When Annie Andrews became a pediatrician, even a hospital-based one, she expected to treat children that fell off the bed and broke their arm or ate something they shouldn’t have. She certainly didn’t anticipate caring for so many children who had been shot.
“It's not something you think about when you consider what a pediatrician does, but as a hospital-based doctor for the past 12 years I've seen it happen again and again. And I started to get really worried about it,” said Andrews, who is a pediatrician and assistant professor of pediatrics at the Medical University of South Caroline (MUSC).
That worry manifested into a charge to describe the most up-to-date statistics on firearm-related injuries and deaths in order to set the stage for efforts to find evidence-based solutions. Andrews’ article, recently published in the journal Pediatrics, calls for physicians and other health care workers to recognize this as an epidemiological and public health challenge.
According to the study data, gun-related deaths in children surpassed deaths caused by motor vehicle collisions beginning in 2019. In the U.S., gun violence now kills more children under 19 than any other cause. In the past two decades, the firearm death rate has increased 14%. Conversely, due to precautions and safety laws such as those in New York requiring children to be in a rear-facing car seat until 2 years of age, child death rate due to car accidents has steadily declined since 2001.
While the MUSC paper is the first to report firearms as the number one cause of death for all children in 2019, it has been the leading cause of death for Black children in the U.S. for decades.
“One of the really striking things that we were able to highlight was the health inequities embedded in pediatric firearm injury,” said Andrews.
The pediatrician and her team noted that he overall firearm-related death rate was more than four times higher for Black children than for white children, with the homicide rate over 14 times higher for Black children.
The study points out that the gap has been increasing since 2013, which is a crucial finding for those working to design preventative interventions and policies.
Turning the Tide
Cities and states across the U.S. are implementing a variety of evidence-based programs that bring together health care, law enforcement and others.
MUSC has partnered with numerous grassroots organizations to create a hospital-based program called Turning the Tide. Ashley Hink, M.D., a trauma surgeon at MUSC who serves as the medical director of Turning the Tide, said partnerships are the keystone of the program. Violence interruption, she said, is also a critical part of the program’s strategy.
For example, after receiving a call from the police or hospital that a violent event has occurred on their street or in their neighborhood, trained community members from Turning the Tide will respond on-site. They go into the location to encourage those involved in the conflict not to retaliate or escalate the situation with more violence.
Such programs have been shown to be effective but require funding, which has been and likely will continue to be a challenge in some areas. However, the attention on de-escalation as a violence reduction tactic has received much more attention in the past few years than ever before. President Joe Biden has been vocal in his support of community programs that reduce gun violence, spurring some lawmakers to take action.
For example, Gwen Moore, a congresswoman from Wisconsin, introduced the National Community Violence De-Escalation Training Act of 2021, which, upon law, helped fund de-escalation training for eligible entities such as churches, schools, public safety officers, transit operators and others. Similarly, in Austin, Texas, a 2020 budget reallocation saw $50 million diverted into a Reimagine Safety Fund, an initiative dedicated to violence prevention and alternative forms of public safety.
Back at MUSC, in addition to the Turning the Tide program, Andrews says the culture at the hospital has evolved to add training on pediatric firearm injuries for residents, and doctors have been speaking with parents about secure gun storage and offering safety locks during well child checks.
“We need to critically ask ourselves what we can do to prevent these injuries that happen every day,” the pediatrician said. “And once an injury has occurred, we need to figure out what we can do to prevent patients from getting harmed again in the future.”