Childhood sexual abuse: identification and management


What is it about ?

We speak of child sexual abuse when a child is involved in sexual activities that he does not fully understand, that he does not want or to which he does not agree (he does not consent ). Belgian law considers sexual relations with people under the age of 16 as sexual abuse. Below this age, a child is considered incapable of giving consent for sexual activities.

Children can be sexually assaulted by adults, but also by other children who, given their age or stage of development, are in a position of power or trust in relation to the victim.

The law distinguishes between two forms of sexual abuse: rape and indecent assault. In case of rape, there is always penetration with the penis, the finger or any other object. It can be vaginal, anal, or oral. In indecent assault, there are unwanted sexual acts but there is no penetration, for example, sexual harassment, unwanted contact in intimate places, showing genitals or intercourse sexual to the child. Viewing porn or taking sexually oriented photos or videos is also a form of sexual abuse.

Children who are sexually abused are often also victims of another form of violence. For example, the perpetrator may use emotional blackmail or resort to physical violence to silence the child.

What is its frequency?

Child abuse is much more common than you might think. In 2016, 7,080 reports of neglect or abuse were reported to the Trust Center for Abused Children, the Flemish equivalent of SOS Children. This represents 20 reports per day.

The figure for child sexual abuse varies greatly from country to country. This is cultural, but the definition of child sexual abuse also varies from country to country.

How to recognize it?

Sexual abuse is not always easy to recognize. Some children do their best to act normally and hide the abuse out of fear or shame. You may suspect sexual abuse if:

  • the child himself tells about sexual abuse;
  • the child shows physical signs;
  • the child’s behavior has changed;
  • a medical examination shows lesions for which there is no good explanation;
  • pedophile activities are discovered in the environment, and the child could be a victim.

Children who are sexually abused often behave differently from other children their age. They may engage in adult sexual behavior, such as dressing seductively or behaving in a provocative manner. We can also often observe a knowledge of sexuality that does not correspond to age. Many children who are sexually abused are increasingly lonely and anxious and avoid physical contact. Some people get aggressive and hit the wall because they have no one to talk to about their problem. Younger children sometimes return to previous behaviors: they start sucking their thumbs or wetting the bed again. Sleep disturbances and nightmares are also a common problem. Older children can develop eating disorders or exhibit risky behaviors, such as alcohol or drug use.

Sexual abuse can lead to feelings of depression and depression in many children over time. Dark thoughts and suicide attempts can occur.

In addition to changes in the child’s behavior, there are physical signs that suggest sexual abuse:

  • bruises (bruises), scratches or wounds in unusual places (on the inside of the thighs for example);
  • the child has pain in the genitals;
  • injury, bruising, or a strange discharge from the genitals.

If children or teenage girls are pregnant or develop a sexually transmitted disease, you should always consider the possibility of abuse.

What can you do ?

If you suspect a child is being sexually abused, try to discuss it. Talk to a doctor, friend, partner or coworker and ask if he has noticed anything. You can also call 103 (Listening Children) or ask SOS Children for advice. They help you to manage the situation well and possibly to already take steps yourself.

Try to talk to the child yourself, but without exerting pressure. Some children do not dare to say anything out of fear or because they no longer trust adults. Show your concern. This can be a first opportunity to let people know that something is wrong. Since it is not easy to start this kind of conversation, there are several websites that provide step-by-step instruction on how you can do it and steer the conversation in the right direction.

If a child tells you that he or she is being sexually abused, don’t promise to keep it a secret. The child would have even less confidence in adults. Good management of child abuse requires consultation with others.

Explain to the child that it is necessary to go to the doctor to see and treat injuries and to take samples, which can lead to a conviction of the perpetrator (s).

It is preferable to file a complaint with SOS-Enfants or at the free number 103. They open a file and examine the case.
Listening to child victims of sexual abuse can be very challenging. Talk to your doctor, your partner, your friends or colleagues. Sometimes it can be helpful to talk to a therapist or psychologist, or to go to a support group.

What can the doctor do?

The care of a sexually abused child must take place in several stages:

  • a conversation about the facts;
  • a physical examination with a finding of possible injuries and taking samples;
  • a psychic assessment;
  • if necessary, recourse to the competent authorities.

Childhood sexual abuse is a serious crime that must be dealt with with the necessary expertise. This is the reason why we often ask for the help of a specialist, for example a pediatrician, a psychologist or a psychiatrist, support by ONE …

Sexual abuse can have a big impact on the child. The doctor will therefore always try to start a conversation first in order to establish a relationship of trust. He will carefully write down the child’s history and complaints.

If the abuse took place less than 24 hours ago, the doctor will refer the child to an emergency department with a Sexual Assault Set (SAS). There, a clinical examination is carried out and samples are taken which may lead to a conviction of the authors. These can be bodily fluids such as semen, saliva and hair that can be searched for DNA, but also, for example, fibers from clothing worn by the perpetrator.

Up to 2 weeks after the abuse, an experienced expert can find and document signs of abuse. In this case, an appointment is made with a doctor experienced in recognizing the symptoms of sexual abuse.

In the event of (suspected) child abuse, a doctor has the right to report it to SOS-Enfants, even if the parents do not agree.

The doctor will prepare a file and will collaborate within a multidisciplinary team to support the child as well as possible. In this team, there is always a psychologist or psychiatrist responsible for psychological support.

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Source

Foreign clinical practice guide ‘Identification and management of child sexual abuse’ (2000), updated on 18.10.2016 and adapted to the Belgian context on 11.01.2020 – ebpracticenet