Every generation experiences a moment when public health transforms the inevitable into the preventable. Seat belts, car seats, and graduated driver licensing laws didn’t put an end to driving. Instead, they reframed risk, layered interventions and saved lives, with emphasis on the unique safety needs of the youngest and most vulnerable.
As a pediatric trauma surgeon at Children’s Hospital of Philadelphia (CHOP) and associate at CHOP’s Center for Violence Prevention (CVP), I refuse to accept that firearm deaths among children are unavoidable. These are preventable tragedies, and we must similarly adopt evidence-based public health strategies to create a meaningful impact now.
Beginning in 2020 and continuing, firearm injury surpassed motor vehicle crashes as the leading cause of death for children and teens. In a recent JAMA Pediatrics research letter, I discussed our CHOP study that revealed an alarming development — more than half of American children now live in states where they are most likely to die from a firearm injury. Pennsylvania is one of those states. Since 2016 and continuing up to the most recent data release in 2024, children and teens in PA have been more likely to die by firearms than any other cause.
Through public health initiatives, we continue to save countless children from preventable traffic crashes. We can and must do the same to protect our youth from preventable firearm deaths.
In my work at CHOP, I care for children from all backgrounds. I regularly come face to face with the predictable, preventable consequences of unsecured guns: the private school student who found a family handgun after a breakup; the toddler who discovered a service revolver; the teenager who ended a promising life. We must stop talking about these situations as isolated accidents and take steps now to protect our children.
The dramatic decline in youth motor vehicle deaths did not result from a single solution. It evolved from evidence-based actions addressing multiple fronts. These include safer vehicle design, improved road engineering, laws such as seat belt and child restraint mandates, public education campaigns and routine clinician counseling that reinforced safer behaviors. We must adapt a similar, comprehensive public health strategy to prevent firearm injuries and death in our children and teens.
We can take the following evidence-based steps now to make an immediate impact:
- Normalize firearm safety counseling as part of routine pediatric care. Clinicians discuss car seats, household poisons and pool safety at well visits. Similarly, we need to standardize nonjudgmental screening for firearm presence, engage in age-appropriate counseling and offer concrete resources. Last year, for example, CVP expanded its firearm safety education and firearm locking device distribution program to all 30 CHOP primary care centers, making such counseling routine — a model that should be considered nationwide.
- Expanding safe storage initiatives through clinics, schools, and community organizations. Pairing free or low-cost locks and safes with messaging that respects families reduces barriers to secure storage. Our recent studies show that education and easy access to locking devices increase safe storage practices.
- Investing in community-centered prevention and mental health support. Mentorship, violence intervention programs, after-school activities, and trauma-informed care reach adolescents at elevated risk for homicide or self-harm and strengthen community resilience. At CHOP, programs such as the Violence Intervention Program and Family Advocacy and Support provide case management services to youth and their families who have experienced assault injury or other traumatic events.
- Enacting evidence-based policies at the local, state, and federal levels. Legislation plays a critical role in curbing gun violence by establishing clear rules, closing dangerous loopholes, and creating accountability for firearm sales, ownership and use. CHOP supports evidence-based policies that have demonstrated effectiveness in protecting children such as universal background checks, safe-storage requirements and bans on high-capacity or assault-style weapons.
There is no single solution to this multifaceted, complex issue that will solve the problem of gun violence. But ignoring it or attributing inaction to preserving the right to bear arms, is costing young lives. Through public health initiatives, we continue to save countless children from preventable traffic crashes. We can and must do the same to protect our youth from preventable firearm deaths.
Michael L. Nance, MD, is Chief of the Division of Pediatric General, Thoracic, and Fetal Surgery at Children’s Hospital of Philadelphia.
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