As a primary care pediatrician, Libby Ireson, MD, talks to all her patients and their families about gun safety.
That's because nearly 4.6 million children live in a home with an unsecured firearm. To keep children safe, firearms should be stored unloaded and locked up with ammunition stored and locked separately.
Ireson practices at Children’s National, where health care providers in clinics, emergency rooms, and inpatient wards routinely ask patients’ families about unsecured guns in their homes.
Children’s Hospital Association asked Ireson about her approach to and advice for conducting firearm safety screenings.
1. Why is it important to ask families about guns in their homes?
The presence of a gun in a home where a child lives or plays — especially when not stored securely — significantly increases the risk of firearm injuries due to homicide, suicide, and unintentional shooting. These injuries and deaths are preventable.
I care deeply about the health and safety of my patients and their families, and secure storage of firearms is an essential component of counseling on injury prevention.
2. Do you follow a script when conducting a firearm safety screening?
My script for talking about gun safety has evolved over time. I’ve been lucky to work with and learn from researchers, educators, and community members dedicated to helping the medical community understand how to successfully approach this topic.
I ask about secure firearm storage in every well-child check from infancy through teenagers and young adults. Sometimes I’m meeting a family for the first time when we have this conversation.
After asking about car seats, smoke detectors, childproofing, pool safety, etc., I ask, ‘If you have any firearms in your home, how are they stored?’ I’ve learned from experts that framing the question this way may be perceived as less accusatory than starting with, ‘Do you have firearms in your home?' The conversation can take different directions from there depending on the family’s response.
Whether or not there is a firearm in the child’s home, we talk about the importance of asking family or friends if they have unsecured firearms in their homes before the child visits.
3. Do you ever get nervous doing these screenings?
Like anything new, I definitely stumbled over my words when I first started incorporating these questions. What has helped me most is being consistent and asking every single time. I’ve been lucky to have several opportunities to practice and role play these conversations in medical education settings. Now it feels like second nature.
Most of the time, my initial question above leads to an easy, productive conversation and we move on. Not to make light of a serious topic, but I once had a teenager reply without missing a beat, ‘the only guns in our house are these,’ while pointing to their biceps.
Sometimes, I can sense that families are surprised or taken aback by the question. When that happens, I may briefly worry that I’ve compromised our patient-doctor relationship, but I stay true to my belief that I have a duty to do everything in my power to help my patients and their families promote their own health and safety.
I do my best to achieve a safety-focused, normalizing, nonjudgmental approach. I’m certainly not perfect, but in these situations, I think ‘perfection is the enemy of progress' really holds true.
4. What happens if someone reports an unsecured gun in their home?
First, I thank them for telling me. Then I relate it back to other safety topics we might have talked about: ‘Just as we were discussing when you can stop using the booster seat, it’s important to talk about preventing firearm injuries. Could we talk more about how your firearm is stored?' I try to take a motivational interviewing approach. The conversation often takes different directions depending on the family’s reasons for owning and for how they store their gun.
I rely on resources – like healthychildren.org, Be SMART, and past webinars and conference sessions – to discuss what secure storage is, how to implement it at home, and the various devices that can meet each family’s needs.
While I’m certainly not a firearm expert, I am able to comfortably talk through the basics of different secure storage devices, including cost, where to get them, and referring to additional resources for further guidance. This sounds like a time-intensive conversation, and time is often limited in these visits. But this conversation can happen in just a few minutes.
Some families may be in the precontemplative stage of changing their firearm storage habits. I hope they see that it’s important to me and that I want to support them in our shared goal of keeping their kids safe. Each conversation might be a step in the safe direction, even if they won’t consider making a change in the moment.
5. What’s one tip you want to give health care providers to encourage them to conduct firearms safety screenings?
Practice, practice, practice! For many folks, these conversations do not come naturally. Practice talking to family and friends about secure firearm storage. Talking more about it in clinical and nonclinical settings will help it feel normal to you and your patients, too.
No one is surprised when your pediatrician or a carpool parent asks about child safety seats in a vehicle. Secure firearm storage is no different. It saves lives.
Libby Ireson, MD, conducted research about gun violence prevention efforts at children’s hospitals on behalf of CHA. Read the report, Keeping Kids Safe: Firearm Prevention Efforts at Children’s Hospitals, and learn about the Youth Violence Intervention Program at Children’s National Hospital.
