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Pediatric firearm injury prevention anticipatory guidance

Visit	Anticipatory guidance for caregivers	Background, rationale
All ages	The best way to keep your child safe from injury or death from guns is never to have a gun in the home. If it is necessary to keep a gun in your home, or if the people you visit have guns: The guns should be stored unloaded and locked. The ammunition should be locked away separately from the gun. The keys should be kept where children cannot have access.	A gun kept in the home: Increases the risk of homicide or completed suicide. Is more likely to kill or injure someone known to the family than to kill or injure an intruder.
9 months through 2 years	As above for all ages.	Many young children are unintentionally killed or injured by guns each year; most are injured by a sibling, a friend, or themselves.
3 through 4 years	As above for all ages, plus: Encourage caregivers to ask if there are guns in the homes where their child plays.	Children this age are naturally curious and will get into everything. They do not understand the consequences of firing a weapon. Loaded guns, like other safety hazards (eg, medications, cleaning solutions, etc) should be kept out of the reach of children.
5 through 6 years	As above for all ages, plus: Encourage caregivers to ask if there are guns in the homes where their child plays.	Children this age lack the maturity or cognitive capacity to reliably follow advice concerning guns. They do not understand how dangerous guns can be even if they have been warned by adults and demonstrate that they understand that they should not touch guns, should get away from guns, and should tell an adult.
7 through 8 years	As above for all ages, plus: Encourage caregivers to ask if there are guns in the homes where their child plays. Ask the child: "What would you do if you saw a gun?"	Children this age lack the maturity or cognitive capacity to reliably follow advice concerning guns. Given the potential serious consequences of gun injury, children this age cannot be relied upon to avoid handling a weapon. There is evidence that programs designed to teach children to avoid contact with guns are not effective in overcoming the child's innate curiosity and social pressure to handle guns.
9 through 10 years	As above for all ages, plus: Encourage caregivers to ask if there are guns in the homes where their child plays. Ask the child: "What have you been taught about guns and what not to do with them?" Children who are beginning to hunt should be taught how to use guns and hunting knives safely – and only under adult supervision.*	Children this age lack the maturity or cognitive capacity to reliably follow advice concerning guns. There is evidence that programs designed to teach children to avoid contact with guns are not effective in overcoming the child's innate curiosity and social pressure to handle guns. Approximately 10% of unintentional firearm injury deaths in children <15 years of age occur while hunting; approximately 40% of unintentional hunting deaths in children <15 years are self-inflicted.
11 through 14 years	As above for all ages, plus: Encourage caregivers to ask if there are guns in the homes where their child plays or visits. Guns should be removed from the homes of adolescents who have a history of suicide attempts or other risk factors for suicide, depression, or aggressive or violent behaviors. Ask the child/adolescent: "Is there a gun at home?" "Do you ever carry a gun?"^¶ Children who are beginning to hunt should be taught how to use guns and hunting knives safely – and only under adult supervision.*	Most unintentional firearm injury deaths in children <15 years of age occur in this age group. Approximately 40% of such incidents occur at the home of a friend. The shooter is most often a brother, another family member, or friend. Approximately 10% of unintentional firearm injury deaths in children <15 years of age occur while hunting; approximately 40% of unintentional hunting deaths in children <15 years are self-inflicted.
15 through 21 years	As above for all ages, plus: Guns should be removed from the homes of adolescents who have a history of suicide attempts or other risk factors for suicide, depression, or aggressive or violent behaviors. When considering colleges, be aware of policies that allow individuals to legally carry guns on campus. Ask the adolescent: "Is there a gun at home?" "Do you know anyone with a weapon?" "Do you ever carry a gun?"^¶ "Can you get a gun if you want to?"	A gun kept in the home: Increases the risk of homicide or completed suicide. Is more likely to kill or injure someone known to the family than to kill or injure an intruder.

* Information regarding safe handling and storage of firearms is provided by Project ChildSafe.

¶ Information regarding youth violence prevention and additional resources are available from the Centers for Disease Control and Prevention.

Data from:

Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Ann Intern Med 2014; 160:101.
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4^th ed, Hagen JF, Shaw JS, Duncan PM (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2017.
Dowd MD, Sege RD, Council on Injury, Violence, and Poison Prevention Executive Committee, American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics 2012; 130:e1416.
Hemenway D, Solnick SJ. Children and unintentional firearm death. Inj Epidemiol 2015; 2:26.
Webster D, et al. Firearms on college campuses: Research evidence and policy implications. Johns Hopkins Bloomberg School of Public Health. October 15, 2016. Available at: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-gun-policy-and-research/_pdfs/GunsOnCampus.pdf. Accessed on February 22, 2017.

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