Lauren McAliley, MSN, MA, CNP
Pediatric Nurse Practitioner, Child Advocacy and Protection, UH Rainbow Babies & Children’s Hospital
What should I do if I suspect a child has been sexually abused?
If you think a child has been sexually abused, you may feel overwhelmed, confused and angry. By recognizing the signs and taking action, you can protect a child from further abuse and help begin the healing process.
Recognize the Signs of Abuse
Certain physical and behavioral symptoms can indicate sexual abuse. A child may feel responsible for the abuse or pressured to keep the abuser’s secret, so these warning signs may be the only clue that something is wrong.
While they can, and most often do, have other medical explanations, physical signs of abuse can include bleeding, bruises, sores, swelling or foul-smelling discharge in the genital area; a pattern of urinary or yeast infections; trouble sitting or walking; or stained or torn underwear. Often, there are no physical signs.
The most clear behavioral sign of abuse for younger children is showing inappropriate and/or explicit sexual knowledge or behavior, often combined with one or more of the following:
- Changes in mood, sleep patterns or appetite
- Shying away from physical contact
- Problems at school, like skipping class
- Lack of interest in normal activities and hobbies
Some behavioral symptoms, like skipping class, may be related to school or family issues or other stressors. School- aged children may exhibit other behaviors, like attempts to avoid being around a certain person or a sudden interest in locking doors and windows at night.
Talking to a child you suspect has been abused is a delicate task. Many feel reluctant to say anything if the abuser is someone close to them. And some do not fully understand what happened. Talk somewhere the child feels safe and away from suspected abusers. Be nonjudgmental when asking questions. Use “I statements”—like “I noticed you seem upset lately”—so the child does not feel accused. This helps show the child you are not angry with him or her. The calmer you are, the more likely the child will share.
If you think a child has been sexually abused, contact the authorities and seek medical care. Many pediatricians and emergency physicians are trained to identify and treat children who have been sexually abused/assaulted. Physicians and nurses are legally obligated to report signs of abuse they find during an exam.
Enduring sexual abuse is traumatic, and the aftermath can last for a long time. Counseling can help make sense of it. With therapy and support, abused children can grow up to be well-adjusted adults.
Providing Child- and Family-Sensitive Care
The Pediatric SANE (Sexual Assault Nurse Examiners) Program at University Hospitals Rainbow Babies & Children’s Hospital provides child- and family-sensitive care from a team of pediatric nurses who are specially trained in caring for children who have been sexually abused/assaulted. The SANE team cares for children brought to the hospital’s Marcy R. Horvitz Pediatric Emergency Center within 72 hours of the suspected abuse. The team provides an evidence collection exam, as well as support and resources for the family and child.
For children reporting beyond 72 hours, parents can call 216-844-3761 for a scheduled exam in the UH Rainbow Care Clinic. Here, specialized exams and care will be provided by a Pediatric Nurse Practitioner who specializes in the medical evaluation of children who may have been sexually abused.