Gun violence has become a topic we cannot escape. School shootings, mass shootings, and 1-on-1 firearm violence are widely reported. Commentaries on the public health crisis of firearm violence headline medical journals. However, beyond the sheer volume of senseless deaths, the agonizing ripple effects of exposure to gun violence on young witnesses and survivors remain largely underrecognized. The door to this topic was opened in the lay press with a recent Washington Post article, “Scarred by School Shootings”; the authors counted students who were exposed to school shootings (in addition to those who died) and focused on victim impact: “Many are never the same.”1 The deep and invisible wounds inflicted by fear, personal loss, and desensitization if violence is repetitive may be hidden from physicians’ eyes and underreported by parents until behavior erupts or sadness strips meaning from everyday life.2,3 Although not every child or adolescent who witnesses or experiences gun violence will develop emotional, behavioral, or academic problems, the increased risk is documented in numerous old and new studies.2–5 Factors that promote resilience include a connection to a caring adult, ready access to mental health and substance abuse services, and friendships with peers who solve problems nonviolently. However, for youth in high-risk communities, the availability … Address correspondence to Lydia Furman, MD, Division of General Academic Pediatrics, Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Room 784, Mailstop 6019, 11100 Euclid Ave, Cleveland, OH 44016. E-mail: lydia.furman{at}uhhospitals.org
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