Sexual abuse is one form of child abuse. It includes a wide range of actions between a child and an adult or older child. Often these involve body contact, but not always. Exposing one's genitals to children or pressuring them for sex is sexual abuse. Using a child for pornography is also sexual abuse.

Most sexual abusers know the child they abuse. They may be family friends, neighbors or babysitters. About one-third of abusers are related to the child. Most abusers are men. If you think a child may have been abused, it's important to report it.

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.

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.

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.

• 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. About 6 out of 10 abusers fall into that group.
• About 3 out of 10 of those who sexually abuse children are family members of the child. This includes fathers, uncles, or cousins.
• The abuser is a stranger in only about 1 out of 10 child sexual abuse cases.
• Abusers are men in most cases, whether the victim is a boy or a girl.
• Women are the abusers in about 14% of cases reported against boys and about 6% of cases reported against girls.
• Child pornographers and other abusers who are strangers may make contact with children using the Internet.

It is not always easy to tell whether 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.

Some child sexual abuse survivors may show symptoms of PTSD. They may behave in a nervous, upset way. Survivors may have bad dreams. They may act out aspects of the abuse in their play. They might show other fears and worries. Young children may lose skills they once learned and act younger than they are. For example, an abused child might start wetting the bed or sucking his or her thumb. Some sexual abuse survivors show out-of-place sexual behaviors that are not expected in a child. They may act 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 and running away. 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.

Sexual abuse can be very confusing for children. For a child, it often involves being used or hurt by a trusted adult. The child might learn that the only way to get attention or love is to give something sexual or give up their self-respect. Some children believe the abuse is their fault somehow. 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 (and parents) might wonder if that means they are "gay."

Almost every child sexual abuse victim 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 mental delays. Also some victims might enjoy the attention, closeness, or physical contact with the abuser. This is more likely if these basic needs are not met by a caregiver. All told, these reactions make the abuse very hard and confusing for children.

If childhood sexual abuse is not treated, long-term symptoms can go on through adulthood. These may include:

• PTSD and anxiety.
• Depression and thoughts of suicide.
• Sexual anxiety and disorders, including having too many or unsafe sexual partners.
• Difficulty setting safe limits with others (e.g., saying no to people) and relationship problems.
• Poor body image and low self-esteem.
• Unhealthy behaviors, such as alcohol, drugs, self-harm, or eating problems. These behaviors are often used to try to hide painful emotions related to the abuse.

If you were sexually abused as a child and have some of these symptoms, it is important for you to get help.

For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years if they do not get treatment. There are many treatment options, described below:

Cognitive-Behavioral Therapy (CBT)

CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert himself or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, "the world is totally unsafe."

Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD.

CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children.

Psychological first aid/crisis management

Psychological First Aid (PFA) has been used with school-aged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem solving skills. PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe symptoms may be referred for added treatment.

Eye movement desensitization and reprocessing (EMDR)

EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.

Play therapy

Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other methods to help children process their traumatic memories.

Other treatments

Special treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol.

If a child says she or he has been abused, try to stay calm. Reassure the child that what happened is not her fault, that you believe her, that you are proud of her for telling you (or another person), and that you are there to keep her safe. Take your child to a mental health and medical professional right away. Many cities have child advocacy centers where a child and her family can get help. These centers interview children and family members in a sensitive, warm place. They can help you report the abuse to legal authorities. They can help you find a medical examiner and therapist skilled in child sexual abuse.

Children can recover from sexual abuse and go on to live good lives. The best predictor of recovery is support and love from their main caregiver. As a caregiver, you might also consider getting help for yourself. It is often very hard to accept that a child has been sexually abused. You will not be supporting your child, though, if you respond in certain unhelpful ways. For example, you will not be able to provide support if you are overwhelmed with your own emotions. Don't downplay the abuse ("it wasn't that bad"), but also try not to have extreme fears related to the abuse ("my child will never be safe again"). It will not help children if you force them to talk, or if you blame the child. 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 your child.

Although caregivers cannot protect their children 100% of the time, it is important to get to know the people that come around your child. You can find out whether someone has been charged with sexual abuse and find out where sexual abusers live in your area by going to the website FamilyWatchdog.com.

Most importantly, provide a safe, caring setting so children feel able to talk to you about sexual abuse.

Other tips to keep your children safe include:

• Talk to others who know the people with whom your child comes in contact.
• Talk to your children about the difference between safe touching and unsafe touching.
• Tell the child that if someone tries to touch his or her body in their private areas or do things that make the child feel unsafe, he should say NO to the person. He needs to 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 your children that abusers may use the Internet. Watch over your child on the Internet.