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My cousin was sexually abused. How can I protect my kids?

The question: I recently found out that my cousin had been sexually abused as a youngster – by someone close to the family. Apparently, his parents had no idea. Now I'm sick to death that something similar might happen to my kids. Are there warning signs that I should be looking for to tip me off if something's wrong? What can I do to prevent it from happening without scaring them into thinking it will happen?

The answer: Not many things are more terrifying for a parent than the thought that their child might be the victim of sexual abuse. We know that the long-term effects of abuse can be horrific. As parents we need to try to walk the fine line between ensuring our children are safe without becoming totally paranoid. Your cousin's story would be quite typical in that the abuser is often well known to the child. It is important to remember that sexual abuse doesn't always involve physical contact. Indecent exposure, lewd behaviour and exposing children to inappropriate sexual imagery are all examples of abuse.

Your cousin's parents can be forgiven for being unsuspecting, as symptoms can be subtle or even non-existent. Signs that a child may be experiencing sexual abuse can include being excessively fearful, overly anxious or unusually withdrawn. Some children can become aggressive. At times there can be a change in appetite (increased or decreased) or a disruption of sleeping habits.

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Of course, these are symptoms that occur commonly in all children, so parents need to rely on their gut instinct to know when something potentially harmful is upsetting their child. Some children may try to avoid spending time with the abuser. Physical signs of abuse are uncommon but should prompt immediate medical attention. Such signs include bruising, bleeding or discharge from the genital region. Pain and redness in the genital region should also be investigated. One should be concerned about any young child whose play activities include inappropriate sexual language or behaviour. If in doubt, suspicious symptoms or behaviours should always be reported to your physician, local child protection agency or the police.

Children can be introduced to the concept of "good touch" and "bad touch" from an early age. Usually this concept can be taught by parents without causing undue alarm. Answer any questions your child might have honestly and try to use language that is appropriate to their developmental level. I admire your cousin's courage in disclosing his abuse. Hopefully he has been offered treatment and support.

Send pediatrician Michael Dickinson your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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