Early in my career as a pediatric emergency room doctor, a mother brought her young daughter into the ER. The mom had recently ended a romantic relationship with a man, and he subsequently sent her texts graphically detailing the sexual violence he planned to inflict on her 3-year-old daughter in retaliation. Understandably, this prompted concern that perhaps the child had already been sexually abused, and the mother hoped that I could perform a physical exam to determine if this was indeed the case. Unfortunately, most kids who have experienced confirmed sexual abuse do not exhibit conclusive physical signs. So I was unable to provide any definitive reassurance, despite my tremendous sympathy with her plight. The texts were so distressing that I shielded the nurses and residents from them, and to this day, I’ve never shared their details with anyone. After my shift, I couldn’t stop worrying about that little girl. One of my closest friends is also a pediatrician, and she is the person I process difficult cases with. She asked what the texts said, and I told her I didn’t want their content living inside her head for eternity, too. Of course, my friend isn’t my patient, but I still felt as if the Hippocratic Oath applied: first do no harm. There was no need to cause her trauma as part of processing my own.
This happened nearly 15 years ago, and when I recall this family’s story, I wonder if I’d be similarly impacted today. Not infrequently, I tell people that I’ve reached a point in my career where I’m impossible to surprise. My intent is to reassure them that they don’t need to fret over what they disclose because no matter how terrible it may feel to them, it’s unlikely to startle me. All doctors, but especially those who see tragedy frequently, must compartmentalize to function. I have now seen so many horrific cases of sexual abuse that I don’t know if those texts would hit me quite as hard if I were reading them for the first time today. But while I view my emotional toughening as a necessary, probably adaptive professional process that has naturally evolved, sometimes I worry about what it says about me when I’m not crying. Part of me knows that I should be.
It occurs to me that my own numbing to stories of childhood sexual abuse is perhaps being mirrored by our culture. I became involved in childhood sexual abuse prevention work after realizing that parents receive virtually no routine guidance on how to protect their children. At first, I thought the problem must be that people didn’t understand the prevalence of childhood sexual abuse — how else can we explain the disconnect between the dramatic scope of the issue and the dearth of prevention efforts. However, now I wonder if I’ve been thinking about it all wrong. Maybe the problem is, in fact, the complete opposite. Maybe people do loosely understand how common sexual abuse is, but have become inured to the endless barrage of news stories featuring teachers and coaches and religious leaders arrested for possession of child sexual abuse materials and wealthy, powerful men exploiting adolescent girls. Maybe as a culture, we’re like the child who sticks her fingers in her ears, squeezes her eyes shut, and screams, “La La La! I can’t hear you!!” because we have heard so many of these stories and have become so overwhelmed by them that we choose to block them out.
I fell into sexual abuse prevention work by accident, but the first time I spoke to a group of parents about strategies for averting abuse, I found the experience cathartic. It felt as if I was effectively honoring the children I have cared for by helping families get ahead of child predators, so that perhaps fewer children experience sexual abuse in the first place. Sexual abuse isn’t framed as a problem that can be easily addressed, and since it’s obviously awful, if it doesn’t seem fixable, then people feel paralyzed by it. But the truth is that sexual abuse is largely preventable through straightforward strategies that anyone can implement. Child predators are like a football team that keeps winning with a single play; their behavior is entirely predictable. But if we can teach parents and children to defend the play, we can alter the game. For child predators to succeed, they need three prerequisites: secrecy, access to a child they perceive as vulnerable, and compliance from that child. Families can keep kids safe by understanding these dynamics and administering simple strategies in response. It should be widely understood that adults don’t ask children to keep secrets. A secret is not the same as a surprise. With a surprise, the recipient is expected to eventually find out and be happy. A surprise would be baking Grandma cupcakes for her birthday. Secrets are different. With a secret nobody is ever supposed to find out, and if they did, they presumably would not be happy. Merely teaching kids that adults do not ask children to keep secrets helps stop childhood sexual abuse because predators cannot operate without secrecy. And simply by having straightforward conversations early on about not keeping secrets, bodily autonomy, and trusting one’s inner voice when an interaction doesn’t feel right, parents establish open communication and that alone confers protection. Children who live in families where these topics are discussed are less vulnerable because they become more likely to recognize problematic interactions early and know to seek help. Families also need to understand that child predators achieve compliance from children by moving them through predictable grooming patterns that generally include establishing trust through bribes and desensitizing them to touch and sexual content. Kids should know to tell a parent if an adult ever offers them unusual gifts or special treatment, seems to be touching them more than would be anticipated, talks to them about sex outside of an expected context (e.g., health class at school), or shows them sexual images.
I recently had a conversation with an economist who studies poverty, and he shared his conclusion that data doesn’t change people’s beliefs, but stories and relationships do. His example was that when people learn that a friend once received government assistance, it challenges their assumptions about who the beneficiaries of such programs are. There is certainly no shortage of stories about childhood sexual abuse. This is true both in the media and when you simply start talking openly about this topic, which is usually only mentioned in hushed whispers. Every time — truly every single time — that I speak to a group or even reference my prevention work in passing, people pull me aside to tell me about their camp director or cousin or what happened to their friend many years ago. I believe my economist friend is correct that stories do have the potential to change how people view problems, but that only holds true if we open ourselves to them — even when faced with the impulse to plug our ears. I consider professional distancing to be different from plugging my ears, but do they have the same effect?
My husband observes that I seem to be on a predictable cycle, where approximately every 18 months, a case from the ER emotionally levels me. It cannot be that particularly challenging cases just happen to arrive every 18 months; clearly, this is a phenomenon about me. My theory is that we can all only maintain resilience in the face of challenge for so long. For me, apparently, that timeline is about 18 months, after which my defenses break down, and a sad story flattens me. Then I work through it and regroup, and the cycle begins again.
The goal of my sexual abuse prevention work is to educate families about the simple steps they can take to prevent sexual abuse and ultimately make the world a safer place for kids. But I’m hopeful there may be a secondary benefit, for myself and others. Properly reframing sexual abuse as a fixable problem is empowering, and maybe that is what allows us to finally face these stories that have the power to change us.
Bronwen Carroll, MD, is a pediatric emergency medicine physician at Boston Medical Center and assistant professor of pediatrics at Boston University Chobanian and Avedisian School of Medicine. She is a mother of four and will publish a book in fall 2027 about how to talk to our kids about preventing sexual abuse. You can visit her website at bronwencarrollmd.com and follow her on Instagram at @bronwencarrollmd.
Need help? Visit RAINN’s National Sexual Assault Online Hotline or the National Sexual Violence Resource Center’s website.
