Child Sexual Abuse: Know the Warning Signs

Whether you are a parent, teacher, or someone else who cares for and loves children, the best defense against sexual abuse is to educate yourself and your children about it.

What Is Child Sexual Abuse?

Child sexual abuse involves an adult engaging in any type of sexual activity with a child or adolescent. It may also involve an adolescent engaging in sexual activity with a younger child.

There are different forms of sexual abuse. Like other forms of abuse, it can be physical, verbal, or emotional. It may be subtle enough that a child does not know what’s happening, but only feels uncomfortable. Child sexual abuse may include:

  • Touching behaviors such as:
    • Fondling a child’s genitals, breasts, or anus for sexual pleasure or other unnecessary reason
    • Playing sexual games or making a child touch someone else’s genitals
    • Inserting objects or body parts (fingers, tongue, or penis) inside the vulva, vagina, mouth, or anus of a child, for sexual pleasure or other unnecessary reason
  • Non-touching behaviors such as:
    • Exposing genitals to a child
    • Showing pornography to a child
    • Making sexual remarks to a child
    • Having a child pose, undress, or perform in a sexual fashion (including for photographs)
    • Peeping into bedrooms and bathrooms

In most cases of sexual abuse, the child knows the offender. The offender is often someone the child trusts or loves, such as a parent, neighbor, or relative.

Signs and Symptoms of Child Sexual Abuse

Children often don’t tell others about sexual abuse because they feel frightened, ashamed, and confused. Their abusers often convince them that it must be kept a secret. Be alert for the following potential warning signs:

Physical Signs

  • Underwear that is torn, stained, or bloody
  • Difficulty walking or sitting
  • Redness, pain, bleeding, or bruising in the external genital area, vagina, or anal area
  • Unusual discharge from the vagina or anus
  • Frequent, unexplained urinary infections or sore throats
  • Sexually transmitted infections
  • Pregnancy

Emotional Signs

  • Clinical depression and thoughts of suicide
  • Lack of trust
  • Change in response to adults or older children (although males account for most cases of abuse, don’t rule out the possibility of female abusers)
  • New fears or hysteria
  • Low self-esteem
  • Depression with physical complaints such as:
    • Headache, stomachache, or chest pain
    • Insomnia
    • Fatigue
    • Loss of appetite

Behavioral Signs

  • Clinging
  • Sleep problems
  • Bed-wetting, thumb sucking, or loss of bowel control
  • Fear of undressing, or wearing extra layers of clothing
  • Fear of going to the bathroom, refusal to have a bowel movement, or constipation
  • Difficulty making friends
  • Getting to school early and staying late, to avoid being at home
  • Marked fear of a person (including parents) or certain places
  • Promiscuity, seductive behavior, or age inappropriate interest in sexual matters
  • Persistent, inappropriate sex play with peers or toys, or excessive masturbation
  • Truancy or dropping school performance
  • Running away from home
  • Abusing alcohol or drugs

When You Suspect Sexual Abuse

  1. Stay calm. If you show anger or disgust, the child might take it personally. Don’t panic or overreact. This is a difficult experience and the child needs help and support.
  2. Take what the child says seriously.
  3. Listen carefully and compassionately to the child and answer questions honestly.
  4. Be positive. Child abuse is never the child’s fault. Reassure the child they are not to blame. Tell the child that you are proud of them for speaking up. Give lots of love, comfort, and reassurance.
  5. Respect the child’s privacy. Don’t pressure the child to talk about the abuse. The child will talk about it at their own pace. Don’t discuss the abuse in front of people who don’t need to know about it.
  6. Report the abuse to the local authorities as soon as possible. They can help keep the child safe and provide assistance and resources.
  7. Take the child for a medical exam in case there might be physical injury, damage, or disease that has resulted from the abuse. An exam may also provide important evidence.
  8. Get help from a variety of sources : the child’s pediatrician, a counselor, a police officer, a child protective service worker, or a teacher.
  9. Do not prevent the child from talking about the abuse.
  10. Do not confront the offender. Keep the child away from the suspected person. Notify the authorities and let them handle the legal process.

How to Help Prevent Sexual Abuse

Here are some ways that parents can help lessen the chance of sexual abuse:

  • Tell children, “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."
  • Teach children that respect does not mean blind obedience to adults and to authority.
  • Encourage professional prevention programs in the local school.
  • Know the people who spend time around your child, especially caregivers.
  • Communicate frequently and openly with your child in a non-judgmental way.

American Psychological Association

Healthy Children—American Academy of Pediatrics


About Kids Health—The Hospital for Sick Children

Canadian Red Cross


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Child sexual abuse. American Academy of Child & Adolescent Psychiatry website. Available at: Updated November 2014. Accessed June 8, 2016.

Defining child sexual abuse. Stop It Now! website. Available at: Accessed June 8, 2016.

Lahoti SL, McClain N, Girardet R, McNeese M, Cheung K. Evaluating the child for sexual abuse. Am Fam Physician. 2001;63(5):883-893.

McDonald KC. Child abuse: approach and management. Am Fam Physician. 2007;75(2):221-228.

Responding to child sexual abuse. American Academy of Child & Adolescent Psychiatry website. Available at: Updated December 2014. Accessed June 8, 2016.

Sexual abuse. American Academy of Pediatrics Healthy Children website. Available at: Updated November 21, 2016. Accessed June 8, 2016.

Tip sheet: Warning signs of possible sexual abuse in a child's behavior. Stop It Now! website. Available at: Accessed June 8, 2016.

Last reviewed June 2016 by Michael Woods, MD  Last Updated: 6/8/2016