Clinical Reference Systems: Pediatric Advisor 10.0

Parenting a child who has been sexually abused can present difficult challenges. Children who have been sexually abused often develop symptoms that can be frustrating for the family.

It is important for parents not to see their child's symptomatic behavior as being purposefully bad or naughty. These symptoms are often reactions to the trauma of being sexually abused. Try to separate your feelings for your child from your reactions to the child's behavior. You can let your child know that some of the things he does are not OK but that you still love him.

SYMPTOMS OF SEXUAL ABUSE AND HOW TO DEAL WITH THEM

The symptoms most often seen can be divided into three types: fearful symptoms, sexualized behaviors, and aggressive behaviors.

Fearful Symptoms

Fearful symptoms may be more common where physical pain, violence, or threats have been part of the abuse. Possible symptoms of fear are:

• nightmares
• fear of a person
• fear of a type of person (for example, men with beards)
• becoming withdrawn
• regressive behavior (thumbsucking, baby talk).

As a parent you should:

• Accept your child's fears as real fears.
• Encourage your child to return gradually to her normal activities.
• Give your child choices in situations where she is afraid, such as sleeping with a night-light on or the door open.
• Continue to tell your child that you will protect her as much as you can.

You should not:

• Force your child to do things she is really afraid of.
• Allow your child's fears to control her life or your life.
• Punish your child for being afraid.
• Tell your child her fears are silly or stupid.

Sexualized Behaviors

There are several possible reasons why sexually abused children may act sexually:

1. They have learned it as a way to please people.

2. They may confuse sexual behavior with affection.

3. They may see it as a way to be "in charge" of a sexual relationship, unlike when they were sexually abused.

Symptoms of sexualized behavior include:

• increased or excessive masturbation
• putting objects inside their genitals
• touching other children in a sexual manner particularly children younger or smaller than they are
• indiscriminate affection with adults.

As a parent you should:

• Instruct your child about the importance of keeping genitals private. Make clear rules about not touching others' genitals.
• Gently remind your child that no one likes to be touched against their will.
• Depending on the child's age, talk about healthy sex and the relationship between sex and love.
• Remember that some masturbation is normal for children and is OK if done in private.
• Make every effort to protect your child from further victimization. A child showing sexualized behaviors is at high risk for further abuse.

Aggressive Behavior

Sexually abused children may become aggressive because of anger. They may be angry at the person who abused them and angry at others for not being able to protect them. They may also be angry if changes in their life or family have occurred, such as their father moving out of the house.

Symptoms of aggressive behavior include:

• hitting, biting, kicking others
• breaking toys
• refusing to obey
• hurting themselves (for example, head banging or hitting themselves)
• tantrums.

As a parent you should:

• Talk with your child about why he is angry. Let him know you understand.
• Gently remind your child that no one likes to be hit or hurt.
• Make clear rules about not hitting others or destroying property.
• Create healthy ways of releasing anger, such as exercise or artworks. For example, you could ask your child to paint a picture of why he is mad.
• Use consistent, fair consequences for aggressive behavior.

Do not hit your child as punishment for hitting others. This is confusing to the child.

The fearful symptoms, sexualized behaviors, and aggressive behaviors listed above may be seen in sexually abused children. However, they can also be seen in children who have suffered many other possible traumas including divorce, physical abuse, death in the family, witnessing domestic violence etc. Some of the symptoms are seen in children who have suffered no particular trauma. Such symptoms can simply be a part of growing.

If your child is experiencing severe symptoms, you should contact a mental health professional for specific advice. Working with a mental health professional to help the child is often recommended for families where sexual abuse has occurred.