Guide for Medical Professionals

  • One in four girls and one in seven boys are sexually molested before the age of 18.
  • The emotional and physical effects are devastating and are often long-term.
  • Approximately one third of adult women in your practice have been sexually abused at some time in their lives.
  • 90% of sexually abused children are victimized by someone they know.
  • Juveniles commit 43% of sexual abuse against
    children under six.
  • 15% of North Dakota teens report having been
    sexually abused.

Our society pays a high price for the tragedy of child abuse. Billions of dollars are spent on medical and mental health treatment, social services, education and lost productivity. Child abuse victims are also more likely to be in abusive relationships.

The ND Alliance for Children’s Justice is providing this guide for medical professionals so you can better understand the complex problems associated with child sexual abuse.

The Alliance is a multi-disciplinary task force of North Dakota professionals and parents whose vision is that all adults will feel equal responsibility for the care and protection of all children. The final goal being that no child in this state will experience any form of child sexual abuse...ever.

This publication highlights some important information about child sexual abuse and how medical professionals can play a crucial role in helping to prevent it. Please refer to the website for additional information and resources.

What is Child Sexual Abuse?

Child sexual abuse is sexual activity perpetrated on a child by an adult, an adolescent, or an older child. Sexual abuse can be categorized as non-touching or touching offenses. Remember, sexual abuse is NEVER the child’s fault.


  • Indecent exposure
  • Frank discussions about sexual acts designed to shock the child or arouse a child’s interest
  • Behaviors such as voyeurism, exposure to sexual materials or letting a child hear or watch sexual acts


  • Fondling or any kind of inappropriate touching
  • Rape or attempted rape
  • Using a child to create pornography

What to Look For—Signs of Abuse

Children will rarely report they are being sexually molested. Medical professionals, staff and volunteers should be informed about certain behaviors associated with child sexual abuse.

  • Sexualized behavior, see Understanding Children’s Sexual Behavior, by Toni Cavanaugh Johnson
  • Hostile or aggressive behavior
  • Fearful, withdrawn, self-destructive behavior
  • Abuses alcohol/drugs
  • Mature beyond chronological age
  • Eating disorders
  • Running away from home

In addition to the above indicators, there are additional long-term consequences of having been sexually abused as a child.

  • Post-traumatic stress
  • Low self-esteem/eating disorders
  • Depression/Bipolar/Anxiety
  • Criminal behavior/Truancy
  • Suicide

There are also a number of medical complications that may be experienced by the child and/or adult abused as a child.

  • Premenstrual Distress, vaginal infections, PID and excessive menstrual bleeding
  • Chronic recurrent pain, itching, swelling of genitals
  • Chronic pelvic pain and hysterectomy before age 30
  • Recurring complaints of gastrointestinal pain/problems and pelvic pain.
  • Trauma to breasts, buttocks, lower abdomen, genital and rectal areas
  • Fibromyalgia and chronic headaches


A woman in your practice tells the nurse that she is concerned about a rather dramatic behavior change in her five-year-old daughter. The little girl was always outgoing and happy, but over the past few months, has become withdrawn and secretive. When asked if she would like to tell her mother anything, tears welled and she fearfully said, “No.” The previous day she had touched her older brother’s genital area and used a sexual term which she would not have been expected to know or understand.

The doctor, realizing that the behavior pattern of the child strongly suggested child sexual abuse, encouraged the mother to give assurance to the daughter that whatever she told her mother would be believed. The mother needed to know what occurred in order to help her, even if she had been told to keep it a secret. After further discussion the child did divulge, in her own child’s language, that her father was molesting her. The mother contacted her daughter's physician to disclose the information. The doctor then reported to the appropriate social service agency.

  • Develop a child protection policy and protocol, which includes screening and background checks for staff and volunteers who work with children.
  • Provide child sexual abuse prevention education to staff and volunteers.
  • Invite a local expert to inform staff about their role in preventing all forms of child maltreatment.
  • Attend training seminars/conferences to stay well informed about child welfare issues.
  • Listen to and believe children.
  • Report suspected child abuse to appropriate county social service agencies.


Reporting suspected child abuse is required of medical professionals, under North Dakota law. Emphasis is placed on reporting suspected abuse. The reporting person need not have positive proof, but may merely suspect maltreatment of a child. To file a report, contact the county social service office in the county where you reside.

All medical professionals are not expected to be experts in the area of child sexual abuse. These cases are often difficult to evaluate; however, North Dakota does have physicians who are specially trained and who are experts. There is always the possibility that one may need to defend the evaluation in court. These cases are time consuming but are necessary to ensure the child’s well-being.

The State of North Dakota has two Child Advocacy Centers who have multidisciplinary teams that are experts in child sexual abuse. These centers are available for consultation and can do the evaluation and/or physical examination once a referral is made.


  • Child sexual abuse happens to children from all walks of life.
  • Sexual abuse can affect people for the rest of their lives and have long-term medical consequences.
  • Attentive and loving supervision of children prevents emotional vulnerability. Vulnerable children are more susceptible to the attentions of abusers.
  • Awareness is the first step in the prevention of child abuse.

If every adult takes responsibility for the care and protection of children, we can make North Dakota free of child sexual abuse.


Children’s Advocacy Center
Medcenter One
300 North 7th Street
Bismarck, ND 58502
701-323-5626: 701-323-6973 (Fax)

Red River Child Advocacy Center
Coordinated Treatment Center
c/o Meritcare Health System
736 North Broadway
Fargo, ND 58122
701-234-6600; 800-828-2901 (Press 3)

Contact the Alliance for Children’s Justice at:
Prevent Child Abuse North Dakota
ND Toll Free—1-800-403-9932


Child Sexual Abuse | What Families Need to Know | ND Information
How To Prevent Child Sexual Abuse | What You Can Do | About Us | Links