ON THE MORNING OF MAY 24, 2022, the students of Robb Elementary School, in Uvalde, Texas, started their day like any other. They tied their shoes, put on their backpacks and said goodbye to their parents and caregivers. They went to school expecting to see their friends, to learn and to prepare for the start of summer break in just a few short days. Many of them received awards for being on the honor roll that very morning. It should have been an ordinary day.
It was not. The lives of 19 third- and fourth-grade students — ages 9, 10 and 11 — were taken in a horrific display of violence. On that day, Dr. Roy Guerrero, Uvalde’s only pediatrician, was called to the emergency room to help with the injured children. Ultimately, he lost five of his young patients — children he had taken care of for much of their lives.
Helping keep children safe is one of the most essential roles of pediatricians like myself and Dr. Guerrero. We have advocated for car seats and safe-sleep practices. To keep children safe from disease, we encourage vaccinations. We remind our patients to wear their bicycle helmets and suggest their parents monitor their children’s social-media use.
We do this because protecting children from preventable injury and death is, perhaps, the most fundamental obligation we owe our young people. But there is a limit to what pediatricians can do in the exam room.
Public policy is an essential tool as well. Across the country, states have established laws requiring the use of helmets, car seats and immunizations to attend school. The federal government also sets critical public policy. Just this year, Congress passed an important law prohibiting dangerous infant-sleep products.
We’ve made fantastic progress reducing child injury and death from a variety of causes. But not when it comes to guns. In fact, firearms are now the leading cause of death in children, surpassing car accidents. Pediatricians counsel families about gun safety, but the duty to keep children safe extends beyond pediatricians and educators. It is a duty we share as a society.
I am sorry to say, we have failed our children. Every year in the United States, more than 3,500 children and teens die by firearms, including those by suicide. That is like having a Uvalde-scale tragedy every other day. Roughly another 15,000 children and teens are wounded by firearms every year.
Add to that disturbing list an estimated 3 million children who are exposed to gun violence each year. When children are exposed to violence, it leads to increases in stress and anxiety, and decreased physical activity, as a result of feeling unsafe.
The effects of gun violence disproportionately impact communities of color. Black, Hispanic and Indigenous youths are more likely to die from firearm homicide than their white counterparts. Exposure to gun violence in these communities contributes to trauma and health inequities, with lifelong implications that exacerbate unacceptable health disparities.
We can’t talk about firearm violence without talking about trauma. Science teaches us that such violence can have life-long negative impacts on physical and mental health and well-being. We owe it to our children to protect them from this trauma.
It is not just the victims of gun violence who experience trauma. Trauma often is the precursor to such violence. A recent study by The Violence Project, a nonprofit and nonpartisan research center focused on violence prevention and intervention, found that 100% of the perpetrators of mass shootings from 1966 to 2019 had a history of childhood trauma — child abuse or neglect, emotional abuse, bullying or exposure to significant violence.
Research also shows that childhood trauma can lead to negative changes to the body’s stress response; the brain of a traumatized individual is wired to scan for danger and has less capacity for emotional and behavioral regulation.
Not only do we need to do more to directly protect children from firearms, but we also need to identify affected children and engage them in a trauma-informed way and get them the care they need, as well as ensure they cannot access firearms. However, access to mental-health services and trauma-informed care alone will not solve the epidemic of gun violence. Therefore, we have no choice but to also address the availability of firearms for individuals who are at risk for doing harm to themselves or others.
Over the course of three decades as a pediatrician, I have treated five children who were accidentally shot by themselves or another child with a gun that was left unsecured. I once cared for a 2-year-old in the emergency department who died after finding an unlocked, loaded pistol under the couch in his home. I cared for a 14-year-old who died after a bullet pierced his aorta when his best friend accidentally shot him with an unlocked, loaded pistol they were playing with. A teenage girl was shot in the spine by her boyfriend as they pretended to play Russian roulette with a gun they assumed was unloaded; she lost all bodily function below her waist. Two others survived gunshots, but with injuries that will burden them for life. We simply must do more to encourage gun owners, especially those with children, to safely store their firearms.
You might expect that gun violence would touch my professional life as a doctor. But gun violence has also touched my personal life. Three boys I grew up with died by suicide with a firearm when we were teens. One of my brother’s best friends was shot in our home by his irate cousin. He was 21, and his wife and my mother were there when it happened. My mother said over and over, “There was so much blood. We couldn’t stop the bleeding.” He died before the ambulance arrived.
There have been other deaths as well. Mine is not a unique story. Far too many Americans have been affected far too many times by gun violence. We need to do more, and we need to do better.
As some of the examples I’ve given demonstrate, unsecured firearms are a threat to public safety. A multisite study found that keeping a gun locked and keeping a gun unloaded have protective effects of 73% and 70%, respectively, with regard to risk of both unintentional injury and suicide for children and teenagers. Funding to educate and train health care
