As a pediatric surgeon at St. Louis Children’s Hospital, Dr. Bo Kennedy has seen firsthand how bullets can shatter tiny bodies.

He’s collected dozens of horror stories from his time in the hospital’s emergency department, including the time a 3-year-old boy stuck a loaded gun in his mouth and pulled the trigger.

“That’s what he did with his water pistol to get a drink out of it,” Kennedy said. “And obviously he didn’t survive.”

Because of their experience treating guns’ youngest victims, St. Louis pediatricians have increasingly considered it their responsibility to promote gun safety by talking to parents about how to keep guns away from children.

They’re following guidance from American Academy of Pediatrics, which recommends doctors talk to parents about firearm safety during visits. The academy’s official stance is guns should be kept locked, unloaded and away from where kids can find them.

But having that conversation is becoming more difficult, Kennedy said.

“Talking about guns has become much more of a volatile issue in the past 20 years,” Kennedy said. “The [National Rifle Association] has named any conversation about keeping guns in a way that’s safer into a control issue, and I think people have become very polarized.”

'You want to keep your child safe'

According to the journal Pediatrics, between 2012 and 2014, an average of 7,000 children were killed or injured by firearms each year. Of those shootings, 1,300 were fatal, and close to 80 — about 6 percent — were accidental shooting deaths.

In the last month alone, there were at least two incidents in St. Louis in which young children died or were injured after finding a loaded gun.

A first-grade girl in Florissant died after her older brother found a loaded pistol in a dresser drawer and accidentally shot her. Just a week before that, a toddler in Pagedale found a 9mm handgun in his father’s backpack while he was looking for snacks. He pulled the trigger and shot himself and his 7-year-old brother.

Read more: 'Bullets don't discriminate': St. Louis children face high rates of gun violence

Guns carry different risks for children of different ages. In those under 12, the greatest risk comes from accidental shootings. Adolescents and teenagers are in danger of finding a gun and using it to kill themselves, Kennedy said.

While accidental shootings in children are going down, suicides are increasing. Nationally, more than 650 children each year intentionally shoot themselves with a gun, according to the Pediatrics study. Three-fourths of those died.

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Pediatrician Ken Haller, the immediate past president of the Missouri chapter of the American Academy of Pediatrics, asks the “gun question” at nearly every checkup, tailoring it to fit the age of the child.

In the case of 3-year-old Azaya, a stone-faced toddler in a pink coat, he works the topic into a larger conversation about general safety in the home during a routine checkup. Pediatricians call this “anticipatory guidance,” but parents will recognize it as the part of the visit in which doctors ask about potential hazards such as swimming pools or incorrectly installed car seats.

“Are there things in your house that could be hazardous?” he asked Azaya’s mother, Angella Brown. “Any guns or weapons in the house?”

“What we want to make sure of is if people have weapons — particularly guns — that they’re stored in a place that’s locked, the ammunition is stored separately from the weapon itself,” he told Brown.

Haller also recommended that Brown ask about weapons in other houses before Azaya goes on a playdate or visits other relatives, another piece of advice the AAP recommends doctors give.

The conversation isn't political, insisted Haller, a SLUCare pediatrician who works in Danis Pediatrics, the primary care practice at SSM Health Cardinal Glennon Children's Hospital.

His only agenda is to keep younger children from playing with a dangerous firearm and older children from using it to hurt themselves.

“I have not said to anyone, 'You should not have a gun,' or 'Having a gun is bad,' or 'Having a gun is the wrong choice for you,'” he said. “What I do say is, 'If you choose to have a gun, I know you want to keep your child safe; I want the same thing. Here are some things you can do to make sure you have the safest possible environment for your child.'”

Even though individual doctors may not have a political agenda, the American Academy of Pediatrics does. The professional organization has officially come out in favor of stricter gun laws and maintains, “The absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.”

NRA: Physicians should 'stay in their lane'

Many people agree the safe-storage guidelines endorsed by the professional organization are common sense. Even the National Rifle Association advocates keeping guns unloaded and away from unauthorized users like little kids.

But some people think doctors aren’t the ones who should give that advice. In Florida, a state law barred doctors from discussing gun ownership with their patients. Courts eventually found that law violated a doctor’s First Amendment rights. A similar but less-restrictive law in Missouri outlaws requiring doctors to ask about guns, and prohibits them from documenting if patients own firearms.

While guns can of course be a safety hazard, doctors have historically shied away from treating gun safety as a public-health issue. Since 1997, federal laws have barred the Centers for Disease Control and Prevention from funding any research that would potentially promote gun control, and funding for research into gun safety pales in comparison to other public-health issues with similar morality rates.

That hasn’t kept doctors – many with a front-row seat to gun violence – from taking a stand on gun safety. That’s prompted gun-rights supporters to call out physicians for what they consider a threatening political agenda.

In November, the NRA proclaimed on Twitter that doctors should “stay in their lane” after the American College of Physicians called for stricter gun laws in a tweet that included a mocking picture of a comical-looking doctor.

Paul Bastean, owner of the Ultimate Defense shooting range in St. Peters, agrees with the NRA, even though he’s a little more polite. He’s a former police officer who teaches safety classes himself.

Credit Sarah Fentem | St. Louis Public Radio Paul Bastean speaks with a customer at his St. Peters firing range and gun store, Ultimate Defense.

Pediatricians have good advice, Bastean said. He followed the same guidelines to keep his own kids safe.

But he’s also wary of what he sees as doctors’ political agenda. Accidental gun injuries, he says, account for a small fraction of injuries compared with, for example, trampolines.

“Why they’re taking a small piece of how children are injured and focusing on that doesn’t have a genuine feel to it — it feels more politically motivated,” he said. “When I take my kids to the pediatrician, one of the questions isn’t, 'Do you own a trampoline?'”

There are close to 4,000 annual accidents requiring hospitalization related to childrens’ trampoline accidents, according to the U.S. Consumer Product-Safety Commission – three times the 1,244 accidental gun injuries each year.

But those accidents are rarely fatal. And kids don’t use a trampoline to kill themselves.

Pediatricians talking to parents isn’t going to make anyone safer, Bastean said.

“I think if they are incapable of grasping the danger of potentially having a loaded firearms within the reach of children, I don’t think a pediatrician saying, 'What are you thinking?' is going to change that situation,” Bastean said.

It’s ultimately up to parents to be responsible and teach kids to respect guns’ lethal potential, he said.

A call for common ground

But doctors say they would be negligent if they didn’t do everything they could to try to prevent gun injuries and deaths. And some are confident they can do that without alienating gun-owning parents.

A 2016 Washington University Study found that 75 percent of parents surveyed think pediatricians should ask parents about guns. But that same survey found parents were unlikely to change their behavior if a doctor told them outright to keep a gun out of the home.

However, the researchers found parents were more likely to listen to pediatricians when doctors worked a conversation about gun safety – not control – into a larger conversation about other potential hazards.

The results show there’s potentially hope for finding common ground.

“What pediatricians want for children is what parents want for children for them to be safe to lead healthy, happy lives,” Haller said. “Discussing gun safety is one of the most important things we can do to that make sure parents, children and families have that opportunity.”

Correction: Dr. Ken Haller is a SLUCare pediatrician who works in Danis Pediatrics, the primary care practice at SSM Health Cardinal Glennon Children's Hosptial. An earlier version of this story misstated Haller's role at the hospital.

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