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Children playing, Kikwit DR Congo by Amanda Gwee

What kills twice as many children and teenagers as cancer, 5 times as many as heart disease and 15 times as many as infectious diseases? The frightening answer is guns in the USA.[1] Members of the gun lobby argue that ‘it is not guns that kill people but people that kill people’. This fatuous argument ignores the obvious truth that guns do not fire themselves so it is the combination of guns and people that is deadly, whereas people without guns are far less lethal. The very accessibility of guns to children and adolescents puts them at risk of accidents and suicides. A depressed teenager who takes an overdose has a less than 5% chance of dying, compared with a 90% risk if the teenager uses a gun.[2] Even if teenagers are prohibited from buying guns, an estimated 30% of US households own a gun. The powerful rifle wielded by the disturbed youth responsible for the deaths of 20 primary school children and 7 adults in Newtown, Connecticut in December 2012 was in the family home.[3]

A letter to a Sydney newspaper after Newtown commented poignantly that these massacres would continue in the USA until Americans loved their children as much as their guns. Do Australians, or the citizens of any other country for that matter, deserve to be smug about guns? Australia is recognised as one country that has had some success in addressing gun-related violence following the horrific Port Arthur massacre of 1996 in which a lone gunman with an automatic rifle killed 35 people and wounded 23. Port Arthur is one of the worst massacres ever perpetrated by a single killer but was not an isolated example; there had been several smaller massacres in Australia before Port Arthur. From 1981 to 1988, 40 people had been killed in 7 different episodes in which 5 or more people were killed at once.[4]

In response to Port Arthur, the Australian Government initiated a National Firearms Buyback, which has resulted in the destruction of just under a million prohibited firearms. These are mainly the deadliest semi-automatic rifles, but also self-loading and pump-action shotguns. Since then, the number of gun homicides in Australia has more than halved, from 69 in 1996 to 30 in 2012.[4] Firearm-related suicides fell by 80% following the buy-back. There have been no more gun massacres in Australia in the last 12 years, and importantly, there has been no displacement to other methods of homicide or suicide. But firearms control is not easy. An estimated 5% of Australian households own a gun, and the destroyed weapons are thought to have been replaced by an equal number of illegally imported guns, although fortunately mostly handguns rather than the rapid-fire long guns used in massacres.[4]

Children have always wanted to play with imaginary guns. First, it was cowboys and Indians, then civil wars, World Wars and Star Wars. Friends who refused to let their children have plastic guns found their children using sticks as pretend guns. But children who use pretend guns are well aware of the difference between imagination and reality. Their play with guns confirms that distinction between fantasy and fact while experimenting with the boundaries of acceptable aggressive behaviour.[5] Allowing young children access to firearms is a truly terrifying interference with the innocent exploration of play.

What can paediatricians do about guns and children? The American Academy of Pediatrics has published a policy statement advocating removal or reduction of guns from homes and communities as the best way of preventing suicide, homicide and accidental injury to children and adolescents.[2] Legislators are not renowned for listening to paediatricians, but we can only hope that Barack Obama, who seems to have the will, gets support to back his stand against the powerful US gun lobby. Paediatricians in other countries cannot pretend that guns are only a problem for the USA or for adults in their own country. We need to be strong advocates of enhanced gun control and education of children about the dangers of guns to ensure that children and adolescents are protected from being injured accidentally and occasionally protected against their own murderous or suicidal instincts.

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Baby with gun silver flocking by Christopher Hayden

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