Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater.

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 stranger. When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.

No child is psychologically prepared to cope with repeated sexual stimulation. Even those who do not know that it is 'wrong' will begin to have resulting problems from the abuse. 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.

Sexually abused children may 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
secretiveness
aspects of sexual molestation in drawings, games, fantasies
unusual aggressiveness
suicidal behavior

Parents can prevent or lessen the chance of sexual abuse by:
Telling 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"
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 baby-sitter tells you to do"
Encouraging professional prevention programs in the local school system

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:

Encourage him or her to talk freely. Don't make judgmental comments.
Show that you understand and take seriously what the child is saying.
Assure the child that they did the right thing in telling.
Tell the child that he or she is not to blame for the sexual abuse.
Offer the child protection, and promise that you will promptly take steps to see that the abuse stops.

What to Do
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 or district attorney's office. Individuals reporting in good faith are immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the child.

Parents should consult with their pediatrician or family physician, 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 the child to deal with the trauma of the abuse. The 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 made by children 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 as 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.

Know When to Seek Help for Your Child
Parents are usually the first to recognize that their child has a problem with emotions or behavior. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

YOUNGER CHILDREN
Marked fall in school performance.
Poor grades in school despite trying very hard.
A lot of worry or anxiety, as shown by regular refusal to go to school, go to
sleep or take part in activities that are normal for the child's age.
Hyperactivity; fidgeting; constant movement beyond regular playing.
Persistent nightmares.
Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
Frequent, unexplainable temper tantrums.

PRE-ADOLESCENTS AND ADOLESCENTS
Marked change in school performance.
Inability to cope with problems and daily activities.
Marked changes in sleeping and/or eating habits.
Many physical complaints.
Sexual acting out.
Depression shown by sustained, prolonged negative mood and attitude,
often accompanied by poor appetite, difficulty sleeping or thoughts of death.
Abuse of alcohol and/or drugs.
Intense fear of becoming obese with no relationship to actual body weight,
purging food or restricting eating.
Persistent nightmares.
Threats of self-harm or harm to others.
Self-injury or self destructive behavior.
Frequent outbursts of anger, aggression.
Threats to run away.
Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
Strange thoughts and feelings; and unusual behaviors.

If problems persist over an extended period of time and especially if others involved in the child's life are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.