Child Sexual Abuse: The Health Epidemic in Our Neighborhoods, Schools and Homes

By Stephen Messner, M.D., Medical Director and Chair, The Children's Healthcare of Atlanta Stephanie V. Blank Center for Safe and Healthy Children

One in 10 children will be a victim of sexual abuse before age 18.1 

That’s about three children in the average classroom. One child per baseball team. One child per bus stop.

Ninety percent of child sexual abuse victims know their abuser.2 Abusers can be neighbors, teachers, coaches, friends and even family membersindividuals that parents know and trust. While it’s important to teach children about “stranger danger,” the real threat is often much closer to home.

As adults, we increase the risk for children when we fail to face the reality of child sexual abuse and educate ourselves on how to keep children safe. Prevention starts with having the knowledge to recognize when abuse may be occurring, as well as the tools to prevent children from being victimized in the first place.

So, what exactly is child sexual abuse?

Child sexual abuse is any sexual contact between an adult and a child, or sexual contact between two children when one exerts power over the other.

Child sexual abuse can also include actions that don’t involve physical contact, such as exposing private parts to the child, showing the child pornography or communicating in a sexual manner with the child by phone or internet.

To minimize the opportunity for your child to be at risk for child sexual abuse, consider the following recommendations:

  • Be sure you know where your child is and how he or she is being supervised at all times.
  • Make surprise visits to your child’s daycare center, classroom, sports practice or church group. Watch for odd behaviors or anything that does not feel right to you.
  • Be aware of your child’s internet use. Understand who your child is communicating with and what social networks he or she is using.
  • Be alert to what we call “grooming behavior” in which an adult or older adolescent repeatedly seeks access to your child in one-on-one situations, frequently gives gifts to your child, kisses/hugs your child inappropriately, etc.
  • When possible, limit one-on-one situations between an adult and a child or two children.

Prevention starts with having the knowledge to recognize when abuse may be occurring, as well as the tools to prevent children from being victimized in the first place.

Recognizing child sexual abuse
Take note of potential warning signs:

  • Physical signs that could directly indicate trauma such as sexually transmitted infections, bruising, bleeding, and redness around the genital area. Keep in mind that in many cases there are no visible signs of abuse.
  • Physical issues that have no medical cause and could be associated with anxiety such as chronic stomach pain or headaches.
  • Emotional or behavioral signals including withdrawal from people or activities the child once cared about, fear of people, places, or things, depression, unexplained anger and rebellion, “too perfect” behavior, and other behaviors a child has previously outgrown such as bedwetting.
  • Sexual behavior or language that is not age-appropriate.

Responding to child sexual abuse
If a child considers you an adult they trust, he or she may disclose to you that they are being sexually abused. How you respond to their disclosure is extremely important.

  • Stay calm and do not act visibly upset or shaken.
    • If your physical or verbal response is escalated because you are upset, a child may be afraid that he or she has upset you.
  • Do not ask leading questions.
    • Stay away from “yes” or “no” questions. It is important to let the child use their own words to describe what happened.
  • Tell the child that you believe him or her.
    • Encourage the child and let them know that what has happened to them is not their fault.

Share this information with family and friends and talk about what you’ve learned. By being an example for others, you may empower other adults to take the needed steps to protect the children in their lives.

If you suspect a child you know is being sexually abused in Georgia, contact the Division of Family and Children’s Services at 1-855-GA-CHILD. The hotline can be accessed 24 hours a day, 7 days a week. In addition, you should also contact law enforcement in your county to file a report. To learn more about recognizing and preventing child abuse from the training team at the Center for Safe and Healthy Children, visit

For national resources and crisis intervention, call the National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). To find a local child advocacy clinic in your state, visit


  1. Townsend, C., & Rheingold, A.A., (2013). Estimating a child sexual abuse prevalence rate for practitioners: studies. Charleston, S.C., Darkness to Light. Retrieved from
  2. Finkelhor, D. (2012). Characteristics of crimes against juveniles. Durham, NH: Crimes against Children Research Center.