When Oprah Winfrey recently broadcast her show on child sexual abuse, she rallied millions of viewers to help identify — and ultimately apprehend — child molesters who had run from the law.

But the show did more than just create the world's largest citizen posse. It also served to deliver a highly potent message direct to the heartland: That every child is at risk for sexual abuse and that every parent must raise the bar of protection if they are to keep their children safe from harm.

"Child sexual abuse is something we all have to be concerned about. It really does take a village to raise a child, but much of what will keep our children safe must be learned in the home. And parents need to take that responsibility very seriously," says Karel R. Amaranth, executive director of the J.E. and Z.B. Butler Child Advocacy Center at The Children's Hospital at Montefiore Medical Center in New York.

According to the U.S. Justice Department's Bureau of Justice Statistics (BJS), 67 percent of all victims of sexual assault reported to the police were children under the age of 18. Some 34 percent are under the age of 12, and one out of every seven victims is under the age of 6.

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Not Just Strangers

Now if you're thinking this means cautioning your children about taking candy from strangers and holding their hand extra tight in the shopping mall — well, you're only partly right. According to BJS, assault by a stranger accounts for just 3 percent of molestations in children under the age of 6, and just 5 percent in children aged 6 to 11.

Since winning the child's trust is part of the abuse pattern, the vast majority of sexual abuse occurs with adults the child knows and comes to trust. And it often occurs right in their home.

"Sexual offenders are not 'dirty old men' or strangers lurking in alleys. More often, they are known and trusted by the children they victimize, and frequently are members of the family, such as uncles, brothers, fathers, and stepfathers," says Esther Deblinger, PhD, a member of the National Child Traumatic Stress Network, and the developer of a treatment for childhood sexual abuse.

Amaranth says the abuser can just as easily be a neighbor, a close family friend, a baby sitter, a soccer coach, a scout leader, or anyone in a position of trust and authority.

While experts caution parents to be vigilant about all those who seek exclusive contact with their children, they also caution against starting a "witch hunt" for anyone who is nice to their kid.

"The message you don't want to give your child is that the world is a bad or scary place — or that they should be afraid of everyone who is nice to them," says Amaranth.

So how do you strike a balance between protecting your child and encouraging growth and trust?

It begins, say experts, by building awareness and trust into your own relationship with your children.

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Building Protective Bonds

"One of the best ways in which a parent can protect their child from sexual abuse is with early intervention. And by that I mean taking steps to prevent abuse before it actually happens," says Amaranth.

To this end, she says, parents must use age-appropriate measures to introduce their children to the concept of sexual abuse and teach them how to respond if the threat occurs.

"By discussing the topic with your children on a regular basis you make it easy for them to come to you in the event that something does happen in their lives. They will feel comfortable telling you about it and they won't be afraid or embarrassed," says Donna Fielder, PhD, assistant professor and social worker at LaSalle University in Pennsylvania.

Also important, she says, is for children to understand what abuse is — and to know it's never their fault.

"A child needs to fully understand, in an age-appropriate way, that whatever happens, they did nothing to cause it," says Fiedler.

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Good Touch, Bad Touch

But how do you talk to your children about such a difficult if not frightening topic? Child-advocacy experts say begin at a very early age, using the concept of "good touch," "bad touch," and "secret touch."

"Explain that there are 'good' touches — like a hug, or a pat on the back, or a kiss on the cheek; there are 'bad' touches — like when somebody hits you or pushes you. And there are 'secret' touches — where somebody wants to touch you and they say you have to keep it a secret," Amaranth tells WebMD.

Then, she says, make sure the child knows that if anybody wants to give them a "secret" touch, they should say "no" — and tell Mommy or Daddy right away.

Moreover, Fiedler says many parents can also use the bathing suit analogy to further help their children define "secret touch" areas.

"You can tell them that any area where a bathing suit covers is their private place — and this is the area they don't want other people to touch. As the child gets older, more age-appropriate details can be added," says Fielder.

Moreover, both experts say parents need to have this talk with their children on a very frequent basis.

"Make it part of family conversation. When your child comes home from school ask them to tell you about the 'good' touches they had that day; then ask them about any 'bad' touches. Finally ask if anyone tried to have a secret touch. If your child gets used to hearing these terms they will feel more comfortable sharing information with you on the subject," says Amaranth.

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Listen to Your Children

In addition to talking to your kids, child advocacy experts advise parents to listen — and become tuned in to what is "normal" behavior for their children. The point here: To immediately be able to recognize when something is out of sync — often an early sign of abuse.

"Basically if a child's behavior changes significantly in a way that does not fit with normal development, parents should inquire what's up — and consider sexual abuse or other traumatic experiences as a possibility, " says Lucy Berliner, director of the Harborview Center for Sexual Assault & Traumatic Stress in Seattle, Washington.

What's also important, say experts, is to look for patterns in behavior changes, specifically as they relate to an individual — such as an uncle, stepfather or neighbor — or a specific event, such as soccer practice or a scout meeting.

"Does your child become upset or seem uncomfortable every time he has to spend time with Uncle Joey — or in older children, every time they have soccer practice or gym class? You need to pay attention to these kinds of outside cues," says Amaranth.

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Don't Jump to Conclusions

At the same time, she cautions parents not to jump to conclusions prematurely.

"Some children just really don't like gym class — and some may just not like Uncle Joey because he has a scary haircut or bad breath. It's important to pay attention to the cues, but it's also important to assess those cues in the context of their total behavior," she says.

Fielding agrees and says no real determination can be made by a single observation.

"What you really need to do is look toward a constellation of events and situations that seem to tell a story," says Fiedler.

When all else fails, they say, simply ask your child what it is about a specific person or event that makes them feel uncomfortable.

"Older children may be less forthcoming, but frequently young kids will often just blurt it out," says Amaranth.

Abuse: Know the Signs

In addition to knowing your child, becoming familiar with the signs of sexual abuse is also helpful. And while experts say that every child can respond to trauma in a unique way, there are some behaviors that are commonly observed in children who are experiencing abuse.

Because some of these signs can be caused by other factors, such as depression, experts warn parents not to make a snap judgment on any one behavior. That said, you should remain aware of the following warning signs of trouble:

1. A sudden onset of sexualized behavior; the younger the child is when this occurs, the more likely it is linked to sexual abuse.

"This includes a sudden desire to touch their body, to touch the bodies of other children or even adults, to want their parents to touch them," says Amaranth. This, she says, is often done in an attempt to "normalize" the behavior they have experienced with the abuser. Sometimes it can be a sign the child has been exposed to pornography.

2. Sudden or rapid onset of fears — including fears of being around a certain person, or fears about attending a regular activity they normally looked forward to.

"A strong preference not to be around, go with, or be left in the care of a particular person should create an index of concern that something has happened that is upsetting," says Berliner.

But also important to remember, says Amaranth, is that children are often very protective of the abuser, so sometimes they will try to hide their reluctance, particularly if you question them about it.

3. A sudden change in personality — from very quiet to very aggressive, or from very outgoing to very quiet and withdrawn.

4. Acting out, particularly showing anger and aggression towards others. In younger children Fielder says this can be manifested while playing with toys, or playmates, sometimes causing them to suddenly become the playground bully. In older children the anger can manifest as substance abuse, particularly alcohol.

5. Sleeping disorders — such as sleeping much more than usual, or having difficulty sleeping. "Children may also become obsessed with secrecy or privacy — for example locking their bedroom door," says Fielder.

6. Fire setting — or having an obsession with fire.

"There is a connection between fascination with fire and abuse — possibly related to the child being oversexualized as a result of the abuse," says Fiedler. In very young children, she says, the fascination may be depicted in drawings of fire or in pictures that utilize a lot of red.

Children's drawings can also show signs of abuse and related depression if the pictures show them as meaningless in the presence of large powerful people, says Fielder.

8. Rapid onset of eating disorders — such as overeating or undereating. Amaranth says teenage girls who are being abused frequently become anorexic, or they pile on the fat, hoping they will be less attractive to the abuser.

9. Be on the lookout for any physical signs of sexual abuse such as unusual penile or vaginal discharge, pain in the genital area, body bruises, cuts or abrasions that can't be explained, unusual marks on the body, constant urination or difficulty urinating.

"If you do see any of these signs, take your child to a pediatrician immediately," says Amaranth.

10. Any significant change in behavior that seems abnormal. This includes changes in personality, habits, behaviors, likes and dislikes, and particularly any change in attitude toward something the child used to enjoy, such as a sporting activity, dance class or scouting events.

If You Suspect Your Child Is Abused: What to Do

There is perhaps no greater pull on our parental heartstrings than that which occurs when our child is in harm's way. Discovering — or even suspecting — our child may have been sexually abused can, say experts, throw any parent into an emotional tailspin.

However, it's at this precise moment that child-abuse experts say parents need to remain calm.

"It's important to stay calm and not transmit your own emotional upset to your child. Don't grill a child for every detail, or alarm the child by panicking," says Eblinger.

Instead, take immediate steps to protect your child from any imminent danger by removing all contact with the suspected abuser. And while your first instinct may be to confront the accused yourself, experts say that's not the right approach.

"If you discover your child is being abused, especially if they tell you about it, the first contact you want to make is with the police," says Amaranth. This, she says, is even more important if your child is under the age of 5. Why?

"Children under the age of 5 are not considered credible in the justice system, so even if a child is 4 years old and clearly says someone touched me — even if they can describe it — they are not considered legally credible witnesses, so a court case cannot go forward," says Amaranth.

If you contact the police, however, a little bit of detective work on their part can often go a long way in discovering additional evidence that could make apprehending the abuser far more likely.

"The police will also advise you on how to proceed in terms of dealing with the abuser, particularly if they reside in your home, or are a close family member," says Fiedler.

Contacting a child-advocacy center can help; most major medical centers have one. Here you will find experts trained in not only counseling children who have been exposed to abuse, they can also be a treasure trove of information on what parents can expect from their children, as well as the justice system.

"A child-advocacy center is also a good place to turn if you suspect your child is being sexually abused but they have not yet corroborated your suspicions," says Amaranth. When this is the case, trained counselors can talk to your child and help discover if, in fact, abuse is occurring.

Calming Parent's Fears

While there is no question that sexual abuse is a crime and reporting it is necessary, experts believe the vast majority of sex crimes against children go unreported. One reason, they say, is that parents are sometimes afraid the police will remove the child from the home — particularly if the abuser shares the residence.

"A mother, for example, may not want to turn in the abusing stepfather because she's fearful that child-protective services will place the child in foster care," says Fielder.

What most don't realize, says Fielder, is that should the child confess the abuse to someone else, or if a teacher, neighbor, pediatrician or other family member reports the suspected abuse on their own, the mother may lose the child anyway.

"In the eyes of the law that mother was not protecting her child," says Fielder.

While guidelines governing what happens when a parent reports child abuse can vary from state to state, Amaranth says that nationwide there is a push toward leaving the child in the home and instead removing the abuser from the premises.

"Even if the child must be removed for a short time, most state officials try to place them with a relative or someone they know," says Amaranth.

Adds Fielder: "You are far more likely to keep your child if you demonstrate that you have taken steps to protect them, rather than protect the abuser."

Parents Resources

If you suspect your child is being sexually abused — or if you are a friend, neighbor, or relative of a child you believe is a victim — the following organizations can help:

Childhelp USA National Child Abuse Hotline (800) 4-A-CHILD ((800) 422-4453) or visit

Child Abuse National Hotline (800) 252-2873, (800) 25-ABUSE.

To find your local state child abuse hotline, check your local government directory under "Child Protective Services" or "Abuse Hotline." Online you can find a directory of local state child abuse hotlines at: www.therapistfinder.net/Child-Abuse/Child-Abuse-Hotlines-Phone-Numbers.html.

To find a child-advocacy center in your area, call your local hospital. Online visit the National Child Traumatic Stress Network, www.nctsnet.org. For a direct link to a listing of child advocacy centers by state, visit www.nctsnet.org/nccts/nav.do?pid=abt_ntwk

By Colette Bouchez, reviewed by Louise Chang, MD

SOURCES: Karel Amaranth, MA, executive director J.E. and Z.B. Butler Child Advocacy Center, The Children's Hospital at Montefiore Medical Center, New York. Esther Deblinger, PhD, National Child Traumatic Stress Network. Donna Fielder, PhD, assistant professor, LaSalle University, Philadelphia. Lucy Berliner, director, Harborview Center for Sexual Assault & Traumatic Stress, Seattle. National Child Traumatic Stress Network. Bureau of Justice Statistics, July 2000