Parents are inundated with advice and guidance on all manner of topics from an array of sources, but as a pediatric emergency medicine physician, I have been astonished to realize that parents hear almost nothing about the risk that actually poses the greatest threat of causing serious harm to their children. Approximately 10 percent of children in the United States experience sexual abuse, with one in four girls and somewhere between one in seven and one in thirteen boys sexually assaulted before age 18, and some studies finding rates even higher than these. The sexual abuse and sexual assault of children is horrifying to consider, and perhaps for that reason, something that most parents cannot imagine happening to their family. However, the data reveal an unfortunate differing reality. The fact is that our children are far more likely to be sexually abused than to encounter almost any other childhood threat that we routinely warn them about. Parents receive direction on safe sleep environments for newborns, choking hazards, childproofing, water safety, fire safety, car seats, and bike helmets. However, sexual abuse impacts many more children annually than all those hazards combined.

Everyone knows that child predators are out there and of course, a child being sexually assaulted is something that any parent would fear. So why exactly aren’t we talking about it? I think that there are a few reasons. Many of us grew up in homes where our parents didn’t talk to us about sex and so it still may feel uncomfortable and taboo. Another challenge is that when parents think about sexual abuse, both the threat itself and the solutions feel frightening, but vague. We all know how car accidents happen, and we know that appropriate restraints will keep our kids safe. We all understand drowning, and we know to keep children who cannot swim away from open water. Understanding how sexual abuse happens and how to protect our children from it is far more difficult to conceptualize and because of that, feels more complicated to address. But it doesn’t have to be. If we make implementing strategies to reduce the likelihood of sexual abuse and talking to kids about sexual abuse a standard part of injury prevention in childhood, just as we implement so many other safety measures and talk to them about so many other topics, we can start to combat an epidemic that has lived in the shadows for far too long.

Sexual abuse itself requires access to a child, compliance from a child, and secrecy. Therefore, protecting children from sexual abuse requires a three-pronged approach. Parents can dramatically decrease the likelihood of their children being victimized by being mindful of who has access to their children. That said, of course our children are going to be in contact with adults outside of our presence, including teachers, coaches, childcare providers, family friends, and relatives. Building children’s self-esteem and confidence, to make them less desirable targets for predators, in conjunction with educating children on what predator behaviors they should be looking out for and what to do if they see them, makes children less likely to be approached by predators and less likely to comply if they are. Finally, fostering open conversations and facilitating strong communication within our families increases the likelihood that children will reject commands of secrecy and be willing to disclose concerning encounters that they may experience early on.

So how is this helpful to know and where should a family begin? Parents frequently feel intimidated and uncertain about talking to their kids about sex at all, let alone sexual abuse. Part of the problem is feeling overwhelmed by how much there is to say and not knowing where to start. My favorite beginning applies to children of all age groups and has the great advantage of being simple, non-threatening, and effective: An adult should never ask a kid (including a teen) to keep a secret. I’ve worked as a pediatric emergency medicine physician for almost 20 years and unfortunately, I see cases of sexual abuse frequently. In almost every case of sexual abuse I’ve seen where the perpetrator has been known to the child, the element of secrecy has played a critically important role in how the abuser has manipulated his victim. It is important to distinguish that a secret is different from a surprise. A surprise is something that somebody will eventually find out and is designed to make a person happy. A surprise is baking a friend a birthday cake. With a secret, no one else should ever know, and if people found out, they probably would not be happy about it. If our children know that adults should never ask a child to keep a secret (and that if that ever happens, they should tell a parent or other adult immediately), that is a good first step towards avoiding abuse. While there is much more to be discussed, initiating a first conversation is often the hardest part and broaching these topics with our children is a necessity.

Bronwen Carroll is a board-certified pediatric emergency medicine physician at Boston Medical Center and an assistant professor of pediatrics at Boston University Chobanian and Avedisian School of Medicine. She graduated magna cum laude from Harvard College and earned her medical degree from the University of Massachusetts Medical School, where she was inducted into Alpha Omega Alpha, the national medical honor society. She completed her pediatrics residency at Massachusetts General Hospital and a pediatric emergency medicine fellowship at Boston Medical Center. A mother of four, she is currently writing a book that guides parents in talking with their children about preventing sexual abuse. To learn more about her work, visit her website or follow her on Instagram.