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Cincinnati Children’s Seeks to Prevent Firearm-Related Injuries Among Children with Novel Approach

Firearm-related injuries are the leading cause of death in children under the age of 19 in the United States

Monday, February 03, 2025

Recently published research led by Cincinnati Children’s experts demonstrates both the need for, and effectiveness of, a program to train pediatric care providers to have conversations with patient families about firearm safety during regular care visits.

Firearm-related injuries account for 20% of all childhood deaths in the United States – more than cancer, infectious diseases, car crashes or any other single cause. In 2020 alone, more than 4,300 children died from firearm-related injuries, which is the equivalent of five school buses full of kids every month. Roughly one in three U.S. households has at least one firearm and nearly half of those do not store them securely. Moreover, 75% of children in those homes know where those firearms are located.

To combat this epidemic, the American Academy of Pediatrics recommends providers have discussions about securely storing firearms with families during regular pediatric visits. Cincinnati Children’s has taken a proactive approach to this in a way no other institution in the country has – by creating an interactive, virtual-reality-based training tool that teaches providers how to have these life-saving conversations with families.

“A lot of us (pediatricians) don’t know much about firearms or secure storage devices, and we might not know how best to communicate with families on this very important topic, “says Joe Real, MD, MEd, general pediatrician and co-lead of Digital Simulation in Cincinnati Children’s Center for Simulation and Research. “Virtual reality offers a safe and realistic environment to practice these conversations before counseling families in real life.”

The training program was developed by Cincinnati Children’s Digital Experience Technologies team and allows providers to practice having these conversations while receiving real-time coaching. The goal is to frame these discussions in a non-judgmental way that provides families with actionable information to help keep their children safe. Because the training can be delivered via a video conferencing platform, like Zoom, it can be accessed almost anywhere and costs less than traditional in-person training.

A demonstration of the training can be found here.

“As we formally assess how useful the platform is – how well tolerated it is, whether the learning outcomes are what we expect, etc. – then the goal is to apply it in practice and see if it makes an impact for our patients,” said Matt Zackoff, MD, MEd, pediatric intensivist and co-lead of Digital Simulation in Cincinnati Children’s Center for Simulation and Research and co-director of the PICU Innovation Accelerator. “Does it change what providers document that they’re talking with families about? Do patients and families cared for by those who have received the training feel like their concerns have been heard or walk away with actionable information? And, ultimately, does this lead to a reduction in injuries and poor outcomes for patients related to firearms?”

Real and Zackoff published research on the training platform in three journals last year, with the most recent in December. These studies revealed several critical findings – that parents want their child’s pediatrician to discuss firearm safety with them, that the training was effective in teaching care providers how to have these conversations with families and, importantly, that hands-on, virtual training specifically improved providers’ skills and confidence compared to traditional training alone.

More about this initiative and research, including links to each publication, can be found at Cincinnati Children’s science blog.

An animation made by Cincinnati Children’s on the importance of safe storage for firearms can be found on our YouTube page.