Mayerson Center for Safe and Healthy Children

Frequently Asked Questions

Normal play activity − such as holding babies in the air and jiggling them − will not cause the brain injuries known as shaken baby syndrome. It takes more forceful shakes.

If you have a fussy baby who has been fed and has a clean diaper, attempt to soothe her with talking, singing, rocking, walking or car rides. Sometimes, nothing helps. If the crying continues, and you’ve tried everything to help, you may simply need to put the baby in her crib and let her cry until she stops or goes to sleep. If you feel yourself losing control, put your baby down and ask a friend, relative or neighbor for help.

Parents should discuss the dangers of shaking with all of the baby’s caregivers, including spouses, significant others, grandparents, siblings, baby sitters and day care providers.

As soon as the child has verbal skills, start talking about private parts and proper and improper touching. Teach children that it’s OK to say “NO!” even to an adult. Teach assertive ways to say no confidently, both verbally and non-verbally, such as standing up straight and using a serious tone of voice.

Try asking the child questions to help prepare for potential situations, such as:

• What do you do if someone tries to touch you in a way that makes you uncomfortable?
• What if someone you know pretends to touch you by accident?
• What if you are playing outside and a stranger asks you to help find a lost dog or take a ride in a car?
• What if someone tells you they will give you money to go with them and can keep a secret?
• What if you were in bed at night and someone in your house came into your room and touched your private parts, saying you should never tell?

Also talk to children about how to get away if someone doesn’t stop when they say no. Teach them they can yell, fight or make a scene to get away from danger.

Reassure children that they can always tell you things they’ve done or things that have happened to them and that you will always love them no matter what. Teach your children that sometimes abuse occurs even if you try to stop it, and it isn’t their fault. And tell them that no one should ever ask them to keep a secret about touching from their parents or caregivers.

Most straddle injuries do not result in injury to the hymen.

Ordinary, every-day people. Your neighbors. Your extended family. People you might never suspect.

Sexual abuse is almost always done by someone known to the child. Physical abuse is almost always committed by a family member or a surrogate parent.

People under stress, who are frustrated or angry, are more likely to lash out at children. In the case of babies who are shaken, the abuser sometimes doesn’t understand the damage that can be done.

Many are, but not all. Studies estimate 30 percent to 60 percent of abusers were themselves abused. But abuse is only part of the story. Adults who abuse children physically may not have been abused themselves, but they likely had little nurturing or had poor role models. Such a history may spawn adults with poor self-images and poor parenting skills. These are ingredients in the makeup of an abuser. None of these factors excuses the abuse, but it may hold the key to helping the abuser.

Please call the police or child welfare agency in the jurisdiction where you live. Talk about your concerns, and someone may be able to help you clarify what may be happening.

All children who are physically active get bumps and bruises, which in themselves are not evidence of child abuse.

Physicians look for a plausible history to explain bruises and a pattern of bruises consistent with a child’s normal activity. Infants, because they don’t walk and are not very active, are not prone to bruising. Toddlers, however, typically have bruises on their shins and foreheads from running and falling into things − but they don’t normally have bruises in protected areas like the inside thigh. The severity and the number of bruises are other factors physicians observe.

If a child truly does bruise more easily than normal, that could be a sign of a serious problem that requires medical attention. Clotting disorders and some connective tissue diseases are among the conditions that may cause a child to bruise easily.

When a child masturbates in public places and doesn’t respond to limits placed on the behavior by caregivers − that may be a sign that the child is doing it as a way to contain anxiety over abuse. Ordinarily, parents or caregivers can place limits on the behavior by explaining to the child that masturbation should be private.

Pay attention to what your child is saying and doing and the kinds of fears he or she expresses. If your child acts in a different manner after returning from an overnight trip, ask if everything is OK.

Major behavior changes also can signify abuse. These may include:

• New fears of people or places
• Withdrawal
• Sexual play beyond what might be considered normal for the child’s age
• Fear that something is wrong with the genital area
• Regression or baby-like behavior
• Sleep disturbances or nightmares

The most important thing is to have a strong enough relationship with your children that they will tell you about problems.

Rarely. Most stories about abuse that never occurred come from adults. Very young children, in particular, are unlikely to make up stories, because they haven’t had any experiences that would allow them to fabricate them. A skilled interviewer experienced with child sexual abuse should be brought in to talk with the child immediately upon a report being made.

This is a concern often in the back of parents’ minds, because they’ve heard stories of how child abuse is frequently seen in the emergency room. When doctors and nurses start asking parents about the specifics of how an injury occurred,, parents sometimes feel they’re being interrogated.

Parents should keep in mind that physicians and nurses need to be looking for child abuse, because they’ll miss opportunities to protect children if they don’t. They also need to have a thorough understanding of how injuries occur in order to provide the best care. Parents who bring their children in for accidental injuries should not hesitate to answer questions and shouldn’t feel they’re being singled out.

Genital warts and herpes are conditions that are frequently sexually transmitted, but sexual contact is only one of the ways children can get these infections. Both conditions can also be spread through non-sexual touching. Your child may have a wart or herpes infection elsewhere on her body and spread the infection to the genitalia or rectum.

When children are diagnosed with an infection that can be transmitted sexually, a parent and physician should investigate for possible sexual abuse. A physician or social worker will likely interview your child to see if he provides a history of abuse and perform an examination and tests to see if he has any other physical indications of sexual abuse, such as the presence of other sexually transmitted diseases or physical injuries.

Barring other indications, physicians at Cincinnati Children’s do not report children as possible victims of abuse to child welfare or law enforcement agencies simply on the basis of genital or rectal warts or herpes.

In many cases, even when vaginal penetration has occurred, a medical examination will not detect it. 

The idea that a girl’s hymen is always broken if penetration occurs is a myth. Prior to puberty, a girl’s vaginal opening is quite small. Her hymen is tissue that partially covers the vaginal opening. Penetration beyond the hymen and into the vagina may cause damage that a physician will observe. Contact around and to the hymen, however, may cause pain to the child without producing noticeable injury. The child may describe this degree of contact as penetration, and in some states it constitutes legal penetration. After the onset of puberty, the opening of the vagina becomes enlarged. Penetration beyond the hymen then may occur more often without any tearing or signs of injury to the hymen.

It depends on what happened. If the child has been fondled or penetrated with a finger, there is virtually no risk. If the abuse involved oral sex, infection is possible but very unlikely. If the abuse involved genital-to-genital contact, the risk is greater but still rare. The risk is greater in parts of the country, such as major metropolitan areas, where HIV infection is widespread. Likewise, a child is at increased risk for other sexually transmitted disease from genital-to-genital or oral-genital contact.

Sometimes. In most cases, even when a perpetrator confesses, the physical examination of the child reveals no physical evidence of abuse. If vaginal penetration occurred, great force was used or the abuse was repetitive, it is more likely that physical evidence will be present.

Sedation may be offered if the examination must be completed and your daughter is overly upset. Before sedation is considered, the physician, nurse or social worker will explain the examination to your daughter and attempt to reassure her. If the examination can be deferred, her examination will be rescheduled for a time when she may be more emotionally able to consent to the examination.

The examination is not physically painful. It mainly involves visual examination with minimal physical contact. Unlike adult pelvic examinations, an internal examination is usually not required in young children.

Oral contact, digital fondling, genital rubbing, vaginal penetration after puberty, rectal penetration, partial or attempted vaginal penetration, and penetration that has had time to heal.

The examiner usually cannot determine the number of episodes that occurred. If evidence of chronic anal abuse is present, multiple episodes of abuse occurred. Vaginal injuries do not reliably differentiate between single episodes of abuse and multiple episodes.

If the injuries are acute (redness, swelling, tenderness, fresh abrasions or tears), the examiner may reliably identify the injury as relatively recent, most likely having occurred within a few days of the examination. Dating injuries within hours or to specific days is usually not possible.

Examination findings may differ when:

• Acute injuries heal between examinations
• One of the examinations was not optimal because the child was uncooperative
• The skill levels of the examiners differ (Examiners with expert training will provide a more accurate and informative examination.)

The child welfare agency and the police are required to do an investigation and assessment within a given time frame, with response times that range from hours to days depending on the severity of the case.

In most cases, no. Only a small minority of cases go to trial. Child abuse cases frequently are plea bargained, which means the child won’t need to testify in court, though he or she may still be interviewed by police, prosecutors and attorneys. When children are needed for testimony, many communities have victim advocate programs that help them through the process and relieve stress. Sometimes, adults may be permitted to testify to what children have said regarding an incident, or videotaped testimony or depositions may be permitted.

Yes − and they need access to it immediately.

Victims of abuse are likely to experience a variety of challenges, from feelings of sadness or anger to acting nervous or scared.  They may have difficulty sleeping or may even have changes in behavior, with increased outbursts or tantrums.  With these changes and struggles, normal parental support and care may not be enough to help the child improve feelings or behaviors.  

There are now evidence-based treatments for children and their families that have been scientifically proven to reduce the negative feelings and behaviors that can occur in victims of abuse.  These interventions focus on making the child feel safe, control his response to stressful memories or situations and increase the communication between child and parent.  At the same time, parents are given additional tools to meet the new emotional and behavioral needs of their child.

After an episode of abuse, some children may appear “normal.”  We know that some of these “normal”-looking children will develop problems with their emotions, behaviors or sleep several weeks to months after a traumatic event.  Children who have experienced abuse benefit from talking to someone where they can express their feelings about the event, receive praise for being so brave to tell others about the abuse, and learn safety skills that can reduce the risk of abuse in the future.   

Children of all ages who are victims of abuse can benefit from treatment.  Some children benefit after just a couple of sessions and other children with more severe emotional and behavioral challenges may require a longer amount of time before they feel normal again.  After the initial visit, a treatment plan created by you and the abuse specialist will estimate the amount of time and type of intervention required to meets the specific needs of your child.

For further information on the common emotional and behavioral struggles of victims as well as treatments designed for abused children, visit the National Child Traumatic Stress Network.

With proper support from parents and caregivers and professional counseling, it is possible for children to get over sexual or physical abuse and live normal, healthy lives. Children who have the best prognosis are those who have good relationships with parents and receive professional counseling. It also helps for children to receive counseling “booster shots.” This can help children deal mentally and emotionally with the abuse at various stages of development.

Yes, at least in some cases. But it’s by no means easy. Overcoming perpetrators’ denial and helping them learn empathy toward their victims are key issues for counseling. Counseling is more likely to succeed with perpetrators of physical abuse than sexual abuse. Sexual abuse often goes on a long time, becomes a pattern, and coexists with other issues, such as domestic violence, poverty or mental illness. The psychological problems that lead to someone committing sexual abuse are complex and difficult to overcome.