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Category:
Abuse

Question:
What are warning signs that tell me if a child has been sexually abused?

Answer Summary:
Unfortunately, there is not a specific sign that can identify a child that has been sexually abused. In some cases, a medical examination may be appropriate, but this type of exam can be traumatic for the child and the parent. There are some generally accepted symptoms that typify the effects of sexual abuse of children.

FAQs: Individual Answers

Dr. Wes Jones, Children's Services Director, Mental Health Center of East Central Kansas

Unfortunately, there is not a specific sign that can identify a child that has been sexually abused. In some cases, a medical examination may be appropriate, but this type of exam can be traumatic for the child and the parent. There are some generally accepted symptoms that typify the effects of sexual abuse of children:

Fear is frequently the initial reaction. Children who express extreme fear and anxiety for no apparent reason should be viewed with concern. Because of the betrayal that the child suffered at the hands of an adult, and because he or she has been made to feel helpless by an adult, the child may exhibit a limited ability to trust. Anger and hostility for no apparent reason may also be an indication because children who have been abused are usually unable to express anger toward the perpetrator without retaliation. Therefore, it is often displaced onto others. The most common sign with younger children who have been sexually abused is inappropriate sexual behavior. This can be sexual acts with other children or it can be seen in their play with toys or stuffed animals. Depression is common, as the child has not been able to express the rage that he or she may feel as a result of the abuse. Guilt and shame may also be present as younger children are normally self-centered and they may mistakenly accept responsibility for the abuser's actions. A sudden drop in school performance may be a clear symptom of sexual abuse, but other signs are usually present at the same time. Physical complaints such as headaches or stomachaches may be indicators of the child internalizing his or her trauma and expressing it through the physical symptoms. Some children may even report that their bodies have been damaged even when there are no clear-cut physical signs of any harm. Regressive behavior, such as losing recently gained developmental skills should be considered a sign that warrants further investigation. Sleep problems are another sign that should be viewed with caution if the child has no past history of such problems. These may include fear of sleeping alone, difficulty falling asleep, nightmares, or even sleep terrors. In conclusion, it should be kept in mind that none of the above signs alone should be considered an indicator of sexual abuse. However, the more signs present, the higher the probability of sexual abuse.

Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater because the children are afraid to tell anyone what has happened, and the legal procedure for validating an episode is difficult. The problem should be identified, the abuse stopped, and the child should receive professional help. The long-term emotional and psychological damage can be devastating.

Child sexual abuse can take place within the family by a parent, stepparent, sibling, or other relative or outside the home by a friend, neighbor, childcare person, teacher, or random molester, for example. However, when sexual abuse has occurred, the child develops a variety of distressing feelings and thoughts.

No child is psychologically prepared to cope with repeated sexual stimulation. Even a two- or three-year-old, who cannot know sexual activity is "wrong," will develop problems from the inability to cope with the over-stimulation.

The child of five or older who knows and cares for the abuser becomes trapped between affection, or loyalty, for 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 prostitutes or child abusers or have other serious problems when they reach adulthood.

Often there are no physical signs of child abuse, or 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 sexual nature;
• Sleep problems or nightmares;
• Depression or withdrawal from friends or family;
• Seductiveness;
• Statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area;
• Refusal to go to school or delinquency;
• Secretiveness;
• Aspects of sexual molestation in drawings, games, or fantasies;
• Unusual aggressiveness;
• Suicidal behavior; or
• Other severe behavior changes.

Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child feel safe can the child talk freely. If a child says that he or she has been molested, parents should stress that it was not the child's fault. Parents should seek a medical examination and psychiatric consultation.

These are some preventive measures parents can take:

• Tell children that "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. For example, don’t tell children to, "Always do everything the teacher or baby-sitter tells you to do."
• Encourage professional prevention programs in the local school system.

Sexually abused children and their families need professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that a child will develop serious problems as an adult.

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