Hurting a child is a violation of trust. Unfortunately, it happens every day. And when the abuse is sexual, it can leave a lasting psychological wound that is

Abuse of children is a common problem. More than 2 million cases of child abuse and neglect are reported each year in the United States. An estimated 150,000 to 200,000 new cases of sexual abuse occur each year.

In the December 2, 1998, issue of The Journal of the American Medical Association, authors reviewing the literature on child sexual abuse found that sexual victimization of boys and male adolescents is common, but often goes unreported and untreated. Boys at highest risk for abuse are less than 13 years old, non-white, of low socioeconomic status, and not living with their fathers. The authors report that the perpetrators tended to be males who are known by, but usually unrelated to, the victims. The abuse typically occurs outside the home and is often repeated.

 What is Child Sexual Abuse?

Child sexual abuse is any sexual act or sexual contact with a child performed by an adult or an older child. It also includes showing an adult's genitalia to a child, showing the child pornographic pictures or videotapes, or using the child as a model for pornographic purposes.

Signs of Sexual Abuse

Children don't always tell their parents or adults if they have been sexually abused. Sometimes the abusers threaten or convince the children they must not tell anyone about the abuse. Therefore, parents should be aware of behavioral changes in their child, including noticeable fear of a person or certain places, unusual responses to questions about whether they have been touched by someone, unreasonable fear of a physical exam, making drawings that show sexual acts, abrupt changes in behavior (such as wetting the bed or poor performance at school), sudden awareness of sexual acts and words, and attempts to get other children to perform sexual acts. Physical signs of sexual abuse may include sexually transmitted diseases, bruises or scrapes. If you suspect a problem, a pediatrician can check for signs of abuse.  

Treatment

All children who have been sexually abused need to be evaluated by a mental health professional to determine the need for treatment. Types and length of treatment needed will vary by the type of sexual abuse, the length of time of the abuse, and the child's symptoms.

Prevention of Abuse

Teach your children what sexual abuse is and about their right to privacy. Teach them that no one has the right to touch them inappropriately or make them feel uncomfortable and that they can and should say "no" to adults when these situations arise. Teach them that anyone has the potential to abuse them, not just strangers. Children should be taught not to keep secrets and should report any touching or behavior that makes them feel uncomfortable to their parents or an adult guardian. Listen when your child tries to tell you something, especially when it is difficult for them to talk about it. Know who your child is spending time with and ask the child about his or her visits with that person; this includes caregivers, such as babysitters.  

If Abuse Has Occurred

If a child tells you he or she has been sexually abused, take your child seriously, respond sympathetically, and try to avoid showing expressions of shock or disgust, which could add to the child's unwarranted sense of guilt. Anyone who suspects that a child is being sexually abused should take them to a physician to treat any physical problems and to look for physical evidence of the abuse. The local child welfare or social services agency should also be contacted.  

Mi Young Hwang, Writer

Richard M. Glass, M.D., Editor

 Jeff Molter, Director of Science News

(JAMA. 1998; 280:1888)

Published in JAMA: December 2, 1998

The JAMA Patient Page is a public service of The Journal of the American Medical Association and the American Medical Association. The information and recommendations appearing on this page are appropriate in most instances; but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA and AMA suggest that you consult your physician. This page may be reproduced noncommercially by physicians and other health care professionals to share with patients. Any other reproduction is subject to AMA approval.

 © Copyright 1998 American Medical Association. All rights reserved.