Gun Violence

Words on Guns: A Pediatrician’s Perspective

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As a pediatrician I have been fighting for sensible gun law for a while. I lost 3 of my small patients to gun violence. So, useful info on how to discuss guns with gun fans:

An AR 15 is an “Armalite Rifle,” after the manufacturer Armalite. Gun nuts will ask you what AR stands for. Don’t say assault rifle or they will dismiss everything else you say.

The problem is the high velocity bullets (they go through a child’s body so rapidly that they destroy tissue 6 inches around a bullet entry), rapidity of fire, and high capacity magazines (more than 10 bullets in a magazine is not necessary unless you want to kill humans). Use those terms.

If they talk about there already being background checks? Only licensed gun dealers are required to do them, and reporting is not mandatory. We need universal background checks with mandatory reporting.

They talk about how Chicago has gun restrictions but still has gun violence? It is because Indiana, across the road, has no restrictions. Easy to cross a road.

“Guns don’t kill people, people kill people”? That’s why we want background checks on the people, not the guns.

“Car accidents kill kids too”? Yes, that’s why we require driver training, a license, registration, and liability insurance. Also why we have traffic law to regulate their use.

We need:

  • to require safe storage of guns.
  • to keep bump stocks and kits that change semiautomatics into automatics illegal.
  • either magazines that cannot be exchanged (rather, need to be reloaded), take more time to replace, or take 2 hands to replace.
  • to limit the amount of ammunition people can buy, like we do pseudoephedrine.
  • to require licensing, registration, and liability insurance. Let the insurance companies pay for the mental health check and decide which guns are too dangerous to insure. The gun lobby and the insurance lobby can have a conversation.
  • red flag laws, the same in every state.

It is generally impossible to sue shielded gun manufacturers (although one case recently did succeed), and was previously against the law for the CDC to fund any research into gun violence – very unusual restrictions passed purely to protect gun manufacturers. The Dickey Amendment, passed in 1996, was recinded in 2018, but we lost decades of research.

The NRA funnels money from gun manufacturers to politicians on both sides – mostly Republican, but some Dems. There is dark money given that is untraceable, so we really don’t know who is on their payroll. The NRA actually supported Bernie Sanders when he first won office because he promised to never vote for any law that put in a waiting period for hand guns (and he never has).

The top ten traceable donations:

  • Mitt Romney $13,637,676
  • Richard Burr $6,987,380
  • Roy Blunt $4,555,752
  • Thom Tillis $4,421,333
  • Cory Gardner $3,939,199
  • Marco Rubio $3,303,355
  • Joni Ernst $3,124,773
  • Rob Portman $3,063,327
  • Todd C Young $2,897,582
  • Bill Cassidy $2,867,074

We need to educate ourselves to even begin the push for change, because what we are doing now is not working.

Gun lobbies only care about sales, while kids are dying.

Lets do this.

Children in the Aftermath of Trauma

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Sad child on black background. Portrait depression girlWe try to protect our children from as much as we can, but sometimes life has other plans.

The murders in Orlando have taken over our thoughts, our conversations at home and with friends, the internet, and the television waves. Our children are being bombarded by the nightmare in front of the TV at home, in conversations with friends, and with questions asked by their peers. It can be too much for a child to deal with.

Your child’s experience of an event will vary depending on their age,  personal style,  life experience, and  closeness to the disaster. A toddler will only care that his or her parents seem to be upset. Older children will hurt for the people involved, worry about friends and relatives that are not within their sight, and worry that it could happen to them sometime, at some other event. What seemed exciting to discuss with friends during the day becomes frightening after the lights go off.

Listen to them talk, and be patient when they ask you the same questions over and over. Reassure them, let them know that such things are extremely rare. Answer questions truthfully, at their own developmental level. Never lie.

Monitor what your child sees and hears – adult conversation and the media can magnify fear and confusion and increase their trauma. Repetition can intensify anxiety; pictures can get locked in their heads.

After the event symptoms of post-traumatic stress may appear, even in children not directly involved. They may be sad or moody, easily angered or irritable. They may be afraid to go to public venues. They may have trouble sleeping or sleep too much. Appetites may suffer. Your child may be anxious when his or her people are not all nearby, and wake from nightmares.

Children frequently have concentration problems after a trauma, and their grades will suffer. They may regress developmentally: your independent youngsters may become clingy, or need help doing things they had been able to do on their own. They may avoid activities they previously enjoyed, and withdraw into themselves. They may become anxious at the thought of going to school, or of being separated from mom or dad.

They can also develop physical symptoms like headaches and stomachaches. They may try to exercise more control on their environment, setting up their toys in a particular way, wanting their schedule to be predictable, or demanding activities they find reassuring. Teens may act out or try alcohol or drugs in an attempt to feel better.

Helping them may be as simple as listening. Be available and receptive but don’t push. A younger child may open up and tell you his story when you break out toys or art supplies; an older one may talk if you tell her a similar story about yourself, when you were scared or worried. Schedule time for just the two of you, and wait.

Children may try to hide their symptoms: they think they should be stronger, they don’t want to be a burden, or they think they are abnormal for having the problem. They may even feel that the disaster was their fault; children are not always logical. Allowing them to bury their symptoms will only erode their spirit from the inside.

Also, be a good example. Take care of yourself, eat healthy food, sleep, and discuss events calmly. Turn off the TV and stay off the web. Exercise. Take breaks to play, read a book, and do something unrelated to it.

Keep to recognizable routines– routine is reassuring and safe. Require reasonable behavior: if they still get in trouble for using that bad word, then everything must be OK. They may test you with bad behavior just to get that reassurance. Don’t spoil them with extra treats, because it will frighten them. Things must be really bad if The Parent gives me toys or lets me eat candy.

Lend a hand to other people. It will help to know that you have the power to help and comfort.

The traumatic symptoms may last quite a while. Triggers like parents going out at night or a security guard at a local festival may bring everything back. Fear of it happening again may linger. An anniversary will renew their anxiety.

If time passes and stress is affecting their lives, think about having them see a counselor or getting them into a peer group with similar concerns. We all need a little help sometimes.

My mom also used to say, “Time heals all wounds.” And with a little help from their guardians it always will.

Charleston: Let’s Not Let Roof Win

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Change- just aheadDylann Roof did not murder nine people at the Emanuel African Methodist Episcopal Church in Charleston only because they were Black; he murdered them because he was a criminally insane psychopath.

Blaming their deaths on their race reeks to me of blaming the victim. We did not blame the kids at Sandy Hook; we do not blame rape victims. We did not tell the grieving relatives in Colorado that their loved ones died because they went to a movie. We told them that James Holmes was a criminal psychopath.

Yes, this particular psychopath had craziness is his head that focused on Black Americans. His brain was irreparably diseased. It is horrible that no-one noticed. It is worse that he was allowed to buy a gun. It is a nightmare that will never end for the families and friends of the people he killed.

But if we feed into his insanity we are giving him jurisdiction over our thoughts. Buying into his “I had no choice, I did it because they were Black,” adds weight to racial division that is already at an explosive level. He wanted to start a racial war: feeding into that is allowing him to win, and giving credit to his insanity.

The traditional description of psycopathology involves lack of empathy, lack of normal fear, and no impulse control. These people don’t care about anyone other than themselves: no one else is real to them. They are unable to comprehend danger to themselves. Their impulse control never develops: imagine a 2 year old who has a toy taken away, who immediately lunges to take it back, hitting the other child. Normal adults mature and learn to control their impulses, learn that other people matter. These people never do.

Psychopaths choose their targets based on the craziness circling in their brains. The victims themselves are completely innocent. If we say that they were killed purely because of White on Black racism we are treating Roof as if his thoughts are worth our consideration. They are not.

Horror, grief and anger may push us toward blowing this up, expanding it so that it includes other white men, or all white people, or even all people of any race other than Black.

That is what he wanted.

All young men are not child killers because one chose to murder at Sandy Hook; all men are not rapists because some rape; all parents are not child abusers because some beat their children. These murders could justifiably feed righteous anger and increase racial tensions, but in the end more anger can only bring more injury and death.

Healing will not happen through hatred. Hatred breeds more hatred – it knows no other path. Tolerance and consideration breed understanding; respect breeds respect; time heals.

We cannot feed evil, or it will thrive. His craziness is your endpoint if you allow yourself to hate.

If we want justice for the lives that are lost, and to find some grace in their deaths, we must use it to put an end to racial bigotry. Do the opposite of what he wanted. Say Enough.

How to Prevent Gunshot injuries

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In America, gun violence is one of the top three causes of death for children between the ages of fifteen and nineteen; one in four deaths from injury in this age range is from a gunshot. In 2009 alone (the most recent year for which statistics are available), there were 114 unintentional gunshot deaths in children and adolescents, in addition to the deaths from homicide and suicide. The American Academy of Pediatrics estimates 10,000 kids were injured or killed by gunshots that year: 4559 intentional, 2149 accidental, and 270 suicide attempts (the rest were undetermined). 3000 of these kids don’t live long enough to get to a hospital; 453 died in a hospital in 2009. A firearm is forty-three times more likely to be used to kill friends or family than a burglar. In my perfect world, there would be no guns inside anyone’s homes. If you must have a gun in your home, keep it unloaded, lock it up, lock up the ammunition separately, and hide the keys. Then realize that your kids will figure out your hiding place.

Whether or not you have guns, teach your children that guns are not toys—and discuss what they should do if they see one: stop, walk away, and tell an adult. Then realize that your child’s curiosity will get the better of him or her when they do see a gun. Unfortunately, it is very likely that your children will end up at someone’s home where there will be a loaded gun. Half the homes in America have a gun, and thoughtless people do keep them loaded and unlocked. I have lost several children in my practice to gunshots—all but one incident took place in a neighbor’s house where the parents didn’t even know there was a gun present.

Kids are fascinated by guns. Your three-year-old can get to that loaded gun on the top shelf of your closet; your eight-year-old does know where the keys to the gun safe are kept; your five-year-old will grab that loaded rifle and attempt to take it into his tree house. Don’t learn this lesson the hard way, as these parents did, in my practice.