This summary guide lists some common impacts of sexual abuse on children’s physical health, and explains what any practitioner working with a child who has been, or may have been, sexually abused, can say and do to support the child.
It is vital that all practitioners think about the child’s physical health and wellbeing, especially if statutory agencies are not currently involved in the child’s life. Even if those agencies are involved, do not assume that the child’s physical wellbeing is someone else’s responsibility.
How might the child’s physical health and wellbeing be affected by the abuse?
If a child is being or has been sexually abused, the impact of the abuse may be show up in one or more of the following ways:
- tiredness and exhaustion
- nightmares
- sleep disturbances
- disordered eating
- panic attacks
- hyperactivity/hypervigilance
- changes in toileting (e.g. soiling, bedwetting)
- intensified symptoms related to chronic conditions such as asthma
- new or worsening eczema or other skin conditions
- ‘dizzy spells’
- non-specific symptoms such as headache or stomach ache
- signs of self-harm.
If physical contact has occurred, there may be physical signs such as:
- genital injuries
- infection (which may present as genital discharge, skin rashes, or sore throat; however, many infections are asymptomatic)
- pregnancy in post-pubescent girls.
Be aware that the child may not tell you if they experience any of the above symptoms; it is important for you to be alert to those symptoms, and to act if you observe them.
Advice can be sought from your local sexual assault referral centre (SARC) or paediatric child sexual abuse specialist.
“Maybe if someone [had asked about tiredness], then I would have … maybe opened up to them about it, but … I was scared about telling people about it because … I always thought I was in trouble. I thought I did something wrong, because I was treated like I’d done something wrong and it was my fault.”
“I overused alcohol and I had eating disorders, which I still have difficulty with … my understanding of the way my body has seized up is very much related to the fact that I was holding something down that I didn’t ‒ couldn’t put a name to.”
For the sources of the quotations above, please download our full guide to this aspect of the Response Pathway.
How can you best help the child?
Supporting the child’s physical health and wellbeing can help to address the above issues, and to mitigate further potential impacts of the abuse in the future – but note that the child may not connect physical health concerns with their abuse.
By starting a conversation with the child about any health worries or symptoms they have, or encouraging their non-abusing parent(s) to do so, you may enable them to talk more about their experiences – and help them to see any link with the abuse they have experienced. Many children feel they can’t talk to anyone about their abuse because no one actually asks them about it. Part A of our Communicating with Children Guide contains more information.
- Use language appropriate to the child’s age, education, understanding, cultural background, sex, and any disability or specific needs when discussing bodies and physical health.
- Be responsive and encouraging to build trust, recognising that the child may need time before they feel able to share any concerns.
- Share age- and needs-appropriate health resources, such as leaflets or weblinks, with the child.
- Provide specific support and tools for children with communication needs to help them express any physical symptoms.
The full practice guide for this aspect of the Response Pathway contains much more detail, and provides links to a wide range of organisations and resources which can help you support the child’s emotional health and wellbeing.
- If a child has disclosed physical health problems or you have concerns, help them see a doctor (by arranging a GP appointment or encouraging their parent(s) to do so).
- If children’s social care or the police have been contacted about sexual abuse concerns, the child may be offered a paediatric medical assessment/examination; if they are not, consider requesting one, even if the sexual abuse is not recent. See our video for information about what a medical assessment involves.
- Seek advice from a specialist child sexual abuse health provider, such as a sexual assault referral centre (SARC). SARCs have trained NHS doctors, nurses and support workers who offer medical, practical and emotional support for children, whether or not a medical assessment is conducted.
- Discussing the child’s health with a SARC specialist may help you better understand their situation.
- If you have concerns about the child’s welfare or safety based on their physical health, contact children’s social care. whether or not they have been involved previously with the child. Before making a referral or re-referral, gather all relevant information (using the Signs and Indicators Template to identify and record possible signs of sexual abuse), and consider input from other agencies – but do not delay if you are concerned.
The child’s non-abusing parent(s) are vital to the child’s support system:
- They may provide valuable insight into the child’s health needs.
- The parent(s) may have their own health and support needs that also require attention.
Our Supporting Parents and Carers Guide contains detailed advice on working with the non-abusing parent(s).