1. Kirton, Carl A. DNP, MBA, RN, ANP


We have a crisis in child and adolescent health in this country.


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Five years ago, my predecessor wrote an editorial (April 2018) with a title markedly similar to this one and a callout that said, "We need to pay more attention to children's well-being." In the editorial, Shawn Kennedy recalled her days working with pediatric patients in the ED, caring for severe trauma cases, patients who fell from apartment windows, teenagers attempting suicide, and kids with gunshot wounds. Fast-forward to 2023, and not much has changed.

Figure. Carl A. Kirt... - Click to enlarge in new windowFigure. Carl A. Kirton

We have a crisis in child and adolescent health in this country; this should come as no surprise to any of our readers. At the time of this writing, four young people have been killed and at least 15 teens shot at a sweet 16 party in Alabama. Only weeks before, Nashville-area students walked out of their schools and converged outside the Tennessee State Capitol demanding stronger gun laws after a mass shooting killed three students and three adults at a small private elementary school in the city. The protest was mobilized by March for Our Lives, a youth-led movement for stricter gun laws that was formed after the 2018 shooting that killed 17 students and staff members at Marjory Stoneman Douglas High School in Parkland, Florida. Have things changed since 2018? Yes, but not in the way you might think.


Long before Kennedy and I were nurses, disease was the major cause of death in children. Advances in medicine such as vaccines and antibiotics led to a decline in disease as the major cause, only to be replaced by injuries and motor vehicle accidents, according to a special report by Cunningham and colleagues (New England Journal of Medicine, 2018). But today, these have been supplanted by gun violence. In a relatively short period of time, between 2019 and 2020, the rate of gun violence and gun death in our youth increased by almost 30%, according to the Centers for Disease Control and Prevention. To put this in perspective, if on your unit something that could harm a patient (medication errors, pump failures, CLABSIs, CAUTIs) increased by 30% in one year, you would likely consider this a crisis, something that must be addressed. What this means is there is no place that children are safe, not at home, not in our neighborhoods, and sadly, not in our schools. As an adult, I would be terrified to live on a block or in a neighborhood where gun violence occurs. And yet even in the wake of gun violence or mass shootings, we ask children to go about their normal lives in our communities and schools.


It's no wonder mental health concerns in our children are on the rise. Cushing and colleagues (JAMA Pediatrics, February) report that mental health ED visits for children are increasing by 8% annually (compared with 1.5% for other ED visits), with 13% of children revisiting within six months. A study by Vasan and colleagues (JAMA Pediatrics, 2021) showed a significant increase in pediatric mental health-related ED visits following incidents of neighborhood gun violence among children living closest to the location of the event. ED nurses may be familiar with the most common types of mental health pediatric emergencies, including psychotic and mood disorders, and disruptive or impulse control disorders. There is still much to be done regarding the psychological effects of gun violence on our children.


In this issue, Jo Ann F. Cummings addresses another mental health concern among adolescents: nonfatal nonsuicidal self-injury (NSSI). The statistics regarding this growing mental health issue are alarming, especially among sexual and gender minorities. The assessment for NSSI by nurses, especially in the ED, is important given NSSI's association with mental illness and that it is a harbinger for future suicidal events. According to research by Holden and colleagues (Personality and Individual Differences, 2022), childhood trauma is positively associated with NSSI. Yes, the type of trauma experienced by survivors of gun violence. A Washington Post interactive school shooting database shows that, to date, more than 349,000 students have experienced gun violence since Columbine. Is there any doubt that the kids are still not alright?