Many children live in houses with guns, but pediatricians often don’t feel comfortable discussing gun safety with parents — even though most parents say they would welcome that conversation.

That’s a key finding from a study published Wednesday in the Journal of Pediatrics. It comes as some state legislatures and doctors tussle over proposals restricting what doctors can say to patients about firearms, and as doctor groups increasingly push physicians to treat gun violence as a public health concern.

The paper is based on a survey of about 1,200 parents in the area surrounding St. Louis. Parents visiting their pediatrician’s office filled out a questionnaire asking whether they owned firearms, whether their children were regularly exposed to guns and how they would react if the pediatrician brought up the question of firearm safety for children.

Based on the surveys, the researchers concluded that more than a third of children lived in houses with guns, while another 14 percent were regularly in houses that had them. About 77 percent said their pediatricians didn’t ask them any questions about gun safety. But, at least when it comes to safely storing guns, three-fourths of parents said the doctor should offer some advice. Parents who owned guns were less likely to want pediatricians discussing gun safety.

“A lot of children die every year because of needless injuries — because of their curiosity. Pediatricians are not firearm safety experts for the most part, but they are experts on childhood development,” said Jane Garbutt, a professor of medicine at Washington University in St. Louis and the paper’s lead author. “Parents look to their pediatricians as their most trusted source of information about a lot of things.”

The research comes while states debate what physicians can or should say to patients about firearms. A Florida law, which bans doctors’ inquiries about guns, is currently facing a court challenge. Several other states — including Texas, North Dakota, Oklahoma and Virginia — have considered similar laws, though none passed.

Such legislation, which is supported by the National Rifle Association, has attracted criticism from groups like the American Academy of Pediatrics and the American Medical Association, which say such measures limit physicians’ First Amendment rights and interfere with the appropriate practice of medicine.

The AAP also recommends all pediatricians screen for whether families have guns in their homes and, if the answer is yes, says doctors should advise parents to remove the guns. “Unintentional injury is a real concern,” said Judith Schaecter, chairwoman of pediatrics at the University of Miami, a member of the AAP’s Council on Violence, Injury and Poison Prevention and one of the doctors challenging Florida’s law. She was not involved in the study.

The NRA did not immediately respond to requests for comment on this study, but the organization has previously argued that families visiting the doctor are looking for medical advice, and that physicians asking about guns intrudes on patient privacy. Lawyers defending the Florida law argue it is trying to “prevent harassment and discrimination.”

This study suggests the issue is more complicated, Garbutt said, and that there are ways pediatricians can appropriately inquire about gun safety without alienating patients. For instance, when a child starts to crawl, pediatricians want to ask about whether they are ever in contact with potentially hazardous materials, like prescription medication and toxic cleaning supplies. It would be easy, she said, to add firearms to that list — grouping them with materials that may be risky without explicitly asking parents about gun ownership.

“You don’t have to ask directly about firearm ownership. You’re just asking about a firearm as a hazard,” she said.

And the study finds such questioning could bring benefits. Of survey respondents, about one in five kept their guns and ammunition together. And a quarter stored firearms loaded, which increases the odds of injury if children find them while playing, Garbutt noted.  More people are getting guns because they want them for protection, she said. That means they’re more likely to keep them readily accessible, where children could also find them.

That underscores the need for a thoughtful approach, said Eric Fleegler, an assistant professor of pediatrics and emergency medicine at Harvard Medical School, who has researched gun safety and pediatric care but wasn’t involved in the study.

“You need to be sensitive to the needs of our patients,” Fleegler said. “Yes, we are talking about something that some people may feel uncomfortable with, but then again, there are some patients who don’t want to talk about immunizations. There are people who don’t want to talk about domestic violence, who don’t want to talk about sex, etc. It’s up to the pediatrician to find out a way to balance this.”

One Second Amendment advocacy group questioned the findings. Because the survey is based mainly on the St. Louis area, it shouldn’t be generalized to the rest of the country, said Timothy Wheeler, director of Doctors for Responsible Gun Ownership, which is operated by the Second Amendment Foundation.

But Garbutt and Fleegler noted that even though the survey isn’t based on a nationally representative sample, other demographic elements — like the number of people owning guns — mirror the rest of the country. That, they said, makes it easier to draw conclusions from it.

Pediatricians, meanwhile, appear skittish. Anecdotally, Garbutt said, many said they didn’t feel comfortable discussing gun safety. That may be because they are afraid of offending patients, or don’t know how to approach the conversation, she said. And controversies like that over the Florida law may play a role, Fleegler noted.

“The presence of these laws really dampens people’s willingness to have these conversations,” he said.

Meanwhile, there needs to be further investigation when it comes to how doctors should handle these conversations, said David Hemenway, a professor of health policy at the Harvard School of Public Health. He is also the director of the university’s Injury Control Research Center, and was not involved in the study. Right now, he added, there isn’t a general sense of how doctors should best approach discussing gun safety.

That matters, Garbutt said. The absence of productive conversations keep children at serious risk.

“There are a lot of risks for children in terms of their chance to come across a loaded firearm. What we know from other studies is if they can find it, they will, and if they find it, they will play with it,” she said. “Parents who have a gun in the home need to make absolutely sure it’s not accessible to their children.”