A prescription for curbing youth violence

Health: Pediatricians are urged to ask patients about the dangers they face in their lives.

March 19, 2000|By Peter Jensen | Peter Jensen,Sun Staff

Along with height and weight, pediatricians have a new question to address during a child's annual checkup: Is there a gun in the house?

That's one of the recommendations adopted recently by the American Academy of Pediatrics, a Chicago-based organization representing 55,000 children's doctors nationwide.

The academy's 10-person Task Force on Violence called on doctors to help address the threat of violence to the health of children and youth. Their study noted that:

* Teen-agers are now more likely to die of gunshot wounds than of all natural causes combined.

* Homicide rates for males age 15 to 19 increased 113 percent between 1985 and 1995.

* Suicide and homicide have become the second and third leading causes of death of teen-agers (behind accidents).

The guidelines doctors recommend screen patients for the risk of violence, and work for gun laws and against corporal punishment. Medical schools are asked to teach students more about the prevention of violence, while medical researchers are called on to study the issue more closely.

Dr. Maxine Hayes, a task force member and health officer for the Washington State Department of Health, recently discussed the academy's violence policy during a visit to Maryland.

What do you envision doctors asking their patients regarding the potential for violence in a child's home or school?

Some of the things I hope physicians will ask about is whether there are guns in the house, whether there is fighting or quarreling and how that's settled -- especially between adults and between adults and children.

How do parents discipline? Is there hitting? How do people manage their anger or frustration? Is there depression?

A lot of violence is influenced by whether people have been drinking. If a woman is pregnant, that is a vulnerable period for battery, too.

Women and children, by far, are the majority of the victims when it comes to abuse and violent behavior so every opportunity to ask them these questions is important.

Don't doctors already screen children for signs of abuse? How is this violence policy much different?

I wouldn't assume doctors were always screening for abuse. In fact, the data suggests that if you are a member of a minority group, you get asked a different set of questions. For some majority families, their doctors never ask about these types of things. That's a disservice to them.

As providers, our biases and attitudes carry over. When you count the data, it looks like a disproportionate share of abusive behavior is perpetuated by the minority is because we ask those questions of them in the first place. The majority population rarely ever gets asked about this.

I've always advocated that you ask everybody. Don't try to guess who should be asked. I'd ask Bill Gates and his wife the same questions if they flew in from Seattle.

If a doctor finds risk factors present in a child's life -- say, the parents own a gun that's not under lock and key -- what is the physician expected to do?

Establishing whether a firearm is in the house is important. Then you should ask, have you taken measures of assuring safety of that firearm? Is it under lock and key? Is it loaded? All those things.

Could asking such a question really make a difference? In the recent shooting near Flint, Mich., the first-grader who shot his classmate was allegedly exposed to a lot of anti-social behavior.

I don't know the circumstance of that situation. But at some point of that child's life, he was under the care of some primary provider, possibly a pediatrician. Some questions should have been established about the social and environmental context of that family.

I think providers often miss opportunities to have these types of conversations and make these social assessments. I think we should be doing psycho-social assessments -- probing depression, anger, emotional conflict, all these are signs for intervention.

This child probably had models of settling arguments that were violent. I don't think it's too early to begin asking children how they would resolve conflict.

The guidelines also calls on doctors to lobby for laws restricting handgun ownership. Is that an appropriate role for a pediatrician?

There's a lot of debate. The pediatric community doesn't have one voice on that. That was a tough one. These recommendations are just that. We don't speak for all members of the academy. Pediatricians do have a role. Sometimes, it's an individual decision about how to act that role out.

It was a reaction to the statistics and the appalling realization that access to these things presents a vulnerability.

How do you see medical schools training doctors to handle youth violence?

I think there's a responsibility for medical schools to be reality-based. The fact is the communities they serve have changed. A lot of people feel they have to have a gun to defend themselves. Things have really changed.

This is what communities are facing. It has a great impact on the health of children and families. We can't care about children without caring about the environment in which these children live.

The policy calls on doctors to do so much more for children, but in these times of managed care it seems pediatricians are spending less time with patients.

Physicians have to ask some of these questions. They don't have to be the ones to ask all of them. But doctors carry so much weight in the public's eye. Survey after survey shows physicians are people who are trusted by society.

If physicians ask these questions, it creates an environment that says it's OK to talk about these things.

SOME CONCERNS

The guidelines on violence and children recommend that pediatricians screen patients for:

* Disciplinary practices and attitudes in the home

* Guns in the home

* Exposure to violence in the media,

community and school

* Domestic violence

* Gang involvement

* Drug abuse

* Abuse

* Parental stress

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