For the past three decades, the American Academy of Pediatrics—some 62,000 members strong—has been an outspoken voice on the issue of gun control, a position that has landed it on the NRA’s (admittedly very long) list of enemies. In 1992, the AAP issued its first policy statement supporting a handgun and assault weapons ban, making it the first public health organization to do so, and it has long recommended that doctors talk about gun safety with parents. Since the massacre at Sandy Hook Elementary School in December 2012, the AAP has stepped up attempts to educate parents about gun safety around children.

But as the fight over gun rights grows ever more virulent at the national level, the AAP and individual doctors have quietly begun to take a softer stance on the issue, turning their focus to peddling realistic policies rather than clinging to a hard-and-fast no-guns line.

On a recent Sunday in April, 70 doctors and scientists associated with the AAP filed into a convention center in Vancouver to discuss firearm injury prevention. Presenters clicked through PowerPoint slides highlighting topics such as risk factors for gun injuries, popular gun-safety myths, and stats on suicide and homicide due to guns in the home. “The issue of guns really follows directly from all the concerns we have about injuries in general. This is one kind of injury that endangers the health and life of kids,” said Dr. Robert Sege, a Boston Medical Center pediatrician, who gave a presentation on how to talk about guns with parents.

The AAP’s outgoing president, Thomas McInerny—who made the Sandy Hook massacre a call to action for gun safety during his one-year post—sat in the audience. While the AAP has been advocating for an end to gun violence for some 30 years now, the shooting in Newtown shocked the nation and galvanized the AAP’s doctors to redouble their efforts in support of new gun-control measures. Newtown pediatrician Laura Nowacki lost eight of her patients in the massacre at Sandy Hook. “I’ve never spoken to the media until all of this happened. But I really believe I have to stand up. I have to use my voice,” she told the AAP News in June.

Several more Newtown victims were patients of Dr. Richard Auerbach; he’d held two of them in his arms in the delivery room where they were born. Auerbach, along with other pediatricians, wrote to Congress last year in support of an ultimately doomed measure to ban semiautomatic assault weapons brought by Senator Diane Feinstein, a California Democrat.

“These guns, these bullets blew open these children’s heads, their bodies, their limbs,” Auerbach wrote. “In what kind of society do we live, whereby these weapons are needed to defend and protect?”

For its part, the National Rifle Association (NRA) says pediatricians have no business talking about gun laws. “The AAP has a long history of advocating for gun control measures that a majority of the American people have rejected time and time again,” says NRA spokesperson Catherine Mortensen, citing in particular the Eddie Eagle GunSafe Program, which it says has been used to teach gun safety to over 27 million children since 1988.

“The fact is, no one does more to promote gun safety, education, and training than the National Rifle Association,” Mortensen says. “And if these pediatricians want to help us promote that message, we would welcome their membership in the NRA. Dues are 25 dollars a year.”

An estimated 20,600 people under the age of 25 are injured by a gun every year and 6,570 die, according to the AAP. Guns kill twice as many in this age group as cancer, five times as many as heart disease and 20 times as many as infections. By 2015, guns are expected to surpass motor vehicle crashes as a cause of death for young people, according to the Center for American Progress, a liberal think tank.

In the year after Newtown, six states—California, Colorado, Connecticut, Maryland, New Jersey and New York—passed comprehensive gun safety laws. Gun rights groups immediately mounted challenges and have countered by lobbying for and passing legal expansions of gun rights. Most recently in Georgia, the governor signed what detractors call the “Guns Everywhere” Act allowing licensed gun owners to carry their weapons in public places, including schools, churches and bars. The NRA called its passage a “historic victory for the Second Amendment.”

In the last year and a half, states have been duking it out in a sort of tit-for-tat legislative pattern—the number of state laws strengthening firearm regulations (64) is close to the number weakening them, according to the Law Center to Prevent Gun Violence, an advocacy group that tracks state gun laws. The largest gun-rights expansion efforts were concentrated in the South, while the coasts passed stronger gun control laws.

Meanwhile, even as fewer Americans choose to own guns—the share of households with a gun has dropped to about a third down from half in the 1980s, according to the Pew Research Center—public support for the regulation of firearms also seems to be down. In the 1990s, support for stricter gun laws hovered between 60 and 78 percent. More recent polling shows fewer than half of Americans think gun laws should be more strict, down from 58 percent from a survey given just after the Newtown shooting.

Because of this public reluctance, the AAP has started to focus on how to realistically reach parents in red states as well as blue—and to soften some of its language on gun control. The most recent policy statement affirms that “the most effective measure to prevent suicide, homicide, and unintentional firearm-related injuries to children and adolescents is the absence of guns from homes and communities,” but no longer calls for a total ban on handguns, instead advocating for “the strongest possible regulations” for their use.

Likewise, pediatricians and gun control advocates have tempered their message—and they say the less controversial efforts are working.

For pediatrician Claudia Fruin, telling parents not to keep a gun in their home is unrealistic, especially in Utah where she practices and is part of the AAP leadership. The conservative state was named the fourth-best for gun owners by Guns and Ammo magazine last year partly due to laws allowing firearms on school grounds.

“There needs to be a compromise. Otherwise we’re isolating people and they’re just pissed off at us,” Fruin says. In January she founded Bulletproof Kids, a public service campaign that advocates for the secure storage of firearms. The group—whose motto, “Owning a gun is a right. Protecting children is a responsibility” was created to be distinctively Second Amendment-friendly—partners the Utah chapter of AAP with law enforcement and businesses including gun shops like Doug’s Shoot’n Sports and “Get Some” Guns and Ammo as well as Liberty Safe, a safe manufacturer, on the safe storage of guns in the home, an issue Fruin says is “hopefully the one thing we can all agree on.”

Fruin says although she was unable to secure a partnership with the Shooting Sports Council (the Utah equivalent of the NRA accuses her of having a political agenda), most parents have been receptive, wanting to know how they can get their hands on a biometric safe. And other states have reached out to Fruin for advice on replicating the program.

In West Virginia, where pediatric resident Lisa Costello notes that one out of every two homes has a gun, similar local efforts are underway to promote firearm safety from the pediatrician’s office.

Costello is one of the chairs for the P.A.V.E. campaign (Pediatricians Against Violence Everywhere), a one-year advocacy effort focusing on firearm injury prevention by the special arm of AAP for pediatricians-in-training.

The operation encourages the 13,000-member group to mobilize on gun safety at the clinic, the community, and the state and federal level, as well as on social media.

“I see this in my clinic, we see this in our emergency rooms, in our inpatient wards, in our ICUS. We see these children and families impacted by firearms. That’s why we’ve been motivated to focus on this issue,” says Costello, who for her part counsels parents on firearms and injury prevention.

“My parents are very receptive to the issue of firearm injury. They appreciate that as a pediatrician I’m concerned for my patients’ health and safety,” Costello says.

Most recently, the NRA and the AAP have been embroiled in a very public legal feud over the rights of doctors to talk with parents about gun safety. In 2011, Florida Governor Rick Scott signed a NRA-sponsored law that forbade pediatricians from asking about guns in the home. A federal judge later struck down the law as unconstitutional and a decision on the state’s appeal is pending. The NRA has sponsored similar legislation in at least five other states—Alabama, North Carolina, West Virginia, Minnesota, and Oklahoma.

AAP guidelines urge pediatricians to counsel parents during checkups about the dangers of allowing kids to have access to guns. About half of all AAP pediatricians say they recommend the removal of handguns from the home, according to a national survey of AAP members.

There’s also the issue of funding for federal research—of which there has been almost none. Even after President Obama lifted the long freeze on gun research—lobbied for and won by the NRA in 1996—Congress still has yet to appropriate the $10 million in funds promised to the CDC for gun research, an amount that even if released would be too little for quality research, according to pediatricians I spoke with. But the amount isn’t likely to matter. As a researcher who spend over $1 million funding his own work put it, “Hell will freeze over before this Congress gives them [the CDC] money.” Moreover, the long moratorium has resulted in a paucity of qualified experts to research firearm injuries.

Despite the challenges, or motivated by them, pediatricians say they’ll continue to push for more research and a change in policy that will make children safer. As for the opposition, doctors insist the tide is turning.

“The NRA’s influence has peaked. Surveys of NRA members show that they’re a little tired of their leadership,” pediatrician and AAP meeting presenter Dr. Sege says. “And in general, pediatricians are never really that far ahead of American families. There are 60,000 of us and we see almost every American child almost every year. If the pediatricians are strong on this issue, it’s hard for me to believe that there will be such a discrepancy over what we believe and what the families we care for believe.”