WHAT YOU NEED TO KNOW:

What is sexual abuse of a child? Sexual abuse of a child occurs when someone has sexual contact with a child who is younger than 18 years. Abuse includes kissing that is not appropriate, fondling the child's genitals, or using force to have sex. It also includes showing genitals to the child or showing him sexual materials. Child prostitution or pornography is also sexual abuse. Parents, guardians, foster parents, relatives, or someone who cares for the child may be responsible for sexual abuse.

What increases a child's risk for sexual abuse?

• Poor, violent, or crowded living conditions
  
  
• Age 6 years or younger
  
  
• Learning or memory problems, a long-term medical condition, or special needs
  
  
• Not having relatives or friends who can take care of him
  
  
• Care from a single or teenaged parent, or someone who lacks knowledge about the normal development of a child
  
  
• Being around someone who drinks alcohol or uses illegal drugs, or is under stress
  
  
• Being around someone who has a history of physical, sexual, or other abuse
  
  
• Being around someone who has a personality disorder, depression, or another mental illness

What are the signs and symptoms of sexual abuse? The child may act strangely or differently, have changes in behavior or moods, or trouble sleeping. He may be depressed, fearful, or have sexual behaviors that are not right for his age. A sexually abused child may also be physically abused. The child may also have any of the following:

• Scratches, bruises, or bite marks
  
  
• Marks from objects used as restraints, such as belts, ropes, or electrical cords
  
  
• Cuts or scars in the genital area
  
  
• Pain or difficulty urinating or having a bowel movement
  
  
• Pain or itchiness in the genital area
  
  
• Sores, growths, or small blisters in the genital area
  
  
• Blood or discharge from the genital area
  
  
• Stains in his clothing
  
  
• Pregnancy

How is sexual abuse diagnosed? Healthcare providers who specialize in child abuse will examine the child's body closely to look for injuries. The child may be asked if he has been touched, kissed, forced to have sex, or photographed naked. Healthcare providers may also want to know who the abuser is, and how long the abuse has been happening. The child may also need any of the following tests:

• Blood and urine tests may show if the child has a sexually transmitted infection (STI) or other infections. The tests may also show physical injury to an organ. A female child may be tested for pregnancy.
  
  
• A culture and smear exam is used to test a sample of a female's vaginal discharge for STIs.
  
  
• Forensic tests may be done to check hair strands and samples of stains or discharge from the skin, clothing, a blanket, or the scene of the abuse. Bring the child in for tests as soon as possible after an incident. Some tests may be most accurate within 24 hours, but they can still be useful even 72 hours afterward.
  
  
• A pelvic or rectal exam may show any injuries from the abuse.
  
  
• A colposcopy is a procedure used to see inside a female child's vagina and cervix to check for injuries. A small scope and light is used during this test.

How is sexual abuse treated?

• Counseling may help the child to feel less scared, depressed, or anxious. A counselor can help him talk about how he feels.
  
  
• Medicines may be given to decrease the child's pain or prevent an infection. Medicines may also be given if the child has other medical conditions.
  
  
• Surgery may be needed to treat injuries, such as a wound in the genital area.

What are the risks of sexual abuse? If sexual abuse is not treated, the child may develop serious health and mental problems. Sexual abuse may lead to unwanted pregnancies. The child's behavior may change. He may develop other serious problems. These include alcohol or drug use, depression, and problems with self-esteem, mood, friendships, and relationships. He may have thoughts of harming himself or others.

How can I care for a child victim of sexual abuse?

• Let the child rest as needed. Tell the child's healthcare provider if the child has trouble sleeping.
  
  
• Report suspected or known sexual abuse. It may be hard to report sexual abuse of children, but it is very important. Healthcare providers can help the child. Healthcare providers are required by law to report sexual abuse. A state or county investigator may need to be involved to assess child safety. The child may need to leave a current living situation to protect him from the abuse.

Call 911 for any of the following:

• The child has trouble breathing, chest pain, or a fast heartbeat.
  
  
• The child feels like harming himself or someone else.

When should I seek immediate care?

• The child feels that he cannot cope with the abuse, or recovery from it.
  
  
• The child has blood or foul-smelling discharge coming from his genital area.
  
  
• The child has problems sleeping, urinating, or having bowel movements.

When should I contact the child's healthcare provider?

• The child is sad or depressed most of the time, or frightened of other people.
  
  
• The child has new signs and symptoms since the last visit.
  
  
• You have questions or concerns about the child's condition or care.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.