17 Philly children and teens shot themselves last year. CHOP’s new gun lock program aims to reverse the trend.

Joel Fein often tells the story to parents of his young patients at Children’s Hospital of Philadelphia: how, when he was a child, he knew the contents of every drawer and closet in his family home. There were no shelves he hadn’t rummaged through, no hiding places he hadn’t uncovered.

His parents didn’t own a gun, he said, but if they did, and it wasn’t locked away in a safe, he probably would have found it. It’s what children do, he said.

Fein and his colleagues at CHOP are part of a growing number of pediatricians working under a newfound urgency to educate families on safe firearm storage as gun ownership rises, suicide rates among adolescents surge, and as guns have become the leading cause of death for American children.

Counseling families about where and how they store their weapons has typically been at the discretion of the doctor, and it’s a recommended practice pediatricians have been following for decades, similar to how they ask about car seats, pools, allergies, and household chemical storage.

But doctors at CHOP are now not only discussing the subject with parents, but also providing free gun locks to Philadelphians in need. Plans are in the works to also offer free keypad safes in the coming months.

Questions about gun safety and storage are now built into many of the hospital system’s primary care patient questionnaires. Much in the same way doctors are reminded to ask about nutrition, sleep, and development, they’re now prompted to discuss the topic at all visits from when a child is born until age 19, said Dorothy Novick, the attending physician spearheading the initiative.

The hope is to educate families about safe storage, and keep guns out of the hands of children, who at just 2 years old, are strong enough to pull a trigger. It’s also essential to reducing suicide, Novick said, which is now a leading cause of death for kids 10 to 14. Teens who live in homes with guns are four times more likely to die by suicide, and there has been a dramatic rise in suicide among Black youth in recent years.

While doctors are advised to explain that a gun-free home is the safest for a child, they’ve realized that’s not always a realistic option for some families, Novick said. They want to make sure, she said, that if a patient’s family owns a weapon, they can have a judgment-free conversation with their doctor to ensure it’s stored as safely as possible.

“We want to do everything we can to keep children from dying,” she said.

The need is there. The number of young people in Philadelphia who have shot themselves has risen starkly in the last five years, according to police data. Of the 158 people who shot themselves last year, 17 were 18 or younger — more than five times the number recorded just five years earlier. Three died.

Twelve children have been killed in accidental shootings in Philadelphia since 2016, according to police records. Those include a 2-year-old accidentally shot by her cousin with a learning disability who found his grandmother’s gun. A 9-year-old boy killed by his teen brother after he held up a gun for a TikTok video and accidentally fired it. And a 4-year-old who shot herself.

Families appear to be responding well, Novick said. Last year, CHOP provided 770 locks to families at three of its primary care centers — plus 683 to families in the Emergency Department. This is important, she said, because research has shown that providing devices at the time of conversation is key to getting gun owners to store the weapon safely.

Only select providers in the hospital system currently offer the locks, but the plan is to soon make cable locks available at all CHOP practices that opt into the program, Novick said. Safes are also on the horizon.

The concept is not necessarily new, but CHOP aims to be more expansive than other local efforts. Scott Charles, Temple University Hospital’s trauma outreach coordinator, has been giving out free gun locks for years, no questions asked, something Novick said inspired her and her colleagues. And nationally, a few other health systems have built similar structured models, including Vanderbilt University Medical Center, she said.

But CHOP says it would be the first institution in the Philadelphia region to formally integrate gun safety across its hospital system. It’s now built into the hospital’s residency training program, and Novick’s team has consulted other health systems on how they could institute a similar process, including Jefferson Einstein Philadelphia Hospital, Lancaster General, Bucks County Health Improvement Network, and Children’s Minnesota.

The work is sensitive, and doctors often field complex questions and concerns from families, including parents who might feel it’s a private matter. All of the information gathered is confidential and protected, Novick said.

“Safe storage is something people on all sides of the ideological spectrum agree on and can get behind,” she said.

CHOP first started surveying families for safe gun storage and providing free locks in 2019, initially focusing on families coming into the Emergency Department. In 2021, it launched as a pilot program to its South and West Philadelphia hubs. Their grant to fund the program expires next year, and Novick’s team is looking for ways to keep the program sustainable in the long run.

Angelic Bradley, whose six children received care from CHOP, said she’s always fielded questions about gun ownership, but it feels more consistent in recent years. Bradley is not a gun owner, but her ex-husband was, she said, and she welcomed the conversation.

“It’s more relevant now because there are more children being shot,” she said.

While it’s impossible to know how many guns are in circulation in the U.S., firearms groups estimate that more than 1 million have been sold in each of the last 53 months. In Philadelphia, the number of gun licenses issued spiked dramatically during the pandemic.

Multiple surveys of gun owners have found that more than 50% of respondents do not store their guns locked away, or with a cable lock. A leading reason, according to one report, is that owners want ready access to the weapon for their safety.

This is a common concern among Novick’s patients, she said. Families affected by gun violence and trauma often ask how they would be able to use their gun in an emergency if it was locked away.

It’s the trickiest question to answer, she said, given the real fear in their lives. She typically tries to talk through their concerns and circumstances, while helping them understand that ultimately, the risk to a child finding the gun is significant.

Toni Richards-Rowley, a pediatrician and member of the American Academy of Pediatrics’ committee on federal government affairs, said many parents of her patients in Souderton, Montgomery County, are gun owners, and the vast majority store them safely.

She’s focused her concern on reducing suicide risk, she said, and often asks children directly, especially those with mental health troubles, whether they know the code to their parent’s gun safe.

Sometimes they do, and the parent is shocked. Richards-Rowley isn’t.

“Children know a lot more than we give them credit for,” she said.