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Injuries Indicative of Abuse
the child’s innermost thoughts and/or subjective emotional feelings. Some of the reactions to sexual
abuse can be similar across age groups, while other reactions may be more common in younger or in
older children. In general, it may be difficult to differentiate children who have been sexually abused
from children who have experienced other kinds of stressful experiences. It is important to remember that
research in the area of child maltreatment suggests that many abused children do not exhibit any obvious
reactions to sexual abuse. Therefore, if a child is not exhibiting concerning behaviors, but you have
reason to suspect sexual abuse (for instance, if the child has been exposed to a known sexual offender), it
is strongly recommended that you consult a professional with expertise in the area of child maltreatment
for guidance.
The following list includes general signs and symptoms that may sometimes be observed in sexually
abused children. When reviewing this list, it is very important to remember that fears and behavioral
difficulties are commonly associated with normal child development. Many of the following are
concerning only when behavioral changes are extreme or occur suddenly. If you have concerns, it is
often helpful to consult a professional with expertise in this area.
Sexualized Behaviors
While there is no one symptom which is diagnostic of sexual abuse, with the exception of pregnancy or a
sexually transmitted disease in a non-sexually active child or adolescent, the literature indicates that the
symptoms most commonly associated with sexual abuse are sexualized behaviors, particularly trying to
engage other children in sexual behaviors, and indicators of age-inappropriate sexual knowledge.
However, it is extremely important to understand that many children who have been sexually abused do
not exhibit sexualized behaviors. It is equally important to understand that children who have never been
sexually abused may exhibit sexual behaviors.(4)
Risk Factors for Sexualized Behaviors
As a general comment, it is important to note that there are numerous factors that may be associated with
age-inappropriate acting out sexually. The following life circumstances are thought to increase the risk of
children engaging in inappropriate sexual behaviors:
Sexual abuse
Exposure to individuals (adults, adolescents or other children) known to have
committed prior sexual offenses
Living in a highly sexualized/over-stimulating atmosphere where personal boundaries
are lacking
Exposure to adult/adolescent sexual intimacy
Exposure to sexually explicit materials including printed materials, videotapes, or
pornography
Living with needy adults who may turn to children to meet their emotional needs or
unmet needs for affection
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