Physical and Sexual Abuse in Children

Child Physical Abuse—

The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of kids are physically abused each year by a parent or close relative. Thousands actually die as a result of the abuse. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden bruises” can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse. Whenever a youngster says he or she has been abused, it must be taken seriously and immediately evaluated.

Kids who have been abused may display:

• a poor self image
• aggressive, disruptive, and sometimes illegal behavior
• anger and rage
• anxiety and fears
• drug and alcohol abuse
• fear of entering into new relationships or activities
• feelings of sadness or other symptoms of depression
• flashbacks, nightmares
• inability to trust or love others
• passive, withdrawn or clingy behavior
• school problems or failure
• self destructive or self abusive behavior, suicidal thoughts
• sexual acting out
• sleep problems

Often the severe emotional damage to abused kids does not surface until adolescence or even later, when many abused kids become abusing moms & dads. An adult who was abused as a youngster often has trouble establishing lasting and stable personal relationships. These men and women may have trouble with physical closeness, touching, intimacy, and trust as adults. They are also at higher risk for anxiety, depression, substance abuse, medical illness, and problems at school or work.

Early identification and treatment is important to minimize the long-term consequences of abuse. Qualified mental health professionals should conduct a comprehensive evaluation and provide treatment for kids who have been abused. Through treatment, the abused child begins to regain a sense of self-confidence and trust. The family can also be helped to learn new ways of support and communicating with one another. Moms & dads may also benefit from support, parent training and anger management.

Physical abuse is not the only kind of child abuse. Many kids are also victims of neglect, or sexual abuse, or emotional abuse. In all kinds of child abuse, the youngster and the family can benefit from evaluation and treatment from a qualified mental health professional.

Child Sexual Abuse—

Child sexual abuse has been reported up to 80,000 times a year, but the number of unreported instances is far greater, because the kids are afraid to tell anyone what has happened, and the legal procedure for validating an episode is difficult. The problem should be identified, the abuse stopped, and the youngster should receive professional help. The long-term emotional and psychological damage of sexual abuse can be devastating to the youngster.

Child sexual abuse can take place within the family, by a parent, step-parent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger. When sexual abuse has occurred, a youngster can develop a variety of distressing feelings, thoughts and behaviors.

No youngster is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation.

The youngster of five or older who knows and cares for the abuser becomes trapped between affection or loyalty for the person, and the sense that the sexual activities are terribly wrong. If the youngster tries to break away from the sexual relationship, the abuser may threaten the youngster with violence or loss of love. When sexual abuse occurs within the family, the youngster may fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told.

A youngster who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of sex. The youngster may become withdrawn and mistrustful of adults, and can become suicidal.

Some kids who have been sexually abused have difficulty relating to others except on sexual terms. Some sexually abused kids become child abusers or prostitutes, or have other serious problems when they reach adulthood.

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 kids may also develop the following:

• aspects of sexual molestation in drawings, games, fantasies
• delinquency/conduct problems
• depression or withdrawal from friends or family
• refusal to go to school
• secretiveness
• seductiveness
• sleep problems or nightmares
• statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
• suicidal behavior
• unusual aggressiveness
• unusual interest in or avoidance of all things of a sexual nature

Child sexual abusers can make the youngster extremely fearful of telling, and only when a special effort has helped the youngster to feel safe, can the youngster talk freely. If a youngster says that he or she has been molested, moms & dads should try to remain calm and reassure the youngster that what happened was not their fault. Moms & dads should seek a medical examination and psychiatric consultation.

Moms & dads can prevent or lessen the chance of sexual abuse by:

• Encouraging professional prevention programs in the local school system
• Teaching kids that respect does not mean blind obedience to adults and to authority, for example, don't tell kids to, Always do everything the teacher or baby-sitter tells you to do
• Telling kids 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

Sexually abused kids and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused kids regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that the youngster will develop serious problems as an adult.

Responding To Child Sexual Abuse—

When a youngster tells an adult that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following guidelines should be used when responding to kids who say they have been sexually abused:

What to Say—If a youngster even hints in a vague way that sexual abuse has occurred, encourage him or her to talk freely. Don't make judgmental comments.

• Assure the youngster that they did the right thing in telling. A youngster who is close to the abuser may feel guilty about revealing the secret. The youngster may feel frightened if the abuser has threatened to harm the youngster or other family members as punishment for telling the secret.

• Offer the youngster protection, and promise that you will promptly take steps to see that the abuse stops.

• Show that you understand and take seriously what the youngster is saying. Child and adolescent psychiatrists have found that kids who are listened to and understood do much better than those who are not. The response to the disclosure of sexual abuse is critical to the youngster's ability to resolve and heal the trauma of sexual abuse.

• Tell the youngster that he or she is not to blame for the sexual abuse. Most kids in attempting to make sense out of the abuse will believe that somehow they caused it or may even view it as a form of punishment for imagined or real wrongdoings.

What to Do—Report any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency. If the abuse is outside of the family, report it to the police or district attorney's office. Individuals reporting in good faith are immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the youngster.

Moms & dads should consult with their pediatrician or family physician, who may refer them to a physician who specializes in evaluating and treating sexual abuse. The examining doctor will evaluate the youngster's condition and treat any physical problem related to the abuse, gather evidence to help protect the youngster, and reassure the youngster that he or she is all right.

Kids who have been sexually abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for the youngster to deal with the trauma of the abuse. The child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.

While most allegations of sexual abuse made by kids are true, some false accusations may arise in custody disputes and in other situations. Occasionally, the court will ask a child and adolescent psychiatrist to help determine whether the youngster is telling the truth, or whether it will hurt the youngster to speak in court about the abuse.

When a youngster is asked as to testify, special considerations--such as videotaping, frequent breaks, exclusion of spectators, and the option not to look at the accused--make the experience much less stressful.

Adults, because of their maturity and knowledge, are always the ones to blame when they abuse kids. The abused kids should never be blamed.

When a youngster tells someone about sexual abuse, a supportive, caring response is the first step in getting help for the youngster and reestablishing their trust in adults.

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