How gun violence harms all our children

On my telemedicine screen, a pimpled dark-skinned forehead appeared; I’ll call her Shania to protect her confidentiality. Her medical records say she’s a 21-year-old Black female with chronic insomnia and obesity. We discuss her daily routine. She often skips breakfast and watches too much TikTok — nothing out of the ordinary. Twenty minutes into her virtual check-up, Shania acknowledges feeling anxious. I ask her why. “I’m scared of dying,” she says. “From COVID?” I ask. “No.” She pauses and, looking down, says, “I’m scared of getting shot.”

Six people in Shania’s neighborhood have died from gunshot injuries in the past several months.

“I grew up there,” she says — as if to offer reassurance that she was fine and that “it,” gun violence — came with the territory. But her difficulty sleeping and stress eating said otherwise.

Like the toxic effects of second-hand smoke on children’s developing lungs, secondhand exposure to gun violence can be toxic to children’s health and developing brains. There are an untold number of young people who suffer lasting emotional wounds from lying awake at night, grieving friends lost too soon and fearing they are going to be next.

Nor do children have to be wounded or see gun violence with their own eyes to feel gun violence. A recent Philadelphia study found that youth who lived within a few blocks of a shooting were more likely to seek emergency department care, up to two months after the shooting, for acute mental health problems. These effects were most pronounced within two weeks of the shooting.

Multiple studies have found that children exposed to gun violence are at increased risk for emotional and cognitive problems manifesting as anxiety, depression, and poor school performance. Extensive research documents the scientific link between violence exposure in young children and traumatic stress on children’s developing brain, immune and physiological systems. In the absence of support, these experiences set children up for lifelong mental and physical health problems.

According to the most recent National Survey of Children’s Exposure to Violence, 8% of U.S. youth reported secondhand exposure — known as indirect victimization — including hearing gunshots and witnessing a shooting. During the pandemic, youth exposure to neighborhood shootings increased, with Black youth most affected.

Gun violence has risen to the No. 1 cause of death in American children. A long-awaited 2022 CDC report revealed that gun-related homicide rates have skyrocketed to levels not seen since the early 1990s. Racial disparities have worsened, with Black youth living in poor communities at highest risk.

We discuss Shania’s obesity. “I walk a lot,” she says. “Two miles to my job, each way.” All six friends were shot in the vicinity of Shania’s job. To avoid crossfire, she takes an Uber on late work nights. Her hours are hit and miss, as is her ability to afford a car service.

I offered Shania melatonin to help her sleep. She said it hasn’t worked for her in the past.On those sleepless nights, she texted with her sister, sometimes until 4 in the morning — but never about her fear of getting shot.

She doesn’t have anyone to talk to when she’s feeling down. Her mother was in and out of her life. Children exposed to community violence often live in families and communities with little support or access to mental health services.

A 17-year-old Black male patient in my clinic lost three friends to gun violence. I asked what he would ask lawmakers to change, if he had the opportunity. “You just gotta live with it,” he said.

Youth exposed to gun-carrying peers are at increased risk of victimization and perpetration. To disrupt the cycle of violence early in childhood, the REACH program in East Los Angeles goes door to door after shootings. Families of children who reside in the vicinity of the shooting are offered free trauma-focused therapy and other support services.

But there aren’t nearly enough programs like this. Most hospitals utilize the violence interrupter models, which typically aim to prevent re-injury amongst high-risk youth. A proposal is pending on the federal level to fund the CDC in ensuring evidence-informed outcomes of community violence interrupter programs.

Like an environmental health approach to second-hand cigarette smoke, there has been success in using an environmental health approach to gun violence. A randomized control study by the University of Pennsylvania found that remediation of blighted land and creation of safe green spaces in high-crime areas of Philadelphia reduced crime and shootings. Most reduction was seen in abandoned lots where community members shared in greening responsibilities. We can build on that now, with little funding and without an act of Congress.

In the aftermath of the Texas elementary school shooting, children across the country are likely inhaling the second-hand smoke of gun violence. We must stop the damage before it’s too late.

Agrawal is a pediatrician in New York City and New York State chair of the American Academy of Pediatrics’ Gun Safety Committee.