Child Sexual Abuse
Child sexual abuse is reported up to 80,000 times a year, but the number of unreported instances is far greater because children are afraid to tell anyone what has happened, and the legal process of reporting can be difficult.
The problem should be identified and the abuse stopped, and children should receive professional help. The long-term emotional damage of sexual abuse can be devastating to children.
Child sexual abuse can take place within the family, by a parent, stepparent, sibling, or other relative; or outside the home, for example, by a friend, neighbor, caregiver, teacher, or stranger. When sexual abuse has occurred, children can develop many distressing feelings, thoughts, and behaviors.
No child is prepared to cope with repeated sexual stimulation. Even a two- or three-year-old, who cannot know the sexual activity is wrong, will develop problems resulting from coping with the over-stimulation.
A child of five 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 or distorted view of sex. The child may become withdrawn and mistrustful of adults, and can become suicidal.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 in sexual terms. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood.
Often there are no obvious external signs of child sexual abuse. Some signs can be detected only on physical exam by a physician. Sexual abuse can also include noncontact abuse, such as exposure, voyeurism, and child pornography.
- Sexually abused children may also develop the following:
- Unusual interest in or avoidance of all things of a sexual nature
- 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 genital area
- Refusal to go to school
- Delinquency/conduct problems
- Aspects of sexual molestation in drawings, games, fantasies
- Unusual aggressiveness, or
- Suicidal behavior
Child sexual abusers can make a child very worried about telling, and only when a special effort has helped the child to feel safe can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm and reassure the child that what happened was not his or her fault. Parents should seek a medical examination and psychiatric consultation.
Parents can prevent or lessen the chance of sexual abuse by:
- Telling children if someone tries to touch their bodies and do things that make them feel funny, to say NO to that person and tell their parents right away.
- Teaching 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 babysitter tells you to do.”
Sexually abused children and their families need immediate 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 abused children will develop serious problems as an adult.
Responding to child sexual abuse
When a child tells an adult that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following guidelines should be used when responding to children who say they have been sexually abused:
What to say
- If a child even hints in a vague way that sexual abuse has occurred, encourage him or her to talk freely; don’t make judgmental comments.
- Show that you understand and take seriously what the child is saying. Child and adolescent psychiatrists have found that children who are listened to and understood do much better than those who are not. Responding to the disclosure of sexual abuse is very important to the child's healing from the trauma of sexual abuse.
- Assure the child that he or she did the right thing in telling. A child who is close to the abuser may feel guilty about revealing the secret. The child may feel frightened if the abuser has threatened to harm the child or other family members as punishment for telling the secret.
- Tell the child that he or she is not to blame for the sexual abuse. Most children in attempting to make sense out of the abuse will believe that somehow they caused it or may even view it as a form of punishment for imagined or real wrongdoings.
- Finally, offer the child protection, and promise that you will promptly take steps to see that the abuse stops.
What to do
Parents should talk with their pediatrician or family doctor, who may refer them to a physician who specializes in evaluating and treating sexual abuse. The examining doctor will evaluate the child's condition and treat any physical problem related to the abuse, gather evidence to help protect the child, and reassure the child that he or she is all right.
Children who have been sexually abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for them to deal with the trauma of the abuse. A child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.
While most allegations of sexual abuse children make are true, some false accusations may arise in custody disputes and in other situations. Occasionally, the court will ask a child and adolescent psychiatrist to help determine whether the child is telling the truth, or whether it will hurt the child to speak in court about the abuse.
When a child is asked to testify, special considerations – such as videotaping, frequent breaks, exclusion of spectators, and the option not to look at the accused – make the experience much less stressful.
Adults, because of their expected maturity and knowledge, are always the ones to blame when they abuse children. The abused children should never be blamed.
When a child tells someone about sexual abuse, a supportive, caring response is the first step in getting help for the child and reestablishing his or her trust in adults.
Reporting child sexual abuse
Report any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency.
If the abuse is outside of the family, report it to the police. Individuals reporting in good faith can’t be prosecuted. The agency receiving the report will conduct an evaluation and will take action to protect the child.
If you need immediate assistance, please dial 911.
The American Academy of Child and Adolescent Psychiatry (AACAP) represents more than 8,700 child and adolescent psychiatrists who are physicians with at least five years of additional training beyond medical school in general (adult) and child and adolescent psychiatry.