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Child Sexual Abuse

The American Academy of Child and Adolescent Psychiatry provides this important information as a public service to assist parents and families in their most important roles. It is neither ethical nor responsible to use the internet for consultation about specific children or families. The Facts for families sheets may be duplicated and distributed free of charge as long as the American Academy of Child and Adolescent Psychiatry is properly credited and no profit is gained from their use.

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, step-parent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher or random molester. However, when the 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 the sexual activity is "wrong," will develop problems resulting 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 The child may become withdrawn and mistrustful of adults, and can become suicidal.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 child abusers or prostitutes, or have other serious problems when they reach adulthood.

Often there are no physical signs of child abuse, or 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, 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, delinquency.

  • Secretiveness.

  • Aspects of sexual molestation in drawings, games, fantasies.

  • Unusual aggressiveness.

  • Suicidal behavior.

  • 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 to feel safe, can the child talk freely.

If a child says that he or she has been molested, parents should stress that what happened was not the fault of the child. Parents should seek a medical examination and psychiatric consultation.

These are some preventive measures that 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.

Professional evaluation and treatment as soon as possible for the sexually abused child and the family is the best way to overcome the risk that the child will develop serious problems as an adult. The child and adolescent psychiatrist helps the child regain a sense of self-esteem and relieve feelings of guilt about the abuse; helps family members understand how to assist the child in overcoming the trauma; and, if the abuser is a member of the family, works to restore him or her to a healthy role in the family.