Sexual abuse of children is more common than most people think. About 1 out of 5 girls and 1 out of 10 boys will be sexually abused during their childhood. Parents can take steps to help prevent and recognize sexual abuse in children.

What is child sexual abuse?

Sexual abuse is when a person (adult or child) takes advantage of a child in a sexual way. In most cases, the abuser is someone the child knows. An abuser may use force, bribes, threats, or tricks to trap a child and to keep a child from telling anyone.

These are some examples of sexual abuse

• Touching a child's genitals (over or under the clothes)
• Making a child touch an adult's genitals
• Mouth to genital contact between a child and abuser
• Adult genitals touching a child's genitals or anus
• Adults showing their genitals to a child
• Showing pornographic or "dirty" pictures or movies to a child
• Using a child as a model to make pornographic materials
• Asking a child for sexual contact over the Internet

What parents can do to prevent sexual abuse

Good communication with your child is one of the best ways to prevent sexual abuse. Children should know they can and should talk with their parents about anything that makes them sad, scared, or confused. Remember that if you need advice, you can talk with your pediatrician.

The following are things parents can do based on a child's age:

18 months–3 years

• Teach your child which body parts are private (parts covered by a bathing suit). Also, teach your child the proper names of those parts (breasts, vagina, penis).
• Know the adults and children that spend time with your child. Make surprise visits to your child's caregiver.

3–5 years

• Teach your child about private parts of the body. Children may touch their genitals and be curious about the genitals of others. Use these opportunities to teach your child how to show respect in the ways that he talks to and touches others.
• Ask for advice. Many sexual behaviors may be normal in this age group, but if a child asks an adult to perform a sexual act or becomes forceful in his sexual behaviors, call your pediatrician for advice.
• Give simple answers. When children ask questions about sex or the genitals, give simple and understandable answers so they know these topics are not "off-limits."

5–8 years

• Teach your child to respect the private parts of others and to expect others to do the same.
• Talk about whom the child can tell if someone makes him feel uncomfortable when he is away from home.
• Listen when your child tries to tell you something, especially when it seems hard for him to talk about it. Make sure your child knows it's OK to tell you about anyone that makes him feel uncomfortable, no matter who that person may be. Ask your child what he would do in certain situations (like if a stranger tries to talk to him or calls him to a hidden area) and how to recognize danger.

8–12 years

• Stress personal safety. Your child should be aware of places where sexual abuse could happen, such as video arcades, malls, locker rooms, and out-of-the-way places outdoors.
• Talk about peer pressure. Make safety plans with your child so he knows what to do if he is asked to use drugs or alcohol, smoke, touch someone sexually, steal, cheat, or bully.
• Teach your child about sexual abuse. And if your child's school has a sexual abuse program, discuss what he learned.
• Always know what your child is viewing and sharing on the Internet. Keep the computer in a room where you can watch your child. (Internet safety is important for all children.)

12–18 years

• Set aside time each week to talk about the good, bad, and confusing experiences. Topics may include the following:
  • — Types of sexual abuse, including date rape, sexual harassment in chat rooms or schools, pornography, and people who ask for sex through the Internet
  • — Preventing sexually transmitted infections and pregnancy
  • — Effects of drugs and alcohol on sexual behavior
  • — Respect for others and by others, stressing the importance of honoring other people's wishes when it comes to how they are treated and touched (A person should have to say "no" only once.)

How would I know if my child is being sexually abused?

Most of the time, sexual abuse is first discovered when a child tells someone what happened. Many parents expect their son or daughter to tell them or another trusted adult soon after the abuse has started, but most children wait weeks or months to tell. Abusers may threaten or convince the child not to tell anyone about it. The child may worry about what will happen and whether anyone will believe her. The child may feel that the abuse is her fault and that she will be punished if someone finds out.

A child's first statements about abuse may be vague and incomplete until they know how others will respond. Abused children may tell a friend first before telling an adult. Children may tell after a personal safety program at their school. Sometimes children tell simply because a trusted adult asks them.

Sexually abused children can have a number of behavioral and physical symptoms. Some sexually abused children have no symptoms at all. The behaviors and symptoms listed below are sometimes warning signs of sexual abuse, but can be caused by other factors or situations.

It is important to talk with your child if you notice the following behaviors:

• New fear of a person (even a parent) or certain places
• Drawings that show sexual acts
• Sudden changes in behavior, such as bedwetting or loss of bowel control
• Sexual acts and words shared with other children or animals
• Questions about sexual acts that are beyond what the child knows or understands
• Changes in sleep habits, such as nightmares

Physical signs of abuse may include the following:

• Anal or genital pain, or bleeding
• Unusual discharge from the anus or vagina
• Sexually transmitted infections such as gonorrhea, chlamydia, or genital warts

Parents should talk with their children in a quiet, private place. First they can share their concern. For example, "Sometimes children have bad dreams because they have been hurt or touched in ways that make them sad, scared, or confused." Then the parent can ask a general question. For example, "Has anything happened to you that made you sad, scared, or confused?" Parents should not ask too many questions; some abused children may decide to talk about their abuse at a later time.

The adult should show concern and support for the child, even if the child does not say they have been abused. In this way, children learn that talking with an adult about problems is a positive experience.

What should I do if my child says he has been sexually abused?

If your child tells you he has been abused, listen carefully and take it very seriously. If a child thinks he is ignored, not believed, or may be punished, he may not tell again. As a result, the child could remain a victim of abuse for months or years.

If your child reveals abuse, you should take the following steps:

• 1. Listen. Let your child talk without interruption, giving him full attention. If you become sad or angry, let your child know that you are not mad at him. Praise your child for telling, and show that you love and support him. Tell him you are going to find a way to help keep him safe and get help.
• 2. Report abuse to the local child protection agency or police, according to state law. If you are unsure who to call, contact your pediatrician or hospital. Ask about crisis support or help.
• 3. Talk with your child's doctor. He or she will let you know if a medical evaluation is needed. Sometimes the child protection agency or police will tell you to take your child to a hospital.
• 4. Protect the child from further abuse until child protection or law enforcement professionals become involved and can provide guidance.

Can I deal with sexual abuse in my family without contacting the authorities?

Parents should not try to stop or treat sexual abuse themselves. In some cases, an abuser has hurt or touched more than one child. If abuse is suspected, parents should follow the steps above and get help.

What will happen to the child and to the abuser if sexual abuse is reported?

When sexual abuse is reported, 2 kinds of investigations may begin: a state child protection agency decides whether a child is safe, and a local law enforcement agency decides whether a crime has occurred.

Abuse by a person who lives in the child's home, is related to the child, or works in a child care or school usually involves both types of investigation. Abuse involving a person who is not related to the child and who lives outside the home may only involve law enforcement.

After sexual abuse is reported, what happens next depends on the circumstances of the abuse. The first concern of the authorities is to prevent further abuse of the child. The child can usually stay in the home as long as her family is able and willing to protect her. Children may live with other relatives or in a foster home if the safety of the child at home is in doubt. These are usually temporary arrangements until safety can be ensured.

The abuser may or may not be arrested, depending on the investigation and circumstances of the abuse. Whatever the circumstances, the child and family will need a lot of support from relatives and friends. The abuser may be referred for treatment. The child and the entire family may also be referred to programs that offer support and counseling.

For more information on child sexual abuse or other forms of abuse, please contact Prevent Child Abuse America (www.preventchildabuse.org or 800/CHILDREN [800/244-5373]).

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

© 2007