Philadelphia Community Services for Children and Adolescents

Appendix C: Child Sexual Abuse

Child sexual abuse is reported over 80,000 times a year in our country. The number of unreported instances is probably far greater because the children are afraid to tell anyone what has happened and sexual abuse is often very difficult to prove.

A child can be sexually abused by someone in the family (a parent, step-parent, sibling or other relative) or by someone outside the family (a friend, neighbor, child care person, teacher or stranger). Whether the abuse is perpetuated by someone inside or outside the family, the child develops a variety of distressing feelings and thoughts.

No child is psychologically equipped to handle repeated sexual stimulation. Even a two or three year old, who cannot know that sexual activity is "wrong", will develop problems resulting from the inability to cope with the overstimulation.

The child of five or older who knows and cares for the abuser becomes trapped between his or her affection 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 experience anger, jealousy, or shame. The child may be afraid the family will break up if the secret is told.

A child who is the victim of sexual abuse often develops low self-esteem, a feeling of worthlessness, and an abnormal view of sexuality. The child may become withdrawn and mistrustful of adults and could become suicidal. Furthermore, a distressing number of adults with severe mental illness were sexually abused as children.

Later in life, some children who have been sexually abused have a difficult time relating to others on sexual terms while other sexually abused children sometimes become prostitutes or child abusers themselves.

A. Preventing Sexual Abuse

Talk to your child every day and take time to listen and observe. Learn as many details as you can about your child's activities and feelings. Encourage him or her to share concerns and problems with you.
Explain: "Your body belongs only to you alone and you have the right to say no to anyone who tries to touch you."
Tell your child that some adults may try to hurt children and make them do things the child doesn't feel comfortable doing. Often abusive grownups call what they are doing a secret between themselves and the child.
Explain that some adults may even threaten children by saying that their parents may be hurt or killed if the child ever shares the secret. Emphasize that an adult who does something like this is doing something wrong.
Tell your child that adults whom they know, trust and love or someone who might be in a position of authority (like a baby-sitter, an uncle, a teacher or even a policeman) might try to do something like this. Try not to scare your children- emphasize that most grownups never do this and that most adults are deeply concerned about protecting children from harm.
Make sure that your child knows that if someone does something confusing to them-touching them, taking a naked picture, or giving them gifts-that you want to be told about it. Reassure the child and explain that he or she will NOT BE BLAMED for whatever an adult does with the child.
Practice having your child say "no" in harmless situations, giving him or her the good feeling of being in charge of his or her own body.

B. Watch Your Child Carefully for Signs of Sexual Abuse

Children who may be too scared to talk about sexual molestation may show a variety of physical and behavioral signals. Any or several of these signs may be important, although in and of themselves these symptoms do not prove that sexual abuse has occurred.

Unusual interest in or avoidance of all things of a sexual nature.
Extreme changes in behavior such as loss of appetite.
Sleep problems: nightmares, fear of the dark.
Regression to more babyish behavior such as bedwetting, thumb sucking, or excessive crying.
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 genital area.
Secretiveness.
Aspects of sexual molestation in drawing, games, fantasies.
Suicidal behavior.
Torn or stained underclothing.
Vaginal or rectal bleeding, pain, itching, swollen genitals, and vaginal discharge.
Vaginal infections or venereal disease.
Seductiveness or otherwise expressing affection in ways inappropriate for a child of that age.
Fear of a person or an intense dislike at being left somewhere or with someone.
Other behavioral signals such as unusually aggressive or disruptive behavior, withdrawal from peers or family, running away or delinquent behavior, failing in school.

C. If You Think Your Child Has Been Abused

Believe your child. Children rarely lie about sexual abuse.
Praise your child for telling you about the experience.
Stress that what happened was not your child's fault. A child's greatest fear is that he or she is at fault and responsible for the incident. It is most important that you tell them that it was not his or her fault.
Try to remain calm. Your point of view and acceptance are important signals to your child. Your greatest challenge may be not to show your own distress about the abuse.
If the incident happened at a school or day care center, do not go to the school or program to talk about your concern. Instead, report the suspected abuse to a crisis intervention agency.
Find a specialized agency that evaluates sexual abuse victims. Professional treatment as soon as possible for the sexually abused child is the best way to overcome the risk that the child will develop serious problems as an adult.
Be sure that your child receives both a medical examination and a psychiatric evaluation. The agencies referred to above should be able to help you find resources for both services.
If the abuse happened in a group setting, talk with other parents to find out whether there are unusual behaviors or physical symptoms in their children.
Let your child know that this kind of thing has happened to many children, so that your child does not develop the belief that he or she is the "only one" and is different from others.

(Parts of this chapter were adapted from the American Academy of Child & Adolescent Psychiatry.)