Physical and behavioral signs of sexual abuse in infants and toddlers

Approximately 2.7 million cases of child abuse are reported each year, 20% of which are cases of sexual abuse. This is probably a minimum estimate because many cases, particularly those involving tntrafamilial abuse, go unreported. Identification of sexual abuse depends upon a high index of suspicion. Occasionally a child spontaneously discloses the abuse. Others, especially young children, may manifest specific behaviors indicative of abuse, such as sexual acting-out, or less specific behaviors suggesting psychologic stress. Only a small proportion of children have genital findings or sexually transmitted diseases indicating sexual contact. The evaluation of such cases requires special skills of a number of professionals who understand the legal, social, psychologic, and medical ramifications of this informa­tion.