It is estimated that, worldwide, at least 1 in 10 girls and 1 in 20 boys experience some form of sexual abuse in childhood. Some are abused within the family environment, by persons they are familiar with. Some are assaulted by strangers whom they do not know. Those who are sexually abused as children are more susceptible to depression, eating disorders, suicidal behaviour, and drug and alcohol problems later in life, and are more likely to become victims of sexual assault as adults. In many countries, children are taught how to recognize, react to, and report abuse situations through school-based programmes designed to help prevent sexual abuse. In this article, David Millar, a retired Consultant child and adolescent psychotherapist,  considers the problems and balances in preventing and protecting our children from sexual abuse.,


We used to speak of ‘childhood innocence’ : these days some  do not even remember the phrase. And yet, most parents and teachers want nothing less than a social environment that is safe, and which will allow them to move, in “innocence”, from childhood into adulthood.

Having to deal with child sex abuse is an unwanted intrusion into this ideal situation. So we must take on child sex abuse by both prevention and cure.


Many unwanted situations in life are better prevented than cured and the prevention of Child Sexual Abuse would must be a paramount example.  At the same time, in most instances, the awareness of a need for prevention usually follows on from the anticipation that there is a need for it. that a difficult set of circumstances is approaching.  Whereas this might be more easily recognised by  adults on the outside of a potentially abusive scenario,  it is, unfortunately it is  so often not the case for a child experiencing the same  said scenario from the inside.  Herein lays a significant problem. The experience of the child in such worldly matters is not as extensive as that of the adult.

The incidence of intrafamilial CSA vs the incidence of extrafamilial extrafamilial abuse is reported differently by different researchers depending upon methodologies employed.  and  Some put the incidence higher in one group than the other.  Experientially, however, In the perception of most clinicians come across intrafamilial abuse (incest) is much more frequently noted than extrafamilial or paedophilic abuse.  However, their general experience points towards the opposite.

We are familiar with the widely used shared phrase ‘stranger danger’ to alert children to the risks sometimes associated with over-familiar strangers. However,  but the opposing notion of ‘family danger’ is harder to comprehend. The phrase is not so ‘catchy’, it is less  and more difficult to summarise under an attention-grabbing phrase.  Freud, of course, pointed out that incest was a near-universal taboo -  so whether or not there is a natural inhibition, there is, certainly, a social or cultural prohibition against sexual relations within families.

Is this perhaps why different researchers produce conflicting estimates of the incidence of  interfamilial CSA and extrafamilial CSA? And is the proper response to  the former the proper response to the latter?

Further, clinical experience shows that the closer the dependency between the abused and the abuser, the more harm is done to the child.



What protects children overall, from extrafamilial CSA is,   of course, is their natural wariness of anyone they have not met before or anyone (child or adult) who might impose on their personal space.  This natural wariness develops from around the age of six months and to a greater or lesser extent remains with us throughout life. 

However,  accompanying and complicating such wariness is the child’s innate physical and psychological attractiveness to adults not to mention their (child-like) seductiveness as a life-affirming, important, survival technique.  In this short document, article I would like to concentrate on the prevention of sexual abuse in children where the perpetrator may be known to the child and may be a trusted or loving figure in their life.

With ‘stranger –danger’ s, we have to apprise teach our children of about approaching   a kind of danger of the kind which they may already sense or know about. have their own sense  But with family members, arming the child against  such dangers is much more difficult.   We need have to instil guardedness against persons towards those who are already intimately attached to them.


In the mid-nineties, Mervyn Glasser’s study  of the childhood experience of adult sexual abuses, concluded that  the most damaging corruption of relationships was that between the mother and her son.

There is an inherent problem in this. Although “stranger danger” is easy to understand, “intrafamilial sex abuse”  has no similar catchy phrase, such as “domestic danger”. These are  two different and opposing problems.  The latter certainly  It does not lend itself to slogans nor does it fit comfortably with competing notions of closeness, bonding and attachment.

So is it sufficient to teach should we simply be apprising our children – all children – of the possible risks that may be posed by a wide range of adults or even older children who are their ‘friends’  – including those with whom they have familial relationships of love and affection?

What has become common  practise in many households with young children is for parents  to indicate to their children which are the acceptable places on their body for friends, siblings and parents, say, to touch and what which  are those places that the child should mainly be touching themselves - when they are bathing for example.  

A child will normally develop a passionate relationship with the parent of the opposite sex. That parent must acknowledge and respect the child’s wishes without responding to them in a self-indulgent or abusive way.


In other words, In terms of protection, should we simply be enhancing aspects of ordinary family life or should we be going further and actually specifying the types of risk that the child should be alert to -  such as genital massage or penetration?  And where does this leave natural hugging, kissing, stroking and bodily playfulness that is a joyful and rightful part of family closeness?  Prevention of CSA within the family does not lend itself to easy answers.  Perhaps parents must learn more and children, when capable, should be taught more.



By school age, of course, preventive measures can, in some instances, be more easily conveyed as the peer group as a whole is being addressed using standardised alerts or warnings although what constitutes age-appropriate warnings are still being debated. 

The Internet can also act as an auxiliary peer group. Social media, acting responsibly, can help children discuss child sex abuse and childhood sexuality more freely.

However, government intervention to encourage openness may have its dangers.

The government’s recent media campaign to alert ALL adults to ALL suspicions connected to ANY child, would be a case in point.  Such campaigns can do more harm than good by making a range of everyday situations seem to be a potential risk  and a range of, otherwise healthy, child  experiences presentations open to misinterpretation.

Addressing child sex abuse is not a simple matter. We risk going from doing too little to doing too much;  and in doing so may find, paradoxically, such that children become, paradoxically, under protected by being over protected.  Action by adults is not enough. There must be input from children in reporting abuse.


That our children need to be protected from a variety of life’s misfortunes is obvious but we as adults or parents cannot always protect them from foreseeable and unforeseeable consequences in life so, instead, how can we teach them to protect themselves?  It may be useful to detail some of our history in this area.

In the 60s and 70s child physical abuse was being acknowledged openly for what seemed like the first time. For example the NSPCC opened its first research unit in North London aimed at drawing attention to child abuse. However,  but it was named: The Battered Baby Research Unit, for, at that time, this as that appeared, at the time, to be the main risk to infants and children. The ‘battered child syndrome’ then gave way in the 70s to ‘non-accidental injury’ or NAI.

Of course, historically,Historically, tales of child expropriation and exploitation were common enough (e.g. Oliver Twist) but that was ‘in the past’ and modern families’ views evolved into a wholly different attitude to child-rearing and the place of ‘childhood’ in a contemporary setting.  But just as we were beginning to acknowledge the physical mistreatment of children within families, in the 60s and early 70s, evidence for the sexual maltreatment of children, sexually, came to the fore.  It was in the mid-seventies that Brendan McCarthy, a Child Psychiatrist and Psychoanalyst, then at The Tavistock Clinic and latterly at The Portman Clinic, was interviewed on early-evening television about his (and others’) growing experience of referrals for child sexual abuse.  He said this was becoming a major problem.  That TV program subsequently attracted the largest ‘mailbag’ (in the days before emails) that it ever had. Women (mainly) of all ages but with a preponderance of women in their 60s, 70s and 80s ‘found their voice’ for the first time and were able to talk openly (to a degree) about their long-kept secrets of being sexually abused as children.  The lid on CSA was lifted . and Society’s struggle to control and contain it is with us still.

Publicity, in itself, provides much of the ‘oxygen’ needed to alert society to the problem and produce the sort of social and legal constraints that we are now familiar with. , to wit, the


The setting up and preponderant use of ChildLine, for is one such example.  Nonetheless, the problem of child sex abuse  continues  - and openness and public acknowledgment alone is not enough. What comes next?  Self-reporting is given a great deal of attention in the media and in our schools so that children and adolescents feel more able to report or ‘disclose’ incidents of CSA to (primarily) those in authority.  I will mention in passing the oft-reported ‘circularity syndrome’of CSA whereby children who are abused, later become abusing adults. This is an aspect of the problem that seems to (re)occur no matter how much is publicly  aired about it.

This pattern of first So, teaching children ‘safe areas’ of their bodies, then  making them socially aware and encouraging open discussion leading to easier disclosure would all seem to be appropriate and effective means responses by responsible adults to protect children and help them to protect themselves.

An interesting development, emanating from an increased confidence in discussing CSA,  departure, here, from the emphasis on adults to protect children or children to protect themselves, is the phenomenon of peer reporting. Peers, as in classmates and friends,  are remarkably prescient when it comes to assessing those in their own age group who may have mental health needs. Furthermore, they often prove to be  and just as knowledgeable about reporting child sex abuse – and more effective in measuring the effectiveness of treatment outcomes.   


There are obvious  reasons for research studies, of course,  to have been resistant to using child-subjects.  for obvious ethical reasons but  Children are much more likely to be open with their peers than with adults. Consequently, I suspect that many peers might ‘know’ which of their friendship group is being sexually abused before many adults would but this would be a difficult area to tap into.


Another, seemingly inherent, aspect of protection needs to be addressed. It  although it is probably the most complicated of all. It and that is  the inability of some (adult) individuals to refrain from acting out their sexual fantasies towards children. I mentioned one aspect of this problem, above, when I referred to the repetition- compulsion, or  ‘circularity syndrome’  as it were, for certain individuals, apparently, to continue to ‘do unto others that which has been done unto them’.   Those who have been abused as children may go on, as adults,  to abuse children.

This ‘circularity syndrome’is only one of many causal factors in this regard which seems resistant to change despite widespread public awareness.  This, even though  At the same time, there is some emerging evidence that psychotherapy for potentially abusing adults (e.g. the Dunkelfeld Project in Germany and anecdotal evidence in Britain) can and does inhibit or prevent some, otherwise, child abusers from enacting their sexual fantasies toward children.

Freud may be credited as the first to highlight, what was for him, observably and psychoanalytically, the reality that each new baby is a sexual being from birth.  We all have to live with the sexual aspect of ourselves from birth,  with the hope and expectation that we adapt appropriately at each stage of development.  But it does leave open the argument, as some child sexual abusers have stated in their defence, that certain children may be capable of sexually enticing adults.  Conversely, being aware of a child’s attractiveness is what, paradoxically, makes their appeal even more innocent in the eyes of a thoughtful, mature adult.  In other words, there is a natural in-built method of mutual appeal and repeal which balances out growing up and growing old.  Nonetheless, we need to build on external restraints (public awareness) and internal restraints (psychotherapy) where inherent conflicts remain.

Increased awareness of the dangers, and the different forms, of CSA should  lead to a better awareness of the signs of CSA, with consequent ability to put a stop to it. Such increased awareness may alert other family members to sexual abuse being committed when it occurs within the family. Clear rules should be implicit – or even explicitly in some cases – and such rules should be seen to be never breached.

However, we should consider further how the State should intervene to further  help our children, by stopping CSA in a more general fashion.



Finally, let us consider the question of prosecution or punishment which arises when a child’s story is heard, believed and proven in a court of law. If someone  one is robbed and the robber caught, the victim is  you are unlikely to feel any sense of guilt or responsibility for their crime – even though,  for example, a mobile phone was left on display in an unfastened handbag.

However, this is precisely what often does happens when, say, a child is molested or penetrated by a close, otherwise responsible, adult.  The child frequently, if not invariably, feels confused and complicit.  This ambiguity can be compounded by a ‘successful’ conviction, for the  especially if it results in the incarceration may be of a significant adult in the child’s world.  Who then is being punished if the (child) victim feels more guilty that the (adult) perpetrator?

The issue gets compounded further when the child may feel not only a confused inner sense of injustice but also an actual external one.  I recall a patient who, at age thirteen saw a TV programme on incest.  The following day, her friends were talking about the programme in the playground and one asked, incredulously: “How could you have sex with your father?”  To which this young woman replied: “I can, I do it all the time.” 

Her disclosure led to her father being sentenced to three years in prison and the girl was referred for therapy.  Not too far into her therapy she announced that her father was due to be released shortly and, as she would be sixteen by then, she intended to leave her therapy and  resume their sexual relationship when he was out of prison as it would now ‘no longer be illegal’ and she ‘still loved him’. This illustrates one further example of how complicated the development of internal and external relationships can be in this area. [N.B.  At a subsequent meeting of professionals parole conditions were placed upon the father not to go near his daughter.]

Prosecutions in this area are fraught with additional complications such as sexual activity between an adult and child. This  usually takes place in private or in ‘secret’, away from the presence of witnesses.  During preliminary  investigations, or if it reaches court, it becomes the child’s word against the alleged offender and the truth often cannot be decisively determined. 

In other instances, a ‘successful’ prosecution can sometimes lead to the breaking up of a family home and may have the effect of piling more guilt on an already fragile child’s conscience.  It should come as no surprise that successful CSA convictions are fraught by these sorts of complicating factors.


Attractive though the ideal of  “childhood innocence” is, it  is the lucky child who maintains it throughout childhood.

“Childhood innocence” is where it all begins , but the means of guiding the child from such innocence to the realities of adulthood  may need to  destroy that innocence. Children  need to know the dangers, both intrafamilial and extrafamilial.  They need these rules of life in the same way that they need to know the rules for crossing the rod.

However, we must always remember that we are dealing with children – and their needs, and indeed rights, must come first. Prosecution of sex abusers may seem attractive to the adult mind, it may, however, have a detrimental effect on the child. It may destroy what little innocence is left in the child.

Prevention is best achieved through education and openness about the problem. Children should be taught that there is no shame in being sexually abused and that they should talk freely to their peers and parents if it occurs. Prosecution of an offender should be handled in a fashion that might, in some way, return the victim, the  child,  to the state of innocence that the offence destroyed.

David Millar  Consultant Child and Adolescent Psychotherapist (NHS) [ret’d]