Chapter 2 Index

A. Evaluation by system

B. Other categories of illnesses:

1. Metabolic and Endocrine

2. Collagen-Vascular Illnesses

3. Chromosomal Abnormalities

4. Generalized

5. Sexual Abuse
--Treatment of Sexually Abused Children

Disclosure of Child Sexual Abuse

Shelter and Advocacy Center

Introduction: Physicians all know that they are required by law to report child abuse.  Other mandated reporters include teachers, social service workers, nurses, and mental health professionals.  What most people who report these cases are not aware of, however, is that their reaction at the time of disclosure can greatly affect how much information is shared, and can even determine if the child will be put in the abusive situation again.  If handled the wrong way, children will not share what they know; this is particularly true if the child does not feel he or she is believed.

Ways Children Disclose Abuse:

1. Can be indirect hints e.g. “My step-dad comes in my room late at night.”
2. Can be disguised e.g. “I have a friend with a touching problem.”
3. Disclosure with strings attached: e.g. “If I tell you what happened to me, promise not to tell.”
4. Disclosure can be accidental: e.g. child keeps a diary that is found by another adult.

Suggestions for Methods of Responding to Disclosure of Abuse:

1. Always talk to the child in a private place.
2. Do not panic or express shock.
3. Tell the child that you believe him or her.
4. Use the child’s language.
5. Reassure the child that it is good to tell, and that it is not the child’s fault; the child is not bad.
6. Determine the child’s need for safety.
7. Let the child know that you will do your best to protect and support him or her; tell the child how you will do this.

Suggestions on How to Treat the Child After Disclosure of Abuse:

1. Treat the child as a child: encourage the child to play with other children; having the child play in groups can be important.
2. Don’t expect the child to be changed.  The same problems exist that were present before disclosure.
3. Increase validation of the child’s disclosure; this will give hope to the child for the future.
4. Let the child know that s/he can talk to you about anything troubling them.
5. Group sessions with children that have gone through the same thing are often helpful.

Discussion: Disclosure introduces children to many systems outside the family: police, attorneys, counselors, child protective workers, physicians.  These contacts can be very frightening and difficult for children to deal with.  From the beginning, it is important for the abused child to know that they are believed, supported, protected and loved.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004