Which Types of Providers Have Firearm Discussions in a Pediatric Primary Care Clinic?

OBJECTIVE: Safe firearm storage decreases self-inflicted and unintentional firearm injury in youth. Medical providers are well-positioned to discuss safe firearm storage with families. The primary objective of this study was to determine which providers are most likely to discuss firearms with their patients. Our secondary objective was to determine whether providers were more likely to discuss firearms with patients at elevated suicide risk. METHODS: This was a retrospective chart review of primary care well child visits occurring January-December 2019 in a large, urban academic clinic. We documented provider-type and training level (exposure); any documentation of firearms in the chart (counseling, screening) was considered as having a firearm discussion (outcome). We also collected demographics, patient mental health history, PHQ-9 scores, and assessed suicide risk. RESULTS: Of the 743 charts reviewed, firearms were discussed in 9% (n=66). Medical students were most likely to discuss firearms (15%), attending physicians were least likely (1%, p < 0.001). Providers did not discuss firearms more frequently among youth at elevated suicide risk. CONCLUSION: Though providers do not frequently discuss and document firearm discussions overall, the higher rates among medical students is promising. Given the lethality of firearms in a suicide attempt, the lack of firearm safety discussions with those at elevated suicide risk was concerning. Further study should evaluate factors that facilitate discussions in this cohort and identify strategies to improve counseling among more senior providers. WHAT'S NEW: Pediatric providers have an opportunity to counsel families about the risk of firearm access. We found that trainees are most likely to counsel families about firearms, and that providers are not more likely to counsel youth at elevated suicide risk.

Identification and Management of Ankyloglossia and Its Effect on Breastfeeding in Infants: Clinical Report.

Ankyloglossia refers to a congenitally tight lingual frenulum that limits the motion of the tongue. Whether the release of a tight lingual frenulum in neonates improves breastfeeding is not clear. Because many of the symptoms of ankyloglossia overlap those of other breastfeeding difficulties, a team partnership is necessary.