Children who have actually been abused will often recant their initial statement because they are afraid of their abuser or because their abuser convinces them that this is "their little secret." Several clues are associated with sexual abuse (but many children give no clues except what they say):

• Genital infections, redness, or discharge
• Burning with urination
• Urinary tract infection
• The new onset of either bed-wetting or stool problems
• Sudden increased sexuality with peers, animals, or objects
• Seductive behavior
• Age-inappropriate sexual knowledge
• Regression
• Other dramatic behavior changes

In most cases of sexual abuse, there are no injuries noted on physical exam. Thus, the history provided by the child is often key to finding out what happened (Pediatrics 2005;116;506-512).

Hopefully, nothing significant happened to your child, but if you’re really concerned, do not let the situation go uninvestigated. Whatever turns out to have happened, remember that we must prepare our children to protect themselves against sexual abuse. Begin by teaching them the proper names and significance of their private parts as soon as they are able to understand (about age 3). Then they will be ready to understand the three key messages:

1. Say no if somebody tries to touch your nipples, rectum, or genitals.
2. Tell a trusted adult if someone tries to touch you.
3. Don't keep secrets. If somebody tells you to keep a secret, let your parents know right away.

Alan Greene MD FAAP

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Khanh-Van Le-Bucklin M.D. & Rebecca Hicks M.D.

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