Signs of Child Sexual Abuse

Child sexual abuse can be very difficult to recognise because children often do not describe it directly. They may feel confused, frightened, ashamed, loyal to the person harming them, or worried that they will not be believed. In pharmacy settings, the signs you notice may therefore be behavioural, emotional, or relational rather than explicit. A child may become unusually withdrawn, fearful, secretive, or distressed in the presence of a particular person, and the concern may emerge only through small details that do not sit comfortably together.^[1]

Sexual abuse can be carried out by adults or by other children, and it can involve contact abuse, non-contact abuse, online abuse, or harmful sexual behaviour.^[4] At Level 2, your role is not to decide exactly which of these is happening. Your role is to recognise when something may be wrong, respond sensitively, and make sure the concern is shared through the correct safeguarding route.^[2]

What You Might Notice

Sometimes the signs are subtle and mixed. You might notice:^[3]

• a child who seems frightened, unusually secretive, or suddenly different in mood or behaviour
• sexualised language or behaviour that does not seem age appropriate
• distress linked to a certain person, place, or situation
• a child who hints at something wrong without naming it clearly

If a child says something that worries you, listen calmly, take it seriously, and do not ask leading questions.

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That matters because your first response can either help a child feel safe enough to be protected, or make the situation harder. You do not need to investigate, test their story, or press for details. It is usually better to let the child speak in their own words, reassure them that they have done the right thing by telling someone, and then record what was said as accurately as possible.^[2]

Your Role in the Moment

A brief interaction at the pharmacy counter or reception desk may be the only chance you have to notice something important. If a child's behaviour, words, or distress raise concern, follow the safeguarding process promptly. A careful, factual record and a calm response may be the first step in protecting a child from serious and hidden harm.^[6]

References (numbered in text) Why we include references

1. Royal College of Paediatrics and Child Health. Physical signs of child sexual abuse: an evidence-based review and guidance for best practice (the 'Purple Book'). RCPCH; 2015. Find (opens in a new tab)
2. Royal College of Paediatrics and Child Health, et al. Safeguarding Children and Young People: Roles and Competences for Health Care Staff. Intercollegiate Document, 4th ed., January 2019. Find (opens in a new tab)
3. National Institute for Health and Care Excellence. Child maltreatment: when to suspect maltreatment in under 18s (Clinical guideline CG89). NICE; 2017 (surveillance updates 2019). Find (opens in a new tab)
4. National Institute for Health and Care Excellence. Harmful sexual behaviour among children and young people (NICE guideline NG55). NICE; 2016. Find (opens in a new tab)
5. HM Government. Working together to safeguard children: statutory guidance. Department for Education; 2018 (updated 2023). Find (opens in a new tab)
6. Centre for Pharmacy Postgraduate Education (CPPE). Safeguarding children and vulnerable adults e-learning programme and assessment (mapped to Level 2). (Web) Find (opens in a new tab)