talk to children about firearms. Children are naturally curious and parents should discuss the dangers and how to respond when they see a child handling a firearm: “Stop! Don’t Touch! Leave the area! Tell an adult!” For more information also please check out HealthyChildren.org