Dr. Alicia Silver, pleased that her young son liked his new glow-in-the-dark dinosaur T-shirt, thought he might want to wear it to school, but her kindergartner objected. When she asked why, his answer broke her heart.
He told his mother they have active shooter drills at school in which the children have to hide in the dark, and “I wouldn’t want the bad people to see me.”
Silver is an attending physician and assistant professor of pediatrics in Children’s Hospital at Montefiore/Albert Einstein College of Medicine Division of Pediatric Hospital Medicine. When she realized that this threat of violence was an ever-present reality for her son, she said, she wanted to look closer at the issue of children injured by guns.
It’s well-known that the United States leads the world in mass shootings, so drills like those at her son’s school have become more common, but mass shootings are relatively rare compared with the number of Americans shot in incidents that don’t make headlines.
Someone is shot in America every 4 minutes and 44 seconds, or about 111,000 people every year, research has showed. Silver wanted to know how many of those victims were children. She took a closer look at the most recent data available, from the 2012 Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Kids’ Inpatient Database, which tracks hospital stays for children.
“The numbers are horrifying,” said Silver said, who is giving a presentation about the numbers at the Pediatric Academic Societies Meeting in San Francisco this week.
She found that roughly 16 children a day, or an estimated 5,862 a year, were hospitalized due to firearm injuries in 2012. However, she believes that the total number of children who are shot is much higher. The data don’t include children who die in the emergency room or before they get to the hospital, nor does it include those who are treated and released.
Those numbers were down about 20% from a study of 2009 data. That sounds like good news, but “I think most people would agree one child being shot is too many,” Silver said.
She was especially struck that the majority of the children under 15 hospitalized with gunshot wounds were unintentionally injured and said these accidents could easily have been prevented if the guns had been locked up. An estimated one out of three US homes with children has a gun, and about 1.7 million US children live in homes with unlocked and loaded guns.
In older children, the background changes. Most of those between 15 and 19 were shot in an intentional assault, according to Silver’s research. This age group makes up the largest number of victims, more than 83%.
The demographics show another divide. The vast majority of children hospitalized for gunshots, 87.6%, were male. African-Americans and the poor also bear the brunt: Over half of the children who had been hospitalized were African-American, and more than half lived in a ZIP code that the government considered an impoverished area.
These injuries cost $130 million in hospital bills in 2012, an average of $22,644 per stay. Most of the children were hospitalized for six days due to the severity of their injuries, and most needed extensive followup treatment once they were released. In addition to physical therapy, many need mental health care.
Dr. John Leventhal, author of the study on the 2009 data, thinks that if there were indeed 20% fewer children shot in 2012, it could be a significant finding. However, he cautions that three years of data is too little time to detect a trend. “You can’t get too excited about a decrease yet,” he said.
The numbers mirror other data showing decreases in fatalities from gun violence for all ages.
Leventhal, a professor of pediatrics and clinical professor of nursing and medical director at Yale-New Haven Children’s Hospital Child Abuse Program, said Silver’s research is important for an additional reason: It indicates the importance of the data on why children are hospitalized. He has also used the numbers to show trends in child abuse, and they has helped him show an increase in the number of children accidentally poisoned by opioids.
Data on all these topics are published by the Agency for Healthcare Research and Quality. President Donald Trump’s budget proposed eliminating it and merging it with the National Institutes of Health, which would itself face a huge budget cut if the Trump proposal went through.
“This is really important information that gives us important insight into what is happening with child health in the United States, and this study shows us another reason why we need to keep it,” Leventhal said.
Both Leventhal and Silver also cited a lack of funding in the United States gun research. Silver conducted the new research on her own time using her own funds.
“We need to invest more in this kind of research to prevent these kinds of injuries,” Silver said.
In the meantime, Silver says she will reach out to parents at her hospital in the Bronx to try to help them better understand the importance of gun safety. Some studies showed that the number of accidents declines after doctors talk to parents about safe gun storage.
“If we can talk to parents about it in the context like how we tell parents to use outlet covers and turn pot handles away so they are not reachable, that could help,” Silver said. “Maybe if we normalize gun safety more, more children will be made safe.”