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System Failure: When Adults Fail to Protect Young Athletes from Sexual Abuse by Health Providers

Jonathan Thackeray, MD, FAAP
February 12, 2018

As a pediatrician, I have followed with great interest, and great sadness, the story of the 156 courageous women and children, many of whom were gymnasts with USA Gymnastics (USAG) who came forward to tell their stories of sexual abuse. In addition to grieving with these children and their families, I am outraged because the abuses of Nassar were so completely and entirely preventable.

Plenty has been written about the evils of Larry Nassar and his betrayal of the children and families who placed trust in him. But should we be surprised that this man who so many trusted was able to commit such harm? No. The reality is that 1 in 10 children, if not more, in the U.S. will be sexually abused before the age of 18. Most of these children will be abused by someone they believe to be safe – a family member, a coach, or a member of the clergy perhaps.

More than 80 percent of sexual abuse cases occur in situations where an adult has one-on-one access to a child. They occur in every imaginable setting, including faith-based organizations, sports camps, hospitals, schools, private homes, and more. Normal interactions of groups of adults and children in these settings are necessary, appropriate, and often beneficial to the child.

This is the recurring story of vaccine preventable diseases.

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"The reality is that 1 in 10 children, if not more, in the U.S. will be sexually abused before the age of 18.

There are few situations, however, in which a one-on-one encounter between a single adult and a child is warranted. And there are simply no situations where it is appropriate for a one-on-one encounter between an adult and a child that involves a sensitive examination of a child, including certain medical exams and physical therapy sessions. Many institutions have developed “chaperone” policies to ensure that sensitive examinations are conducted in the presence of a caregiver for young children, and an additional professional for adolescents. Sample policies are widely available and should be implemented by all child-serving institutions and programs as a minimum standard.

Unfortunately, such a policy seems unlikely to have helped these children. Why? Because according to published reports, both USAG and Nassar’s employer, Michigan State University (MSU), were warned of suspected abuse on multiple occasions, but failed to initiate a report to authorities. While it seems unimaginable, the reality is the failure to report is a common phenomenon, and a look back at history suggests why.

Child abuse has long been an issue that people would rather leave in the shadows, unmentioned and unseen. The American Society for the Prevention of Cruelty to Animals litigated on behalf of abused children before similar organizations for children even existed. And then it wasn’t until another 100 years passed that our country developed “mandated reporter” laws requiring certain professionals who interact with children – teachers, doctors, social workers, and many more – to report suspicions of child abuse to the proper authorities. These laws protect the person making the report, in that the person doesn’t even have to be correct. The reporter only needs to suspect that abuse has occurred.

"The story of Nassar should scare us, as parents, professionals, and human beings. But it should also remind us that child abuse is preventable."

And yet the repeated inaction of USAG and MSU highlights what we often see – the very adults entrusted to protect our children fail them by remaining silent. The mandate is not met, an investigation is not initiated, and the abuse is allowed to continue in the shadows. Reporting suspected abuse, of course, is not limited to those legally mandated to do so. Any individual who is concerned about the safety of a child is encouraged to report those concerns to a local children services agency.

The tragedy of USAG and MSU brings to light the reality that child sexual abuse is an adult issue. It was the failure of an adult who abused children. It was the failure of several adults to not report suspicions of abuse. It was the failure of entire institutions of adults to not initiate policies that may have prevented the abuse in the first place.

The story of Nassar should scare us, as parents, professionals, and human beings. But it should also remind us that child abuse is preventable. It should be the call to action for those institutions who have not yet prioritized child abuse prevention to do so immediately. It should be the catalyst for discussions that are uncomfortable, spark development of institutional safeguards that are complicated, and eliminate unimaginable acts that never need occur.


The American Academy of Pediatrics and its 67,000 members will always advocate for the well-being of children and supports institutional change to prevent child abuse. I encourage families to feel comfortable turning to their child’s pediatrician for help and guidance when concerns of abuse arise.

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HI

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The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

​​​Ab​out the ​​Author

Jonathan Thackeray, MD, FAAP, is a member of the American Academy of Pediatrics Council on Child Abuse and Neglect and the Immediate Past Chair of the American Board of Pediatrics Subboard on Child Abuse Pediatrics. He is the Chief Medical Community Health Officer at Dayton Children’s Hospital and Vice-Chair of Pediatrics at the Boonshoft School of Medicine at Wright State University.