Child Sexual Abuse, Harmful Sexual Behaviour and Child-on-Child Abuse

Child sexual abuse may be carried out by adults, older young people, or other children, and is often not disclosed directly. Concerns can appear through behaviour, physical or sexual symptoms, emotional distress, or patterns that do not match the explanation given.

Children and young people may feel frightened, ashamed, confused, loyal to the person involved, or responsible for what has happened. Many say nothing.

Others may show distress through:

• self-harm
• sleep problems
• school avoidance
• sexualised behaviour
• pain
• urinary symptoms
• requests for emergency contraception
• pregnancy
• sudden changes in mood or functioning

Recognising Sexual Abuse

Sexual abuse can be contact or non-contact, involve coercion or grooming, include image-sharing, or involve pressure to take part in sexual acts. In clinical pharmacy practice concerns may arise during sexual health consultations, when treating genital pain or infection, if emergency contraception is requested, in pregnancy-related contacts, or with sudden deterioration in mental or physical health.

Possible signs include:

• sexualised behaviour beyond the child's developmental stage
• genital or anal symptoms
• fear of a particular person or place
• withdrawal
• self-harm
• school refusal
• treatment patterns suggesting coercion rather than free choice

No single sign proves abuse. At Level 3 you should notice when the overall picture suggests sexual harm may be occurring, respond calmly, and record and escalate concerns promptly.

Harmful Sexual Behaviour and Child-on-Child Abuse

Not all sexual behaviour between children is abusive. Concern increases when behaviour is coercive, secretive, repeated, degrading, linked to fear, or far outside expected age and development.

Do not treat the child displaying the behaviour solely as a perpetrator. They may have been exposed to abuse, exploitation, pornography, violence, or other trauma themselves.

Clinical Response Within Role

If a child or young person discloses possible sexual abuse, respond calmly, do not promise confidentiality, and avoid detailed questioning. Listen, clarify only what is necessary for immediate safety, record the child's words accurately, and follow your safeguarding procedures without delay.

Sexualised behaviour, sexual health presentations, or disclosures should never be dismissed as ordinary teenage behaviour when fear, coercion, developmental mismatch, or distress are also present.