By Adam Hammer, staff writer

An estimated 10 percent of boys and 25 percent of girls in the United States are sexually abused, according to the National Center for Post-Traumatic Stress Disorder. Unfortunately there are often no obvious signs that a child has been sexually abused.

&8220;Parents really have to know their kids to notice the subtle changes,&8221; Connie Skillingstad, executive director of Protect Child Abuse Minnesota, said.

Since sexual abuse often happens in private and usually doesn’t result in physical evidence, child sexual abuse can be hard to detect.

Two main changes that may raise suspicion of sexual abuse are changes in behavior and relationships. Children are less than likely to come forward and talk about abuse with adults; however, there may be subtle changes of acting out &045; or acting in &045; for parents to watch for if they are concerned.

Children are not psychologically prepared to cope with repeated sexual stimulation, according to the American Academy of Child and Adolescent Psychiatry. Even children who do not know that the sexual activity is wrong &045; such as 2- or 3-year-olds &045; will develop problems resulting from the inability to cope with overstimulation.

The following are behavioral changes that may signal sexual abuse has occurred:

– Children may show sexual behavior or seductiveness that is inappropriate for their age. They might also show avoidance of all things in a sexual nature.

– Children, especially boys, tend to act out with behavior problems, such as cruelty to others and running away.

– Some children act in by becoming depressed or by withdrawing from friends or family.

– They may have nightmares or sleep problems.

– Children may also try to injure themselves or attempt suicide.

– They might make statements that their bodies are dirty or damaged.

Another indicator of possible sexual abuse is changes in a child’s relationship with other people &045; especially people who may be the abusers.

&8220;Watch for changes in relationships, and if there are particular people they don’t want to be left with,&8221; Skillingstad said.

Some kids may not want to give hugs or show affection to a relative from which they have received abuse. By the same token, they might be timid toward child-care providers or friends of the family if they are the abusers. If the abuse occurred at school, children might refuse to go.

Not all children can be vocal, especially very young children, which do not possess verbal skills, Skillingstad said. Many kids show signs that abuse has occurred through drawings that have dark overtones.

Physical signs are rare but are sometimes apparent as with reoccurring urinary tract infections, Skillingstad said.

&8220;There’s a variety of things like that parents can keep their eye on,&8221; she said.

Parents should provide a safe, caring environment for discussion so children feel able to talk freely with them, according the National Center for Post-Traumatic Stress Disorder. Tell children that if someone tries to touch their body and make the child feel uncomfortable, they should say no to that person and tell you right away.

&8220;It’s really good to talk to kids about their relationships with other people,&8221; Skillingstad said.

Let children know:

– They have the right to forbid others to touch their bodies in a bad way.

– Respect does not always mean doing what those in authority tell them to do.

– They don’t have to do everything a babysitter or group leader tells them to.

&8220;It’s always a matter of really listening and not always being in charge,&8221; Skillingstad said.

A process of open communication is important; however, pushing the issue of sexual abuse can have adverse effects.

&8220;Unless there’s a reason to suspect it, you don’t want to scare a child,&8221; Skillingstad said. &8220;They should know that they can come and talk to you.&8221;

If a child says he or she has been abused, first, remain calm. Reassure the child that what has happened is not his or her fault. Seek a medical examination and psychological consultation as soon as possible. Also contact the local child protective services.

&8220;We have to get over some of our old fears about child protective services,&8221; Skillingstad said. Some parents assume that protective services will take their children away from them, which is only the case if danger is suspected, Skillingstad said. Parents can also call anonymously with questions.

Long-term effects of child sexual abuse may persist into adulthood if it is not effectively treated, according to the National Center for Post-Traumatic Stress Disorder. Effects can include post-traumatic stress disorder, anxiety, depression or thoughts of suicide and low self-esteem as well as alcohol abuse, drug abuse, self-mutilation or bingeing and purging to mask painful emotions related to the childhood abuse.