PTSD: National Center for PTSD

Sexual Abuse: Children

Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person. These behaviors are meant to arouse the older person in a sexual way. In general, no thought is given to what effect the behavior may have on the child. For the most part, the abuser does not care about the reactions or choices of the child, or they falsely may convince themselves that the child is welcoming of their actions.

Child sexual abuse often involves body contact. This could include sexual kissing, touching, and oral, anal, or vaginal sex. Not all sexual abuse involves body contact, though. Showing private parts ("flashing"), forcing children to watch pornography, verbal pressure for sex, and exploiting children as prostitutes or for pornography can be sexual abuse as well. Researchers estimate that in our country about one out of six boys and one out of four girls are sexually abused. We know less about the experiences of transgender or other gender noncomforming children and adolescents. However, the 2018 Gender Minority Youth (GMY) Study found that transgender adolescents had higher reported odds of sexual abuse than adolescents whose identity aligned with that assigned at birth. Under the child sexual abuse laws, the abuser must be older than the victim in most cases. Some states require the abuser to be at least five years older.

Who Commits Child Sexual Abuse?

Most often, sexual abusers know the child they abuse, but are not family. For example, the abuser might be a friend of the family, babysitter, or neighbor. Less often, abusers could be family, such as parents, uncles, aunts or cousins. Abusers are men in most cases, whether the child is a boy or a girl. Child pornographers and other abusers who are strangers may make contact with children using the Internet.

What Are the Effects of Childhood Sexual Abuse?

It is not always easy to tell when a child has been sexually abused. Sexual abuse often occurs in secret, and there is not always physical proof of the abuse. For these reasons, child sexual abuse can be hard to detect.

Almost every child who has been sexually abused describes the abuse as negative. Most children know it is wrong. They usually have feelings of fear, shock, anger, and disgust. A small number of abused children might not realize it is wrong, though. These children tend to be very young or have developmental delays. Also some victims might enjoy the attention, closeness, or physical contact with the abuser. This is more likely to be the case if these basic needs are not met by a caregiver. All told, these reactions make the abuse very hard and confusing for children. Sexual abuse often involves being used or hurt by a trusted adult. The child might come to believe that the only way to get attention or love is to give something sexual. Some children believe the abuse is somehow their fault. They may think the abuser chose them because they must have wanted it or because there is something wrong with them. If the abuser was of the same sex, children might wonder if that means they are gay.

Some children who have been sexually abused may show symptoms of PTSD. They may behave in a nervous, upset way. They may have bad dreams, act out aspects of the abuse in their play, or show other fears and worries. Young children may lose skills they once learned and act younger than they are. For example, they might start wetting the bed or sucking their thumb after they had previously grown out of those behaviors. Some show sexual behaviors that are not expected in a child. They may act in a way that seems seductive, or they may not maintain safe limits with others. Children, especially boys, might "act out" with behavior problems. This could include being cruel to others or running away from home. Other children "act in" by becoming depressed. They may withdraw from friends or family. Older children or teens might try to hurt or even kill themselves.

What Can Caregivers Do to Help Keep Children Safe?

Although caregivers may not be able to protect their children all of the time, it is important to get to know the people who are part of their life. Most importantly, provide a safe, caring setting so children feel able to talk to you about sexual abuse if it should happen. Other tips to keep children safe include:

• Talk to others who know the people with whom the child comes into contact.
• Talk to children about the difference between safe touching and unsafe touching.
• Tell children that if someone tries to touch their body in their private areas or does things that make them feel unsafe, they should say NO to the person. Then they should tell you or a trusted adult about it right away.
• Let children know that their bodies are private and that they have the right not to allow others to touch their bodies in an unsafe way.
• Let them know that they do not have to do EVERYTHING the babysitter, family member, or group leader tells them to do.
• Alert children that abusers may use the internet. Watch over your child on the internet.

What Should You Do if You Think Your Child Has Been Sexually Abused?

If a child says they have been abused, reassure the child that what happened is not their fault. Tell them that you believe them, that you are proud of them for telling you (or another person), and that you are there to keep them safe. Take them to a mental health or medical professional right away. Many cities have child advocacy centers where children and their caregivers can get help. Staff at these centers are skilled in interviewing children in a sensitive, caring way. They can help you report the abuse to legal authorities and find a therapist skilled in treating children who have been sexually abused. The National Children's Alliance website has more information and a listing of centers.

Children can successfully recover from sexual abuse. Getting support and love from their main caregivers is very important. Try not to downplay the abuse ("it wasn't that bad"), but also try not to have extreme fears related to the abuse ("they will never be safe again"). It is often very hard to accept that a child has been sexually abused. As a caregiver, you might also consider getting help for yourself. Getting therapy for yourself can help you deal with your own feelings about the abuse. Then you might be better able to provide support to the child.

Please see: PTSD in Children and Teens to learn about treatment for children who have been sexually abused or experienced other traumatic events.