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Pediatric emergency medicine physician Bronwen Carroll discusses her article, “The childhood risk we never talk about.” Bronwen explains the staggering data showing child sexual abuse is far more common than many other hazards (like choking or drowning) that parents routinely prioritize for prevention. She explores why this epidemic of sexual abuse lives in the shadows: the topic feels taboo and the solutions often seem vague compared to installing a car seat. Bronwen breaks down a practical, three-pronged approach to child safety, focusing on access, compliance, and (most critically) secrecy. She provides a simple, non-threatening, and powerful conversation starter for all parents: teaching children that no adult should ever ask them to keep a secret, and clarifying the crucial difference between a harmful “secret” and a happy “surprise.” Learn the essential strategies every parent needs to know to start this difficult conversation and empower their kids. Connect with her at www.bronwencarrollmd.com or follow her on Instagram @bronwencarrollmd.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Bronwen Carroll. She is a pediatric emergency medicine physician. Today’s KevinMD article is “The childhood risk we never talk about.” Bronwen, welcome to the show.

Bronwen Carroll: Thanks for having me.

Kevin Pho: All right. Before talking about your article, just briefly share your story. Then we will jump right into the article you wrote for us on KevinMD.

Bronwen Carroll: Sure. I am a pediatric emergency medicine physician, as you said. Through the nature of my work, I see children who have been sexually abused and sexually assaulted in the ER. I think that what most people do not realize is that sexual assault is the most common, really bad thing to happen to children. By far, about 10 percent of kids at a minimum are sexually assaulted before they are 18. So, I have always known that professionally, and of course, I speak to my own children at home about protecting themselves and staying safe. But I never really thought about what other families did.

My daughter’s teacher was arrested for possession of child sexual abuse materials. After that happened, the head of school invited me to speak at a community forum, which involved the Sex Crimes Unit, which had led the investigation leading to the arrest, and the DA’s office that would be prosecuting the case. Then my role was to speak to parents about how to address this event with children. This is a pre-K through 12 school. Obviously, that is a wide developmental range, and this is a difficult topic for anyone to speak about, but certainly parents. It is also a very broad umbrella.

When we talk about kids and sexual abuse, that covers a lot of things. That covers child predators, but that also covers online predators, exploitation, and sex exploitation. That covers just how you speak to your children about pornography. I gave my talk and I went home. In the subsequent 48 hours, I was absolutely overwhelmed by parents reaching out to me. They all said a version of the same thing, which is that nobody had ever raised any of this with them before. I just found that shocking. For me, it was this moment when you see something in a completely new way. After that, I could not just go back to business as usual.

Kevin Pho: All right. You wrote this KevinMD article. Tell us about this article for those who didn’t get a chance to read it.

Bronwen Carroll: Sure. As I said, sexual assault is overwhelmingly the most common, seriously bad thing that happens to kids, and yet parents receive almost no guidance on what to say to their children and how to say it. We talk about car seats and drowning and all kinds of other safety, which is obviously extremely, extremely important, but this big bad thing doesn’t get discussed. The thing that I want people to realize the most is that child predators are completely predictable. They are like a football team with a single play. If we can just teach families and children to recognize and defend the play, you can change the face of a public health crisis that is largely not being addressed.

Kevin Pho: All right. Tell us some of the things parents need to know. Like you said, sexual abuse can manifest in many forms, but what would be the key things parents need to be aware of that you teach them?

Bronwen Carroll: Sure. For sexual abuse to occur, child predators need three things. They need access to a child, they need compliance from that child, and they need secrecy. So, parents need to take a three-prong approach to keeping their kids safe.

Step one is access to a child, and there are two pieces of that. One is parents really need to be aware of who is with their child and who is alone with their child, and make themselves as parents a visible presence. When I say that, I do not mean that parents need to be at every single thing. I am a mom. I have four kids. I have a job. I am certainly not at every single thing. However, child predators choose their victims carefully. One of the things that they look for is kids whom they perceive as having low parental involvement. Simply by introducing yourself to the coach, dropping in on the babysitter, or saying hi to the teacher, you are keeping an eye on who is with your child and making yourself a visible presence.

They also select kids whom they perceive as having low self-esteem and needing attention. Obviously, we should all be building kids’ self-esteem aside from all of this just because it is a good and important thing to do. However, helping our children move through the world with confidence also keeps them safe.

The next thing that predators need is compliance from kids. Sexual assault almost always occurs in the context of people whom children know. When I was a kid, we were all warned about the creepy stranger asking you to pet a puppy from a van. That isn’t who is assaulting kids. Who is assaulting kids is the favorite coach, the trusted teacher, and the beloved member of the clergy. The way that this works is generally through a predictable grooming process in which predators test children for compliance. We need to train our children to recognize these behaviors, to disclose them to us, and essentially to fail these tests.

What predators tend to do is single kids out and offer them special treats or special privileges to build trust and build a relationship. Two things that all parents should be making sure that their kids know is that adults should not be singling them out for special treatment. If the teacher is giving a whole class surprise, that is wonderful. But if kids notice that an adult is treating them differently, even if it seems like a good thing, that is something that they need to talk to their parents about.

Then what predators tend to do is desensitize children to touch and desensitize children to sexual content. What that looks like is it starts with benign touch, right? But if a kid ever feels like an adult is touching their body more than they would expect, that is something that they should tell their parents about. Outside of discussions with a pediatrician or health class, adults should not randomly be talking to children about sex. Adults should not be teaching about sex, showing pornography, or anything like that. Kids should know if that happens outside of an expected conversation, they should let their parents know.

Then probably the simplest and maybe the most important place to start is that adults do not ask children to keep secrets. Now, a secret is different from a surprise. With a surprise, the person is expected to eventually find out and is expected to be happy. So, a surprise is making Grandma a card for her birthday or baking your friend cupcakes. Secrets are different. With secrets, people are never supposed to find out, and it could usually be expected that the secret would not please them. Adults should never ask kids to keep secrets. Children should know that if an adult tells them that something is a secret, even if they say that the child will get in trouble or that something bad will happen, those things are not true, and they should speak to a parent or a caregiver whom they trust immediately.

Kevin Pho: What are some approaches parents can discuss these issues with and ask these questions to guide their children about some of the things that you just talked about? What age should they start? What are some approaches that would work?

Bronwen Carroll: Obviously, there is a developmental range. With very young children, the places that I recommend starting are bodily autonomy, and that is very simple. I tell parents to start when their kids are babies at bath time, not because the baby will understand them, but because it helps the parent practice and become more comfortable. We just start with the very basics: Your body is for you, and nobody else should be touching your body. Then it is really important to teach young children about listening to their inner voice and trusting their own instincts. With preschoolers, we just start there.

By late preschool, certainly by early elementary school, any child can understand secrecy and that adults do not ask kids to keep secrets. One of my favorite parts about that is that it is messaging that applies to a 4-year-old all the way through high school. That should be a through-line through childhood. The nice thing about that is that I have found that it tends to come up in benign ways. If you make your family a family where kids always disclose secrets, then they get to practice doing that with secrets that maybe are not that big.

Then as kids get older, certainly by elementary school, any child who has access to the internet needs to have a conversation about pornography. One of the most important things about starting these conversations is that they are creating what I like to call conversational scaffolding. Conversational scaffolding is something that children, or really anybody who is having a conversation, can return to. It provides structure and it actually, just like real scaffolding, provides support and protection.

If a 12-year-old accidentally stumbles upon pornography on the internet and no conversation about pornography has ever happened in that child’s home, it is going to be exceedingly difficult, if not impossible, to expect that child to broach this conversation with his or her parents. Kids may not even know that parents know what this is. But if there has been a prior conversation, even if it is very simple—like, “You know, sometimes when you’re doing your schoolwork online, pictures can pop up that you don’t expect, and they can even be pictures of people without clothes on”—if you have had that conversation, then the child has something to reference and can say: “Hey dad, do you remember that time you told me about weird pictures popping up on the internet? I think that might have happened on my iPad today.”

Then as kids get older, this transitions into what healthy romantic relationships look like, what consent looks like, and how intoxication and substance use and abuse impact both of those things.

Kevin Pho: One of the other things that you had previously mentioned was building self-esteem makes kids less desirable targets, right? So especially in the teenage years, self-esteem is a big issue for a lot of children. Talk more about how we can do that.

Bronwen Carroll: I think in an ideal world, the less time our kids spend on screens and particularly on social media, the better it is for their mental health generally. But I think that parents underestimate how desirable just parental time and attention is to kids. This does not have to be fancy, and this does not have to be expensive. When you spend time with your kids, yes, it builds that relationship, but it is also sending children a message that you, the adult, value them as people. You find them individuals worth spending time with. Just doing that, really listening, putting your phone down for the parent too, just really listening to your kid and sending them the message that their attention is worthy of your time is the simplest way to build self-esteem. Additionally, I would say tell your kids what you like, what you admire, and what you see. Just hearing that messaging, parents’ messaging to their kids translates into becoming their children’s inner voice. We want those inner voices to be positive.

Kevin Pho: Now, let’s say a child perhaps is suspected to be approached, be groomed, asked to keep secrets, and discloses it to the parent. Tell us about the next steps after a child discloses something like that to their parent.

Bronwen Carroll: Adult survivors of sexual abuse tell us that the primary reason for not disclosing is the fear of not being believed. Kids overwhelmingly do not disclose for a minimum of five years, often until adulthood, often never. The number one reason for not disclosing is the fear of not being believed. First of all, it is good to tell your kids in advance: “If any of these things happen, you can come to me. I will believe you. I will keep you safe.” Then you need to follow through on those promises.

For a parent, obviously, a disclosure like that is extremely distressing to hear. In that moment, all the child really needs is belief, love, acceptance, and protection. So the messaging in that moment is: “I am so glad that you told me. We are going to get help and work this out together.”

Now, in terms of practical nuts and bolts, it depends a little bit on what happened. If there was a physical assault and there is a question of whether you need to go to the hospital for evidence collection because you have a time-limited window to do that, I would advise parents to call their pediatrician. Everybody should have somebody on call 24 hours a day. Or go to an emergency department because the doctors and nurses there are well equipped to help you figure out if something needs to happen right now. Most often, something does not need to happen right now. Then depending on the circumstances, speak to the school district or the police. Again, pediatricians are unfortunately very well versed in this and know how to provide families with the right resources. But most communities have children’s advocacy centers that do forensic interviewing, therapy, and counseling to help families work through these events.

Kevin Pho: What if it’s, say, in the very early stages, someone was just asked to keep a secret, and like you said, a lot of times it comes from someone the child knows, whether it’s a teacher, coach, or relative. And it may be innocuous, it may not be. So in that gray area, what do we do then?

Bronwen Carroll: You train your kids to reply: “Thank you for whatever it is. I am going to tell my dad though, because in our family we don’t keep secrets.” If this was a benign event, then that is fine. Nobody should be offended by that. However, if that is a child predator who is starting the grooming process, your child has just sent extremely clear messaging to back off and move along. Because if I am a child predator and I get that message, I hear I need to stay away from this child because this child is a threat to me. As a predator, I require secrecy and I operate based on shame. It sounds like this isn’t happening here.

Kevin Pho: And tell us some type of resources parents can turn to if they want to read or learn more about this.

Bronwen Carroll: I am working on creating these resources because I have been really startled to see how little is out there. I am very new to social media myself, but I am starting to put out reels on Instagram and TikTok talking about this. I am Bronwen Carroll, MD. I also have a website and I am in the process of writing a book that will hopefully be out in 2027. That will be a really comprehensive guide.

Kevin Pho: And I know this has certainly been implied, but what are some things that parents should definitely not do? Any red flags that they should not do when it comes to preventing potential sexual abuse in their children?

Bronwen Carroll: I think the idea here is these conversations are meant to be empowering. My message is that sexual abuse is largely preventable through education. The idea is not to cause hysteria or just cause one more thing to worry about, as parents are inundated with all these things that they need to worry about. The messaging is this is a problem that by having a family with open communication and conversations, you can largely get ahead of.

I think that it is super important for parents to be careful and to understand that when these events occur, they are never a child’s fault. It is not the kid’s fault for finding himself or herself in a situation where an adult acted inappropriately. When we look at adult survivors and mental health outcomes, the kids who do the best are the ones who disclose and are met with love and support. The kids who do the worst are the ones who disclose and are not believed. The kids who never disclose are somewhere in the middle. So meeting your kids with love, with belief, with support is key.

Kevin Pho: We are talking to Bronwen Carroll. She is a pediatric emergency medicine physician. Today’s KevinMD article is “The childhood risk we never talk about.” Bronwen, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Bronwen Carroll: Sexual assault is the most common serious threat to kids, but by speaking to your kids about it in advance, it is largely preventable. Pediatricians and everybody in health care needs to be encouraging parents to have those conversations.

Kevin Pho: Bronwen, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Bronwen Carroll: Thanks for having me.