Sexual abuse in children - what to know

One in four girls and one in ten boys are sexually abused before they turn 18.

Sexual abuse of children is any activity that the abuser does to get sexually aroused, including:

• Touching a child's genitals
• Rubbing the abuser's genitals against a child's skin or clothing
• Putting objects into a child's anus or vagina
• Tongue kissing
• Oral sex
• Intercourse

Sexual abuse can also happen without physical contact, such as:

• Exposing one's own genitals
• Having a child pose for pornography
• Having a child look at pornography
• Masturbating in front of a child

Suspect sexual abuse when children:

• Tell you that they are being sexually abused
• Have trouble sitting or standing
• Won't change for gym class
• Have sexually transmitted diseases or become pregnant
• Know about and talk about sex
• Run away
• Have adults in their lives that keep them from having contact with other adults
• Keep to themselves and seem to have secrets

Sexually abused children might have:

• Bowel control problems, such as soiling themselves (encopresis)
• Eating disorders (anorexia nervosa)
• Genital or rectal problems, such as pain when going to the bathroom, or vaginal itch or discharge
• Headaches
• Sleep problems
• Stomach aches

Sexually abused children may also:

• Use alcohol or drugs
• Engage in high-risk sexual behaviors
• Get poor grades in school
• Have a lot of fears
• Not want to do their normal activities

If you think a child has been sexually abused, get the child examined by a health care provider.

• Find a provider that knows about sexual abuse. Most pediatricians, family medicine providers, and emergency room providers have been trained to examine people that have been sexually abused.
• Have the child examined right away or within 2 to 3 days of discovering the abuse. The signs of sexual abuse don't last long, and the provider may not be able to tell if you wait too long.

During the exam, the provider will:

• Look for signs of physical and sexual abuse. The provider will check the child's mouth, throat, anus, and penis or vagina.
• Do blood or other tests to check for sexually transmitted diseases and pregnancy.
• Take photographs of any injuries, if needed.

Get the child any needed medical care. Also get mental health counseling for the child. Active support groups that can help include:

• Childhelp -- www.childhelp.org
• Rape, Abuse & Incest National Network -- www.rainn.org

Know that providers, teachers, and child care workers are required by law to report sexual abuse. If abuse is suspected, child protection agencies and the police will investigate. The child must be protected from abuse. The child may be placed with a non-abusing parent, another relative, or in a foster home.

Sexual abuse - children

Carrasco MM, Wolford JE, Eichman AL. Child abuse and neglect. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 6.

Marcdante KJ, Kliegman RM. Child abuse and neglect. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2019:chap 22.

US Department of Health and Human Services website. Child Welfare Information Gateway. How to report child abuse and neglect. www.childwelfare.gov/how-report-child-abuse-and-neglect/. Accessed February 13, 2024.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.