Learning About Sexual Abuse in Children

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Child sexual abuse is any sexual contact between an adult and a child (or between an older child and a younger child). This includes sexual acts and touching. But it doesn't always involve physical contact. For example, showing pornography to a child or taking nude photos of a child is sexual abuse.

Normal sexual play is not sexual abuse. Normal sexual play occurs between children of similar ages who spend time together. It usually involves looking and touching. It's playful and mutual, not forced.

Often children are sexually abused by people they know, like a family member or caregiver. A child who has been abused may be afraid to talk about it. The abuser may threaten or persuade them not to tell. The child may worry about getting the person in trouble. Or a child may feel that they are to blame for what happened.

Sexual abuse is never the child's fault.

What are the symptoms?

Sometimes children who've been sexually abused have physical symptoms, such as:

  • Discomfort while sitting or using the toilet.
  • Genital or anal pain or discharge.
  • Blood in their underwear.
  • Headaches.
  • Belly pain or constipation.

But more often a child will have no physical signs of sexual abuse. Instead, you may notice changes in behavior. For example, the child may:

  • Know more about sex than expected or act very sexual.
  • Have nightmares or sleep problems.
  • Not want to bathe or change clothes.
  • Have mood changes, such as seeming depressed, anxious, angry, or fearful.
  • Be more quiet or withdrawn than usual, or seem to have secrets.
  • Return to behaviors they had outgrown, like bedwetting or thumb-sucking.
  • Eat more or less than usual.
  • Have a decline in school performance or not want to go to school.
  • Act out in risky ways (for example, running away or using drugs).
  • Hurt themself or attempt suicide.

Other things can cause these changes. But if you notice symptoms or behaviors that concern you, talk to your child's doctor.

How is it diagnosed?

It can be hard to diagnose child sexual abuse. Often a child will have no physical signs of abuse, and they may not want to talk about what happened. So if possible, the child needs to be seen by a team of experts in child abuse. This may include a doctor and other professionals with special training. It's best if the child can be seen in a calm, child-friendly setting to help them feel at ease.

Team members will:

  • Interview the child.

    This is often the most important part of diagnosis. If possible, the child needs to describe the abuse in their own words, so a parent or caregiver may not be present. If the child is young, the adult may stay to provide comfort. An older child or teen will usually be interviewed on their own. If the child is very young, the team may talk to the adult instead of the child.

  • Interview the parent or adult caregiver.

    The team will ask if the adult has noticed any physical symptoms or any behavior changes in the child. The team will also ask about the child's medical history. This can help them understand the child's physical and emotional background.

  • Do a physical exam.

    They'll check for any injuries or infections that need to be treated. They'll look for and document any evidence of abuse, such as scrapes or bruises. They may take samples for lab testing.

What if you suspect someone close to you?

If you suspect someone who's close to you, it may not be safe to take home information about child abuse. And it may not be safe to search online on your devices. Consider asking a trusted friend to keep this information for you or to help you find online resources. Or you could use a computer at a public library.

If you've done online searches, it may be a good idea to clear your device's search history so no one can see the sites you visited. Search for "delete browser history" to learn how.

If you're concerned about your or your child's safety, it's important to plan ahead. Think of places you could go or people you could call for help. You may want to save or memorize their phone numbers. And you might pack a bag so you can leave quickly. Talk to your doctor or a counselor. They can offer resources and support.

When should you call for help?

Call 911 anytime you think a child may need emergency care. For example, call if:

  • You witness the sexual abuse of a child. If possible, save evidence of the abuse. Don't let the child change clothes, eat, drink, bathe, brush their teeth, or clean up in any way. Write down all the details about the abuse and the abuser.
  • You believe that a child is in immediate danger of being abused.

Call your doctor now or seek immediate medical care if:

  • You know or think that a child has been sexually abused, even if there are no physical injuries.
  • You know or think that a child may be in danger of abuse. You can also call your local police or child protection services.

Contact your doctor if:

  • A child tells you about being sexually abused. You can also contact the Childhelp National Child Abuse Hotline. Call or text 1-800-4-A-CHILD (1-800-422-4453) for free, confidential advice and support.
  • You notice behavior changes in a child, such as:.
    • Knowing more about sex than expected or acting very sexual.
    • Having sleep problems.
    • Having mood changes, such as seeming depressed, anxious, or angry or being more withdrawn than usual.
    • Having problems in school.
    • Acting out in risky ways, like running away or using drugs.
    • Hurting themself or attempting suicide.
  • You see possible physical signs of sexual abuse, such as:
    • Discomfort while the child sits or uses the toilet.
    • Genital or anal pain or discharge, or blood in their underwear.
    • Headaches.
    • Belly pain or constipation.

Where can you learn more?

Go to http://www.healthwise.net/patientEd

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The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.