Recognition of Sexual Abuse in Children

Abstract

Although sexual abuse of children has likely been present for ages, its recognition in the United States and other countries has dramatically increased in the past 5 years. Reported cases, which represent an unknown fraction of actual cases, now account for approximately 25% of all abuse and neglect reports. Local, county, and state agencies are staggering under the load, and many are relying heavily on pediatricians to assist them in their work. DEFINITION Sexual abuse can be defined as the engaging of a child in sexual activites that the child does not understand, to which the child cannot give informed consent, or which violate the social taboos of society. This definition is broad and includes intrafamilial and extrafamilial forms and all types of sexual activities (eg, exhibitionism, fondling, child pornography, oral, anal, and genital sexual contact). The interface between "normal sexual exploratory behavior" and "sexual abuse" is not clearly defined. Pediatricians should, however, use common sense. If two 4-year-old children are found to be playing without clothes, touching each others' genitals and giggling, there is probably little to worry about. The same is true if two 15-year-old adolescents are discovered together. A probably exists if the 15-year-old child (some states set statutory 2- to 4-year limits within which sexual activities are not to be considered abuse) or if one 4-year-old child is engaging in fellatio or attempting intercourse with another preschool-aged child.