This guide is for anyone working with a child who has been, or may have been, sexually abused.
It is vital that anyone working with children thinks about the child’s physical health and wellbeing, especially if statutory agencies are not involved in the child’s life (because they have declined to pursue a referral or have closed the child’s case). 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.
- Hyperactivity/hypervigilance.
- Change 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 stomachache.
- Signs of self-harm.
Professionals should be aware of physical or psychological symptoms:
- If physical contact has occurred there may be physical signs:
- Genital injuries.
- Infection (which may present as genital discharge, skin rashes, or sore throat; however, many infections are asymptomatic).
- Pregnancy in post-pubescent girls.
- Common psychological reactions include:
- Panic attacks.
- Disordered eating.
- Nightmares.
- Sleep disturbances.
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.”
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 contain more information.
- Use language that matches 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 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.
See Supporting resources and links below for more information.
- If a child has disclosed physical health problems or you have concerns, help them see a doctor (e.g., arrange a GP appointment or encourage 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 examination (forensic medical assessment); if not, consider requesting one.
- Refer to the CSA Centre video and practice guide for information about medical examinations.
- 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 forensic medical examination is conducted; find your nearest SARC on the NHS website.
- Discussing the child’s health with a SARC specialist may help you better understand their situation.
- If you have heightened concerns about the child’s welfare or safety, contact children’s social care.
- Before making a referral or re-referral to children’s social care based on physical health concerns, gather all relevant information (use the Signs and indicators template to identify and record signs of sexual abuse), and consider input from other agencies or a professionals meeting—but do not delay if you are concerned.
Non-abusing parent(s) are vital to the child’s support system:
- They may provide valuable insight into the child’s health needs.
- Parent(s) may have their own health and support needs that also require attention.
- Further guidance is available in the Supporting parents and carers guide.