Penetrating BB shot head wound in an asymptomatic 9-year-old girl: the ultimate teaching moment.

BACKGROUND Air rifle BB injuries represent a common type of childhood accident. The purpose of this case report is to encourage all providers of pediatric care to include nonpowder firearm safety education with standard well-child anticipatory guidance. METHODS A case report is described and experience with similar injuries is discussed from cases found in a literature review using the key words "air rifle," "patient education," "pediatric," "ballistics," and "trauma." RESULTS A 9-year-old girl came to the emergency department after having been accidentally shot in the head by her 7-year-old brother with a toy air rifle. The BB shot entered through the left cheek and traversed up into the soft tissue above the mandible, just medial to the internal carotid artery, and posterior to the facial nerve. Other than local pain, she was entirely asymptomatic. The cheek was repaired without complication. Conservative therapy was recommended. She and her family were given anticipatory guidance, and her course thereafter was uneventful. CONCLUSION Firearm education is not a standard part of every well-child encounter. Injuries by all types of firearms are increasing at epidemic rates. Questioning about the accessibility of both powder- and non-powder-based weapons (ie, air rifle) and providing routine safety education should become the standard of care at all well-child encounters.