FFFSexual Abuse

No. 9; Updated September 2023

Child sexual abuse is a major public health concern. About 1 in every 4 girls and 1 in every 13 boys in the US experience sexual abuse at some time in their childhood. The vast majority of sexual abuse is committed by someone that the child or their family knows. The long-term emotional and physical damage after sexual abuse can be devastating to the child. Children who experience sexual abuse and other “adverse childhood experiences” (ACEs) such as physical abuse or neglect, have a higher chance of developing depression, posttraumatic stress disorder, drug addiction, and suicidal behaviors later in life. They also have a higher chance of developing physical conditions such as heart disease later in life. This is why it is so important to identify it as soon as possible, seek help for these children, and focus on preventing it in the future.

Child sexual abuse often takes place within the family, by a parent, stepparent, sibling or other relative; or outside the home, for example, by a friend, neighbor, childcare person, teacher, or stranger. When sexual abuse has occurred, a child develops many distressing feelings, thoughts and behaviors. Children may be threatened by the abuser and be fearful to tell anyone else, especially if the abuser is someone they know well.

No child is prepared to cope with repeated pain and fear of sexual abuse. Even a two or three-year-old, who cannot understand the sexual activity, will suffer physically and emotionally.

Even a young child who knows and cares for the abuser becomes trapped between affection or loyalty for the person, and the fear, pain and betrayal that goes along with the sexual abuse. 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.

The longer the sexual abuse occurs, the more negatively it impacts a child’s emotional and physical growth and development. Child victims of long periods of sexual abuse often develop low self-esteem, a feeling of worthlessness and an abnormal view of sex. The child may become withdrawn and mistrustful of adults, depressed, intentionally harm themselves, and/or become suicidal.

Some children who have been sexually abused display sexualized behaviors which are not appropriate for their age and may try to pressure siblings or peers into sexual behavior. Some sexually abused children become child abusers themselves as adults, and others may turn to prostitution as teens.

Often there are no obvious external signs of child sexual abuse. Some signs can only be detected on physical exam by a physician.

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
  • 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
  • Poor focus and concentration at school
  • Delinquency/conduct problems
  • Secretiveness
  • Aspects of sexual molestation in drawings, games, fantasies
  • Unusual aggressiveness, or
  • Self harm and/or suicidal behavior

Child sexual abusers often threaten to harm children if they tell anyone about it, so it is difficult for an abused child to speak freely about it. If a child tells a teacher, peer, parent orcaregiver that he or she has been abused, these individuals 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:

  • Teaching 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'

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. Cognitive-behavioral therapies for children and parents can help them to deal with the consequences of sexual abuse. Such treatment can help reduce the immediate emotional aftermath of abuse on children and families, and reduce the severity of future problems.

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Other AACAP Resources

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