Parents are flooded with suggestions and tips on a variety of subjects from numerous sources, yet as a pediatric emergency medicine doctor, I have been taken aback to discover that parents receive almost no information about the risk that truly represents the most significant danger of inflicting serious harm on their children. Around 10 percent of children in the United States suffer from sexual abuse, with one in four girls and between one in seven and one in thirteen boys experiencing sexual assault before turning 18, with some studies indicating even higher statistics. The sexual abuse and assault of children is terrifying to contemplate, and likely for that reason, most parents find it difficult to envision such a situation occurring in their family. Nevertheless, the statistics reveal a distressing contrasting reality. The truth is that our children are much more prone to sexual abuse than to face nearly any other childhood danger that we routinely alert them about. Parents are guided on safe sleep settings for infants, choking risks, childproofing, aquatic safety, fire hazards, car seats, and bicycle helmets. However, sexual abuse affects far more children each year than all of those dangers combined.

Everyone acknowledges that child predators exist, and naturally, any parent fears their child being sexually assaulted. So why aren’t we addressing it? I believe there are several reasons. Many of us grew up in households where our parents shied away from discussions about sex, which still may render the topic uncomfortable and stigmatized. Another obstacle is that when parents contemplate sexual abuse, both the threat and the solutions seem daunting and unclear. We all comprehend how car accidents occur and recognize that using the proper restraints will ensure our children’s safety. We understand drowning risks and know to keep non-swimmers away from accessible water. However, grasping how sexual abuse transpires and how to safeguard our children from it is significantly harder to conceptualize, making it feel more complex to tackle. Yet, it doesn’t have to be. By integrating strategies to decrease the probability of sexual abuse and discussing it with children as a standard aspect of injury prevention during childhood—just as we implement various other safety protocols and discuss many other subjects—we can begin to address an epidemic that has been allowed to persist in the shadows for too long.

Sexual abuse itself necessitates access to a child, compliance from a child, and secrecy. Thus, shielding children from sexual abuse demands a three-fold approach. Parents can significantly reduce the chances of their children becoming victims by being vigilant about who has access to them. Nonetheless, it is inevitable that our children will interact with adults outside our supervision, including teachers, coaches, childcare providers, family friends, and relatives. Enhancing children’s self-esteem and confidence makes them less appealing targets for predators. This can be accomplished by educating children about the behaviors to be vigilant for and how to respond if they encounter them. Consequently, children become less likely to be approached by predators and less prone to comply if approached. Lastly, promoting open discussions and fostering strong communication within families increases the chances that children will refuse secrecy and openly share troubling encounters they may experience early on.

So how is this useful to know, and where should a family start? Parents often feel daunted and uncertain about discussing sex with their kids, especially sexual abuse. One issue is feeling inundated by the amount to cover and not knowing where to initiate the conversation. My preferred starting point applies to children across all age ranges and has the significant benefit of being straightforward, non-threatening, and effective: An adult should never ask a child (including a teen) to keep a secret. I have been working as a pediatric emergency medicine physician for nearly 20 years, and regrettably, I frequently encounter cases of sexual abuse. In nearly every instance of sexual abuse that I have witnessed where the abuser was known to the child, the aspect of secrecy has been a crucial factor in how the perpetrator manipulated the victim. It is vital to understand that a secret differs from a surprise. A surprise refers to something that someone will eventually discover and is intended to bring happiness. An example of a surprise would be baking a friend a birthday cake. A secret, on the other hand, is something that no one else should ever know, and if revealed, it would likely not result in happiness. If our children recognize that adults should never request that a child keep a secret (and that should such a request occur, they must inform a parent or another adult immediately), it marks a good initial step towards preventing abuse. While there is much more to explore, starting that first conversation is frequently the most challenging step, and addressing these subjects with our children is essential.

Bronwen Carroll is a pediatric emergency medicine physician.