Stephanie Chao, MD, FACS, FAAP, associate professor of Pediatric Surgery at Stanford Medicine Children’s Health, has dedicated her research to understanding the true risks of firearm-related mass shootings involving children. Motivated by both her professional expertise and personal experience as a mother, Chao became concerned after her young daughter described an active shooter drill at school.¹

“She told me, ‘Well, the teacher said, in case there’s a bear outside, this is what we should do,’” Chao recalled. “I just thought that that was incredible in that the teacher had to create a story.” This experience led Chao to question the effectiveness of school-based active shooter drills and examine where the true threats to children exist.

Chao co-authored a recent study published in JAMA Pediatrics, which analyzed mass shootings involving child victims. The study defined pediatric mass shootings as incidents in which at least 4 people were killed, excluding the perpetrator, and at least 1 of the victims was under 18 years old.²

Researchers reviewed 121 incidents between 2009 and 2020, which resulted in 308 child fatalities. The study found that 59.1% of these deaths were perpetrated by a family member, with parents alone responsible for 40.9% of all mass shooting deaths. In contrast, classmates accounted for just 6.8% of child fatalities.

“I was surprised by our findings,” Chao said. “We found in our study that 59% of mass shootings that involved children dying were committed by a relative, and 41% of those shootings were committed by a parent. Only a very small percentage, by comparison, was committed by a classmate.”

Chao emphasized the role of pediatricians in addressing firearm safety.

“I think pediatricians are really on the front lines with kids,” she said. “They see all the small booboos, they see the cold, but they also see the things that are the beginnings of lifelong trauma.” However, discussing firearm safety remains a challenge in clinical settings. Chao noted that even seasoned pediatricians find conversations about gun safety uncomfortable and difficult to fit into busy patient visits.

One of Chao’s ongoing research projects, PLEDGE, aims to bridge this gap by developing a school-based curriculum focused on gun safety, safe storage, and mental health awareness.

“We are trying to create a common vocabulary that is nonpartisan,” she explained. “We need to know how to talk about it starting as children.”

Chao believes that treating firearm violence as a public health issue, rather than a political debate, is crucial for prevention.

“Gun deaths in our country need to be treated as a public health problem, and the research needs to address it just like we do any other issue,” she said. “It’s not going to be a single solution. It’s going to be multifaceted.”

Related

This month, a new initiative from The Ad Council called "Agree to Agree" was launched at Northwell Health's annual Gun Violence Prevention Forum. The initiative address firearm violence and is the first national cross-sector youth gun violence prevention campaign with a public health approach.³

The initiative includes a series of PSAs that feature health care professionals speaking to clinicians about gun violence. Using the trusted relationships that providers have with their patients and families, the initiative aims to drive conversation about gun violence prevention.

For more on this initiative, click here.

Reference:

1. Stephanie D. Chao, MD FACS FAAP. Stanford profiles. Accessed March 26, 2025. https://profiles.stanford.edu/stephanie-chao

2. Emengo P, Strope JD, Sabapaty A, et al. Victim-Shooter Relationships in Mass Shootings Involving Child Victims. JAMA Pediatr. Published online February 10, 2025. doi:10.1001/jamapediatrics.2024.6609

3. The Gun Violence Prevention Forum. Northwell Health. Accessed March 26, 2025. https://preventgunviolence.com/