Abstract
Firearm injury is the leading cause of death among children. Evidence shows that counseling around firearm safety from trusted clinicians increases safe storage practices. The American Academy of Pediatrics (AAP) has recommended pediatricians provide counseling on the topic to patients and caregivers, yet gaps remain in understanding how counseling is delivered, especially in the Southeastern US. This study aimed to describe patterns of and barriers to firearm anticipatory guidance among pediatric clinicians in the Southeast. A cross-sectional survey was developed to assess awareness of recommendations/provision of firearm safety counseling. The survey was distributed between July 30-December 10, 2025 across six Southern states through AAP chapters and direct emails from physician champions. Descriptive analyses were conducted to describe the sample and summarize responses to survey questions. Among respondents (n = 131), 92.0% report ever counseling on firearm safety. Counseling was driven mostly by perceived risk (50.4%) and age-specific well visits (61.7%) and delivered during well (83.3%) and behavioral health visits (45.6%). Time was the dominant barrier to delivering counseling (60.0%). Delivery of firearm safety counseling is inconsistent and dependent on context and perceived risk. Structural barriers limit delivery of messaging. Opportunities exist to standardize safety counseling in pediatric care.