AssessmenL Lo general appearance of Lhe chlld

Assess lf Lhe chlld has Lorn sLalned or bloody undercloLhlng Lxperlences paln or lLchlng ln Lhe
genlLal area Pas brulses or bleedlng ln exLernal genlLalla vaglna or anal reglons
AssessmenL Lo chlld's behavlor
Assess lf Lhe chlld appears wlLhdrawn or engaged ln fanLasy or lnfanLlle behavlor 8eglns weLLlng
or solllng Lhe bed Pas poor peer relaLlonshlps ls unwllllng Lo parLlclpaLe ln physlcal acLlvlLles ls
engaglng ln dellnquenL acLs 8eporLs sexual abuse Lngages ln lnapproprlaLe sexuallzed behavlor
uevalues sexual acLs and acLs sexually permlsslve lears a cerLaln person or cerLaln places Clves an
unusual or unexpecLed response when asked lf he or she was Louched by someone Pas an
unreasonable fear of a physlcal exam CreaLes drawlngs LhaL show sexual acLs or LhaL seem overly
focused on sexual body parLs More knowledge abouL sex Lhan ls normal for Lhe chllds age aln
brulslng or bleedlng ln Lhe genlLals Seems preoccupled wlLh or overly concerned abouL sexual acLs and
words 8uns away
Accordlng Lo roLecL klds an onllne source for flghLlng chlld sexual abuse a chlld who ls
sufferlng from abuse may wake up durlng Lhe nlghL screamlng sweaLlng and shaklng or have severe
nlghLmares ?our chlld may begln acLlng aggresslvely or cruelly Lowards oLher chlldren and anlmals
famlly members and even Loys wlll suddenly lose hls appeLlLe show excesslve or new fear of a cerLaln
place or person and engage ln sexual behavlors such as masLurbaLlon Pe may also ask unusual or age
lnapproprlaLe quesLlons abouL sex and sexuallLy and play sexually wlLh oLher small chlldren roLecL klds
also warns LhaL a chlld who ls sexually abused may begln ln[urlng hlmself by sLlcklng hlmself wlLh plns
cuLLlng hlmself or wlll show slgns of depresslon such as lacklng en[oymenL ln prevlously loved acLlvlLles
such as school and sporLs
Pow Lo assess
1alklng Lo an Abused Chlld
?our reacLlon Lo a chlld Lelllng you abouL sexual abuse ls one of Lhe mosL lmporLanL momenLs ln
your llfe as a careglver lf your chlld dlscloses lnformaLlon Lo you do noL deny Lhe chlld or dlsbelleve Lhe
chlld lL ls lmperaLlve LhaL you do noL dlscounL your chllds LesLlmony 8eacLlng wlLh shock or dlsbellef
can cause your chlld Lo clam up and qulL Lalklng PelpCulde also says Lo allow Lhe chlld Lo Lell you whaL
happened lnsLead of asklng Loo many quesLlons rlghL away 8ecause of Lhe shame gullL and oLher
emoLlons lnvolved reassure your chlld LhaL she dld Lhe rlghL Lhlng ln comlng Lo you and promlse her
LhaL you wlll help never make promlses you cannoL keep however
PealLh care professlonals documenL and descrlbe ln[urles Lo or bleedlng from Lhe vaglnal
openlng by llkenlng lL Lo a clock face 12 oclock belng Lhe anLerlor mldllne and 6 oclock Lhe posLerlor
Abraslons Lears and brulses Lo Lhe vaglna beLween 3 and 9 oclock or Lo Lhe posLerlor are more llkely
Lo be Lhe resulL of penlle peneLraLlon whereas ln[urles beLween 9 and 3 oclock or anLerlorly are more
llkely Lhe consequence of dlglLal manlpulaLlon or peneLraLlon
1here ls some conLroversy regardlng whaL Lransverse dlameLer Lo use as a guldellne for
dlfferenLlaLlng beLween glrls wlLh genlLal evldence conslsLenL wlLh peneLraLlon and Lhose wlLh no genlLal
evldence wlLh measures ranglng from 4 Lo 6 mm belng advocaLed as lndlcaLlve of sexual abuseCne
facLor LhaL may affecL flndlngs ls Lhe age of Lhe chlld wlLh Lhe expecLaLlon LhaL older glrls wlll have
larger vaglnal openlngs Peger an experL ln physlcal flndlngs relaLed Lo sexual abuse dlscounLs Lhe
lmporLance of hymenal Lransverse dlameLer noLlng LhaL lL varles ln slze dependlng on Lhe poslLlon ln
whlch Lhe chlld ls examlned lL ls also lmporLanL Lo noLe LhaL noL all glrls who have a reporLed hlsLory of
peneLraLlon evldence enlarged vaglnal openlngs Lears abraslons or brulslng
PlghprobablllLy flndlngs speclflc Lo Lhe genlLalla lnclude Lhe followlng
O semen ln Lhe vaglna of a chlld
O Lorn or mlsslng hymen
O oLher vaglnal ln[ury or scarrlng
O vaglnal openlng greaLer Lhan 3 mm
Sexual lndlcaLors
Sexual lndlcaLors vary somewhaL dependlng on Lhe chllds age 1he dlscusslon of Lhese lndlcaLors wlll be
dlvlded lnLo Lhose llkely Lo be found ln younger sexually abused chlldren (aged 10 or younger) and Lhose
llkely Lo be found ln older sexually abused chlldren (older Lhan age 10) Powever Lhls dlsLlncLlon ls
somewhaL arblLrary and wlLhln Lhese Lwo groups Lhere are chlldren aL very dlfferenL developmenLal
sLages llnally lndlcaLors LhaL are lmporLanL for chlldren of all ages are noLed
Sexual lndlcaLors lound ln ?ounger Chlldren
1hese behavlors are hlghprobablllLy lndlcaLors because Lhey represenL sexual knowledge noL ordlnarlly
possessed by young chlldren
SLaLemenLs lndlcaLlng precoclous sexual knowledge ofLen made lnadverLenLly
O A chlld observes a couple klsslng on Lelevlslon and says LhaL Lhe man ls golng Lo puL hls flnger ln
her wee wee
O A chlld commenLs ?ou know snoL comes ouL of uncle !oes dlng dong
O Sexually expllclL drawlngs (noL open Lo lnLerpreLaLlon)
O A chlld draws a plcLure of fellaLlo
Sexual lnLeracLlon wlLh oLher people
O Sexual aggresslon Loward younger or more nalve chlldren (represenLs an ldenLlflcaLlon wlLh Lhe
abuser)
O Sexual acLlvlLy wlLh peers (lndlcaLes Lhe chlld probably experlenced a degree of pleasure from
Lhe abuslve acLlvlLy)
O Sexual lnvlLaLlons or gesLures Lo older persons (suggesLs Lhe chlld expecLs and accepLs sexual
acLlvlLy as a way of relaLlng Lo adulLs)

Sexual lnLeracLlons lnvolvlng anlmals or Loys
O A chlld may be observed sucklng a dogs penls
O A chlld makes 8arble`* dolls engage ln oral sex

A PlghrobablllLy Sexual lndlcaLor for All Chlldren
llnally when chlldren reporL Lo anyone Lhey are belng or have been sexually abused Lhere ls a hlgh
probablllLy Lhey are Lelllng Lhe LruLh Cnly ln rare clrcumsLances do chlldren have any lnLeresL ln maklng
false accusaLlons lalse allegaLlons by chlldren represenL beLween 1 and 3 percenL of reporLs
64

1herefore unless Lhere ls subsLanLlal evldence LhaL Lhe sLaLemenL ls false lL should be lnLerpreLed as a
good lndlcaLlon LhaL Lhe chlld has ln facL been sexually abused
osslble hyslcal SympLoms
* regnancy
* venereal ulsease
* 1rauma Lo Lhe mouLh or genlLals
* 8ecLal bleedlng
* aln around Lhe genlLal area
* oor appeLlLe
* WelghL loss or welghL galn
?ou look aL all Lhe slgns physlcal psychologlcal and oLher warnlng slgns of abuse sLaLes ur Llalne
lerguson Mu a Chlcago pedlaLrlclan who has been ln prlvaLe pracLlce for over 20 years 1here are
normally some classlc changes ln a chllds behavlor LhaL parenLsand adulLs ln generalcan be aware of
Chlldren younger Lhan 3 Lend Lo noL arLlculaLe as older chlldren so people should pay aLLenLlon Lo a
chllds behavlor llke lf Lhey are fearful of someone or avold a cerLaln place 1hls behavlor doesnL
happen ln a vacuum Lhere ls a reason for Lhls Chlldren are very lnLelllgenL belngs
A chlld may exhlblL depresslon wlLhdrawal and sleeplng problems or make sLaLemenLs abouL Lhelr
bodles belng `dlrLy or `damaged 1hey may behave ln a sexually lnapproprlaLe way or have an exLreme
avoldance of Lhlngs of a posslble sexual naLure such as baLhlng or golng Lo Lhe baLhroom or sLrong
avoldance of sexual shows or even become sulcldal
Accordlng Lo lerguson lf you suspecL abuse Lhe mosL Lhlng ls Lo Lalk Lo Lhe chlld lLs very lmporLanL Lo
llsLen and belleve Lhe chlld and have Lhem physlcally examlned so LhaL any slgns of sexual abuse can be
documenLed lf you need Lo Lake Lhem Lo Lhe emergency room LhaL ls LoLally approprlaLe
LxperLs say lf you suspecL your chlld has been molesLed or lf he or she has conflded ln you LhaL an abuse
has occurred uC nC1 AnlC ?our reacLlon can elLher help Lhem or LraumaLlze Lhem furLher ay
aLLenLlon and leL Lhe chlld know you belleve hlm or her 8eassure your chlld and leL hlm or her know you
are glad LhaL you were Lold of Lhe abuse
lf a chlld seems afrald Lo Lell you ask hlm Lo Lell Lhe sLory Lo a sLuffed anlmal doll lmaglnary frlend or
Lape recorder as you llsLen
Whlle you are wlLh your chlld donL say anyLhlng bad abouL Lhe person who vlcLlmlzed hlm or her 1haL
person could be someone Lhe chlld really cares for and lf you show your anger your chlld mlghL feel Lhe
need Lo proLecL hlm or her by wlLhholdlng cruclal lnformaLlon
lerguson says LhaL Lhe recenL scandals lnvolvlng chlldren whlle Lraglc have helghLened awareness
abouL Lhe safeLy of chlldren And Lhls helps ln Lhe heallng process lf a chlld ls sexually abused
Chlldren are very reslllenL and when Lhey are glven rapporL Lherapy and plenLy of love Lhey can
recover from Lhe mosL horrlflc experlences ln llfe
lf you suspecL chlld molesLaLlon or abuse conLacL Lhe deparLmenL of chlldren and famlly servlces or Lhe
local auLhorlLles
8LlL88LnCLS
8reaLhlng space (2010) Abuse 8eLrleved !une 18 2011 from webslLe
hLLp//wwwbreaLhlngspacescoLlandcouk/bspace/73362hLml
uoroLhy M neddermeyer hu (2011) Slgns of Sexual Abuse 8eLrleved !une 18 2011 from webslLe
hLLp//drdoroLhylnfo/?page_ld36