The intertwined problem of firearm and domestic violence

The intertwined problem of firearm and domestic violence

Every six days a child in the United States is murdered in the context of custody disputes, parental separation, and divorce. Children who are murdered in the context of intimate partner violence are more likely to be killed by firearm than other mechanisms of injury. These deaths represent a significant contribution to pediatric mortality and thus warrant further attention.

Most states do not require family court judges to be extensively trained on domestic violence and child maltreatment – the very issues they are often hearing on the bench. What a judge decides about a child – where they sleep, where they go to school, who provides their health insurance, who has medical decision making – has profound implications for a child’s safety, health, and well-being.

New laws are emerging across states and at the federal level in the last two years to reform family court and promote judicial training on issues of domestic violence and child maltreatment. Most of these laws are named after murdered children: Kayden’s Law (in the 2022 Violence against Women Reauthorization Act), Piqui’s Law (California), and Greyson’s Law (Florida).  

Yet, little has actually changed to address a public health crisis of devastating proportions killing the children of our country: the intertwined problem of firearm violence and domestic violence.

Children are most often murdered at home by a parent or caregiver – the very individual that should be protecting them. The most common mass shootings in America are family shootings. Before they are killed, most of these children have multiple interactions with health care providers, child welfare systems, civil protective orders, law enforcement, and family court. While often presented in the news media and elsewhere as isolated tragedies, many of these stories have similar patterns. And patterns are predictable.

This is a call to action. These are preventable deaths of children.

We need more research on the risk to children for lethality and danger in the context of domestic violence. We need evidence-based assessment tools that can accurately identify children at risk. Validated lethality assessments such as the Danger Assessment created by JHSON scientist Dr. Jacquelyn Campbell can be used to identify adult victims of domestic violence at risk of lethality. No such instrument exists for children. Although, in general, children should be considered at high risk if their mother is also at high risk of lethality.

Tools and checklists reduce bias and can help professionals in health and legal systems identify patterns of perpetrator behavior that indicate a child is not safe. Child safety, health, and well-being must be the priority.

We need better implementation of existing laws on firearm removal in the context of domestic violence. We need nurses and health care professionals to understand the laws around extreme risk protection orders in their jurisdictions, an intervention that evidence suggests is protective for domestic violence homicides. For example, in Maryland psychiatric nurse practitioners can petition the court for firearm removal if a patient they have assessed is at risk of harming themselves or others.

We need increased collaboration across professions and more health care professionals advocating for the health and well-being of children in the context of our legal systems. Kids can’t vote. And legally, they often don’t have a voice.

The Supreme Court will soon hear US v Rahimi on whether the government can prohibit firearm possession by a person with a domestic violence restraining order. Limiting firearm possession for domestic violence offenders will not only protect adult victims of domestic violence, but children and communities as well.

As nurses, we have to take action to address this problem. As Woolf, Woolf, & Rivara (2023) recently wrote: “A nation that begins losing its most cherished population—its children—faces a crisis like no other.”


Kathryn Spearman, MSN, RN is a pediatric nurse and PhD candidate at the Johns Hopkins School of Nursing. Her dissertation work focuses on understanding the impact of post-separation abuse on children’s health and flourishing, and is funded by NICHD (1F31HD111297-01) and a Johns Hopkins School of Nursing Discovery and Innovation Grant.

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