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Sexual Abuse

Sexual abuse is a difficult subject for most people to discuss. But as frighten­ing as the topic may be, sexual abuse is a serious and, unfortu­nately, not infrequent problem. Literally millions of children are victims of this form of abuse. According to studies, 25 percent of adult women and 10 percent of adult men can remember being sexually abused as children or adolescents. Most of this victimization occurs between eight and twelve years of age. Although the majority of sexually abused children are girls, boys are victimized as well.

Sexual abuse includes any kind of sexual act or behavior with a child. It in­cludes not only intercourse but also fondling the youngster's genitals, forcing the child to fondle an adult's genitals, mouth-to-genital contact, or rubbing the adult's genitals on the youngster. Other types of sexual abuse may also take place, even though they may not involve physical contact—for instance, an adult exposing his genitals to a child, showing pornographic pictures or video­tapes to a youngster, or taking pictures of the child for obscene purposes.

Strangers do molest children. But in at least 80 percent of cases, the perpe­trators of sexual abuse are known to the child, and are often authority figures that the child trusts. He or she might be a parent, a stepparent, an adult rel­ative (uncle, grandfather), a family friend, a neighbor, a babysitter, a teacher, a coach or Scout leader, or an older sibling or cousin. While children usually understand who a "stranger" is, they may be caught off guard by the advances of someone they know and love, or respect. The offender usually manipulates the child into engaging in sexual activity, using threats, bribes, or aggressive persua­sion, and convinces the child that he or she has no choice but to participate. The children most susceptible to these assaults have obedient, compliant, and respectful personalities.

In many cases the sexual abuse involves more than just a single incident. Of­ten it is a pattern of ongoing sexual contacts, frequently beginning in the early years of middle childhood and persisting into adolescence. Sometimes the abuse stops only when the maturing child is capable of extricating herself from this terrible situation, often by reporting the incident to another adult. Even after the abuse has stopped, the psychological repercussions of the abuse can last a lifetime. 

Preventing Sexual Abuse

Without alarming your child, you need to alert her that sexual abuse exists, while reassuring her that it probably never will happen to her. Teach her that no matter who may threaten her sexually—even if it is a trusted adult—she must be willing to clearly and forcefully say "No" or "Stop" and walk (or run) away. She also must know that she should always come to you if a sexual incident ever happens to her, no matter whom the perpetrator is and no matter what kind of warning the offender has given her ("Don't tell anyone or I'll hurt you"). Make sure she understands that she won't get into trouble if she tells you about such an incident. Also remember that while girls are the usual victims of sexual abuse, about 10 percent of victims are boys.

Here are some other recommendations from the American Academy of Pe­diatrics that can minimize your child's risk of molestation:

  • Teach your child about the privacy of body parts, and that no one has the right to touch her if she tells the individual not to do so. She should understand that some touching is "good" but some is "bad": Explain that an adult's giving a loving hug is different from his putting a hand on her buttocks or inner thigh. She has the right to say no to anyone who tries to touch her in the parts of her body that are normally covered by a bathing suit. Naturally, your child should respect the right to privacy of other peo­ple too.
  • In early childhood, parents can teach their children the name of the genitals, just as they teach their child the names of other body parts. This teaches that the genitals, while "private" are not so private that you can't talk about them.
  • Sit down with your child and explain various situations that might indi­cate that a possible child molester is making advances. For example, a molester might offer a child candy or toys. (If your child has acquired any unexplained toys or gifts, ask who gave them to her.) He may offer the child money to run an errand or do a short-term job (raking leaves, shov­eling snow). He may take the child on "special" outings or to special events. He may tell the child they share a special secret. He might dress as a clown, Santa Claus, or another trusted or heroic figure to lure the youngster. He might claim that an emergency situation has arisen ("Your mother was in an automobile accident—come with me, and I'll take you to the hospital to see her"). Or he may ask the child for assistance: directions to a particular street or landmark, or help in finding a missing dog or cat. Make sure your child understands that if she encounters a potentially dangerous situation like these, she should run away.
  • Tell a child that a molester or abductor may offer her alcohol or drugs to reduce her inhibitions.
  • Tell your child that threats from a molester or anyone else are against the law—"If you tell your mother what we did, I'm going to hurt/kill her"—and to tell you immediately about them.
  • If your youngster is in a position to do door-to-door solicitation—perhaps selling Girl Scout cookies or collecting money for a newspaper route—have an adult go with her. Warn your child that she should never enter someone else's home unless an adult accompanies her.
  • Investigate whether your youngster's school has an abuse-prevention pro­gram. If not, encourage the school board to institute one. In recent years there has been a dramatic increase in preventive programs to educate children about the disclosure of sexual abuse.
  • Monitor the activities at your child's child-care facility or summer camp. Participate in these activities whenever possible. Listen carefully when your child tries to tell you something of a sexual nature, particularly if she seems to have difficulty talking about it. As much as possible, create an environment at home in which sexual topics can be discussed comfort­ably.
  • Spend enough time with your child that she does not feel the need to seek the attention of other adults. Children from unhappy or unstable homes tend to be the easiest targets for molesters, since these youngsters may be eager for attention and affection.
  • If you do not already know whom your child spends time with, find out. If your youngster spends time in isolated or remote places with adults or older children, investigate what might be going on there. Question the motives of adults who want to spend large amounts of time alone with your child.

When Sexual Abuse Occurs

Most victims of sexual abuse remain silent, often feeling guilty and helpless. They do not run to tell their mother or another trusted adult for fear they will get in trouble if someone finds out about the abuse. Sometimes, when the perpetrator is a family member, they believe that by telling someone, they may split their family apart. Or they may feel embarrassed by what has hap­pened, or they may have been warned by the offender to remain quiet. All the while, however, they may be emotionally devastated. They may withdraw from family and friends; stop participating in school activities, experience chronic anxiety and insomnia, and exhibit aggressive and self-destructive behavior.

Sometimes a sexually abused child may eventually tell her friends what has occurred. Or she may say something sketchy to a parent that hints at the abuse without describing it clearly.

When a child is examined by a doctor, the physician may occasionally detect physical signs of sexual abuse, such as genital or anal changes. The physician might also find evidence of sexually transmitted diseases such as gonorrhea or her­pes. However, often the doctor is unable to find physical evidence of sexual abuse, even though the abuse occurred. This is because the genitals may not have been injured during abusive events, or injury that may have occurred has healed by the time the child is examined.

If your youngster comes to you and reveals that she has been sexually abused, take it seriously. Too often, children are not believed, particularly if they implicate a family member as the perpetrator. It's important to listen to your child, gently and sensitively ask questions to obtain more information, and then take active steps to protect her. Contact a pediatrician, the local child-protection service agency or social welfare bureau, or the police (sexual abuse is a viola­tion of the law). If you don't intervene in this way, the abuse might continue for many more months and even years; at the same time, the child will come to be­lieve, correctly, that home is not safe and that you are not available to help.

In the days and weeks ahead, make sure your abused child understands that she is not responsible for the abuse, and let her know how brave she was to tell you what happened. Reassure her that this abuse will not occur again. Of­fer plenty of love and support. If you are dealing with your own anger about the abuse, she might think that some of it is directed toward her, so continually reassure her that you are not upset with her and are proud of her for telling you what has happened.

Your child should be examined by a physician, and treated for any physical injuries, either internal or ex­ternal, related to the abuse. Your youngster also needs to be examined by a physician if charges are going to be filed. Most children and their families will also need professional counseling to help them through this ordeal.

A number of factors will influence the psychological impact of sexual abuse upon a child, including:

  • The nature of the sexual activity, the frequency, and the use of force. The more intrusive the abusive experience, the more difficult and confusing it will be for the youngster. Sexual victimization that happens over a long pe­riod is much more damaging than a one-time episode. It can lead to run­away behavior and sexual promiscuity and interfere with relationships and intimacy later in life. Perhaps most significantly, the use (or threat­ened use) of force or bodily harm upon the child or her family members can significantly intensify the youngster's psychological trauma. She may react with feelings ranging from anxiety and fear to guilt and depression.
  • The age and developmental status of the child. A younger child may have less difficulty with a brief sexual experience than an older one. This younger child may not fully comprehend what has happened to her, and more often, she may have been subjected to less force and coercion from the perpetrator. By contrast, an older youngster may understand more about the abusive experience and may feel more guilt, fear, and other emotions.
  • The relationship of the child and the abuser. Although victimization by someone unknown to a child is upsetting, it may not be as bewildering as when incest occurs—that is, when a relative abuses a child sexually. With incest, the youngster may feel confusion about her relationship with the perpetrator and whether she can trust this individual again. The child also may feel more pressure not to disclose the abuse if a family member is involved.
  • The family's reaction. If you are supportive of your child and convince her that she is not at fault and that she will be protected, the trauma can be minimized. If family members fail to act on the information they are given by the child, the abuse will likely persist, and the child's sense of trust and intimacy will be damaged.

To repeat, without expert guidance your youngster could suffer some seri­ous, lasting psychological effects from the abuse. Your pediatrician can give you a referral to a counselor, as can the local child-protection agency. In many communities there are sexual-abuse support networks, treatment groups, and therapists who specialize in sexual victimization. All sexually abused children need an evaluation by a professional who is knowledgeable about the psycho­logical consequences of abuse, and who can recommend treatment if it is needed. Families, too, can benefit from support and counseling to help them deal with their own feelings and more effectively provide emotional support for their child.

Signs of Sexual Abuse

Sexually abused children may develop behavioral problems. These behaviors are variable and non-specific. They usually indicate that the child is stressed, and the cause of their distress requires evaluation. Other children may not display any notable behavioral problems. The following are symptoms that a child is distressed. These should not be ignored as they may indicate a traumatic event such as sexual abuse has occured:

  • Her behavior changes dramatically in any number of ways. A younger child may regress to bed-wetting or soiling her underwear. Or her eating habits might change. She may relate to peers differently, either by withdrawing or by becoming more aggressive. She might act up in school, her motivation and concentration may suffer, and her grades may fall. She may appear fearful, frequently crying and clinging to her parent(s), or alternatively, she may avoid normal family intimacy.
  • She has inexplicable physical complaints, such as headaches, stomachaches, or genital complaints.
  • She seems to be afraid of a particular person or place and being left alone with that individual.
  • She overreacts to a question about someone's touching her.
  • She suddenly seems more aware of and preoccupied with sex­ual conduct, words, and parts of the body.
  • She has unreasonable anxiety over a doctor's physical exami­nation.
  • She may seem hypersexualized and tries to get other children to perform sexual acts.

If your child exhibits any of these behaviors and you have concerns, you should talk with your pediatrician.

Last Updated
Adapted from Caring for your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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