Pediatricians ask parents to ‘Be SMART’ about storing firearms safely

October 28, 2020
three tween boys sit on the floor of a family room, with two boys playfully pointing toy water guns at each other
Kids don't always realize the consequences of playing with real guns, which is why the pediatrics team is promoting safe firearm storage. Photo by cottonbro via Pexels.

It’s the rare month when doctors and nurses at MUSC Shawn Jenkins Children’s Hospital aren’t called upon to treat a child with gunshot wounds.

Nationwide, firearm injuries are the second-leading cause of death for children, ranking after car crashes. For all ages, South Carolina ranks 12th among the states for firearm death rates.

Realizing that educating patient families about safe firearm storage is just as important as talking about placing newborns on their backs to sleep, fencing off pools and keeping medications out of children’s reach, a group of pediatricians started working with the Be SMART campaign to talk to parents about how guns are secured in their homes and vehicles. For parents who are interested, they offer free gun locks that have been donated by local police departments.

“We're really the first to join forces between a children’s hospital, pediatrics residency and the Be SMART program and really focus on doing this during well-child checks,” said Annie Andrews, M.D., director of the advocacy curriculum within MUSC’s pediatrics residency.

Be SMART stands for secure all guns, model responsible behavior around guns, ask about the presence of unsecured guns in other homes, recognize the role of guns in suicide and tell your peers to be SMART.

The MUSC Children’s Health program started in June 2018 with residents at the pediatrics primary care clinic in Rutledge Tower asking whether there were firearms in the home and, if so, how they were stored. At the time, just 3% of well-child visits included a discussion of safe firearm storage, according to documentation in doctors’ notes. Now, more than 75% of patients are counseled about gun safety, and the program has moved beyond well-child visits to include the Emergency Department and newborn nursery, with plans to expand into other areas of the children’s hospital.

“Once the residents started doing it, it really caught on, and they’ve been just outstanding,” Andrews said.

a young boy peeps out of a closet 
Children love to explore — but that can lead to them finding things they shouldn't, like unsecured guns. Photo by Ketut Subiyanto via Pexels.

Cassie Stegall, D.O., a second-year pediatrics resident, was excited about the opportunity to get involved. She’s taken the lead on maintaining the existing program and expanding it throughout the hospital. In addition to in-person counseling, the hospital has added a Be SMART video to its interactive GetWellNetwork, the hospital’s system that offers education videos that are accessible on screens in every patient room.

She said parents are sometimes surprised by the question about guns, but she also takes the time to explain its importance. “We ask about this because we always talk about the safety of your child, and we want to talk about safe firearm storage if you have firearms.”

Firearms should be stored separately from ammunition, and both should be locked up, she said. In addition to the gun locks donated by local police departments, the MUSC Department of Public Safety is obtaining gun locks through Project ChildSafe to distribute throughout all MUSC Children’s Health clinical sites.

Stegall said she learned about screening for firearms in medical school, but she saw few gunshot wounds during her training. MUSC Children’s Health treated 17 patients ages 0 to 15 for gunshot wounds in 2017, 12 in 2018, 16 in 2019 and 14 so far in 2020, including five in September alone.

The other residents that Stegall’s talked to say this topic wasn’t discussed during their medical school training. Knowing how to have this conversation is an important tool as they prepare to practice medicine independently, she said.

Andrews said the support of hospital and department leadership has been key to raising awareness of the issue amongst faculty, residents and staff.

“I feel like we have 100% changed the culture within the MUSC Shawn Jenkins family and the Department of Pediatrics, as far as the importance of talking about firearm violence and kids amongst pediatricians. Before we started this, this wasn’t anything that ever got talked about unless a child rolled into the Pediatric Emergency Department, and we actually had a case in front of us,” she said.

Andrews said they can’t know if they’ve prevented a firearm injury that would have happened, but she hopes that the combination of parent counseling and resident education will make a difference.

“We're teaching pediatric residents the importance of this, and I hope many of them will carry this through their entire careers and, over time, what we’re doing will impact the lives of children and will prevent firearm injuries in kids,” she said.