Nine suggestions to prevent sexual abuse among children

Pediatricians know that when they discuss seat belt, bicycle and water safety during annual wellness visits they are helping to reduce a child's risk of harm. Those same visits should include messages about personal space and privacy, says Dr. Martin A. Finkel, an internationally known expert in the prevention and treatment of child sexual abuse, and he is urging pediatricians to begin a dialogue that will help children avoid the physical and mental health consequences of sexual abuse.

"Our failure to incorporate these messages is not because we are unaware of the issue of child sexual abuse, but perhaps because we find the topic unpalatable or don't have the language to address it," said Finkel, medical director and co-founder of the Child Abuse Research and Education Services (CARES) Institute at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine. "It's well overdue that pediatricians add this issue to their prevention repertoire."

In a letter distributed to members of the New Jersey chapter of the American Academy of Pediatrics (AAP/NJ), Dr. Finkel highlights the urgent need for this approach. He notes that one in four girls and one in seven boys become victims of child sexual abuse, that 40 percent of the victims are younger than six, and that a perpetrator is most likely to be a family member or someone with easy access to the child.

In his letter to fellow pediatricians, Dr. Finkel offers a list of nine suggestions that includes specific language they can use to deliver and reinforce these messages with children. Among his suggestions:

•Begin talking to parents about delivering personal space and privacy information by the time a child is three years of age.
•Encourage parents to teach their children the correct names for their private parts so the children have the language to communicate abuse.
•Introduce the concept of "OK and Not OK" touching as opposed to "good touch - bad touch" which can be confusing to children.
•Provide parents with guidance about language they should use and appropriate times for reinforcing messages of personal space and privacy.
•Emphasize to children that it is never OK to have a secret.

"Many children never disclose - or significantly delay reporting abuse - out of embarrassment, fear of consequences, or because they think they won't be believed," Dr. Finkel said. "Is there proof that one single message can be the 'magic bullet' that prevents child sexual victimization? No, but we need to begin building a dialogue that helps children protect themselves, because children who are armed with information about personal safety are much more likely to develop protective behaviors and to disclose abuse."

More than 60 percent of pediatricians who responded to a recent pilot survey conducted by AAP/NJ selected "lack of specific language/approach" when asked to identify the factors that made them hesitant to provide guidance regarding personal space and privacy. The survey was done in collaboration with the New Jersey Partnership to Prevent Child Sexual Abuse and with Prevent Child Abuse New Jersey.

"We know that we can't just tell kids one time to wear their seatbelts and expect that we have successfully addressed car safety," he said. "In the same way, we need to deliver messages about personal space and privacy - beginning in early childhood - and repeat them over and over again. Kids who learn these messages won't be invulnerable to inappropriate touching, but they may be more likely to recognize it as inappropriate and may disclose sooner rather than later."