Clinical Reference Systems: Pediatric Advisor 10.0
Child Sexual Abuse
Child sexual abuse has been reported up to 80,000 times a
year, but the number of unreported instances is far greater.
Many children are afraid to tell anyone what has happened
and the legal procedure for validating an episode is
difficult. It is very important to identify episodes of
sexual abuse. The abuse must be stopped and the child given
professional help. The long-term emotional and
psychological damage of sexual abuse can be devastating.
Child sexual abuse can take place within the family, where
the abuser is a parent, stepparent, sibling, or other
relative. Or the abuser may be unrelated, such as a friend,
neighbor, child care provider, teacher, or random molester.
In any case, the sexually abused child develops a variety of
distressing feelings and thoughts.
No child is psychologically prepared to cope with repeated
sexual stimulation. Even a 2 or 3 year old, who cannot know
the sexual activity is wrong, will develop problems
resulting from the inability to cope with the
A child of 5 or older who knows and cares for the abuser
becomes trapped between affection for or loyalty to the
person and the sense that the sexual activities are terribly
wrong. If the child tries to break away from the sexual
relationship, the abuser may threaten the child with
violence or loss of love. When sexual abuse occurs within
the family, the child may fear the anger, jealousy, or shame
of other family members, or be afraid the family will break
up if the secret is told.
A child who is the victim of prolonged sexual abuse usually
develops low self-esteem, a feeling of worthlessness, and an
abnormal perspective on sexuality. The child may become
withdrawn and mistrustful of adults and can become suicidal.
Some children who have been sexually abused have difficulty
relating to others except on sexual terms. Some sexually
abused children become child abusers themselves or
prostitutes, or they may have other serious problems when
they reach adulthood.
Often there are no physical signs of child abuse.
Sometimes there are signs that only a physician can detect,
such as changes in the genital or anal area.
The behavior of sexually abused children may include:
- unusual interest in or avoidance of all things of a
- sleep problems or nightmares
- depression or withdrawal from friends or family
- statements that their bodies are dirty or damaged, or
fear that there is something wrong with them in the
- refusal to go to school or delinquency
- aspects of sexual molestation in drawings, games,
- unusual aggressiveness
- suicidal behavior
- other severe behavior changes.
Sexual abusers can make a child extremely fearful of
telling anyone about the abuse. Only when a special effort
has helped the child to feel safe may the child be able to
If a child says that he or she has been molested, parents
should stress that what happened was not the child's fault.
Parents should seek a medical examination and possibly a
These are some preventive measures parents can take:
- Tell children, "If someone tries to touch your body and
do things that make you feel funny, say NO to that person
and tell me right away."
- Teach children that respect does not mean blind obedience
to adults and to authority. Don't tell children to
always do everything the teacher or baby-sitter tells
them to do.
- Encourage professional prevention programs in the local
Sexually abused children and their families need
professional evaluation and treatment as soon as possible to
reduce the risk that the child will develop serious problems
as an adult. Abused children need help regaining a sense of
self-esteem, coping with feelings of guilt about the abuse,
and beginning the process of overcoming the trauma.