As a starting point, if a child is experiencing mental health crisis or in immediate danger this should be prioritised and appropriate support sought.


Mental health crisis – 111 option 2 Immediate safety concerns – 999

1. Introduction

1.1 Child sexual abuse is sexual activity that happens to a child under the age of 18 and is unwanted or involves pressure, manipulation, bullying, intimidation, threats, deception or force (Rape Crisis, 2026).

It is common for those who sexually abuse children to use ‘grooming’ techniques to gain compliance and ensure a child’s silence. They may use threats and force, but often use rewards, favouritism and alienation from friends and family, or take advantage of the normalisation of potentially abusive activities. Similar techniques may be used on families and colleagues to secure access to victims and prevent detection. This can take place online and in person.

1.2 The experience and impacts of sexual abuse are different for every child. Victims and survivors of child sexual abuse can be affected in a range of ways, but the impacts of abuse vary in their nature and extent. While the impact can be significant and life-long, people can, and do, recover from sexual abuse.

2. Definition

2.1 Child sexual abuse is defined by UK Government as: ‘forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts, such as masturbation, kissing, rubbing, and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse’.

Child sexual abuse forms as part of a wider continuum of sexual violence (Liz Kelly, 1988).

3. Recognising Child Sexual Abuse 

3.1 Most children do not tell anyone about sexual abuse at the time so it is important that professionals recognise when children might be showing them that something is wrong.

Children may display different signs of having been abused, including emotional, behavioural and/or physical signs. Professionals should also be alert to indicators of harm in the people around the child, or vulnerabilities in the family or environment around them.

Professionals should seek to understand these signs, explore concerns, and build a picture of what they may be showing. The CSA Centre’s Signs and Indicators Template is a tool that can be used to support professionals to discuss, record and share such concerns that a child is being, or has been, sexually abused, and to act on them.

The communicating with children tool Communicating with children: A guide for those working with children who have or may have been sexually abused (second edition) gives professionals the knowledge and confidence to speak to children about sexual abuse.

4. Forms of Sexual Abuse

Children can be sexually abused in many different ways, by different people and in different places and situations, including online.

4.1 Intra-familial child sexual abuse
Intra-familial child sexual abuse refers to child sexual abuse that occurs within the family environment. Abuse may involve relatives, or others (such as foster carers or a parent’s partner) who feel like family from the child’s point of view.

Most people who sexually abuse children in a family context are male, although abuse by females does occur. Abuse may be by other children in the family as well as by adults.

Family members can be involved in the production and distribution of child sexual abuse material (such as images or videos), in child sexual exploitation, and in the organised abuse of children by multiple abusers. It is important that practitioners
consider the risk of other forms of child sexual abuse occurring when assessing children for whom there are concerns of intra-familial child sexual abuse.

4.2 Harmful Sexual Behaviour between Siblings 

‘Sibling sexual behaviour’ is an umbrella term that may refer to any form of sexual behaviour between siblings. Sibling sexual abuse has the potential to be every bit as harmful as sexual abuse by a parent; it can have both short- and long-term consequences for children’s physical and mental health, and lead to relationship difficulties throughout their lifetime. However, some sibling sexual interactions may be exploratory and mutual rather than abusive. Assessing the nature and quality of the sibling relationship is important when assessing the nature of the sibling sexual behaviour.

Given all of the complexities around sibling sexual behaviour, professionals need to be precise about the language they use to describe the behaviours, which can be broadly divided into three types:

  1. normative sexual interactions between siblings – behaviour between young siblings that exists within expected developmental norms
  2. inappropriate or problematic sexual behaviour involving siblings – behaviour between siblings that falls outside developmental norms and which may cause developmental harm to the children involved
  3. sibling sexual abuse – behaviour that causes sexual, physical and emotional harm, including sexually abusive behaviour which involves violence. Imprecise language should be avoided, as adults have varying beliefs and values around what constitutes appropriate sexual 

Sibling sexual abuse: A knowledge and practice overview
Sibling sexual abuse and behaviour | CSA Centre
Harmful Sexual Behaviour Guidance

4.3 Harmful Sexual Behaviour
Harmful Sexual Behaviours (HSB) are defined as; sexual behaviours expressed by children under the age of 18 years old that are developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person, or adult, online (Technology Assisted HSB) and offline.

Harmful Sexual Behaviour Guidance
Harm Outside of the Home

4.4 Child Sexual Exploitation

Child sexual exploitation involves the manipulation or coercion of children into sexual activity. It can occur in person or via technology, and it often involves a power imbalance between the perpetrator and the victim.

Harm Outside of the Home
Child Sexual Abuse & Exploitation (CSA&E)

4.5 Technology Assisted Sexual Abuse 

Technology-Assisted Child Sexual Abuse (TACSA) happens when a child under the age of 18 is harmed by someone who has used technology to enable sexual abuse. It can take place in many different forms and it impacts children and young people from across the globe regardless of their religious, ethnic and cultural background, sexuality, gender, disability status or social class.

What is Technology Assisted Child Sexual Abuse?

5. The Child Sexual Abuse Response Pathway 

5.1 The Centre of expertise on child sexual abuse (CSA Centre) created an online interactive resource, the Child Sexual Abuse Response Pathway, which sets out how to respond to concerns of child sexual abuse at key points: from first concerns and initial safeguarding actions through to child protection and criminal justice responses.

Both the Response Pathway and the supporting resources are designed for all professionals working with children. They are particularly helpful for social workers, Youth Justice Staff, teachers, police officers, health professionals and those in the voluntary sector who work with children and families.

5.2 As an interactive online resource, the Response Pathway builds on current legislation and statutory guidance and national policies and procedures, providing specific advice on responding to child sexual abuse.

Professionals can use the Response Pathway to help inform and guide the steps they take to protect and support children if they are concerned that they are being, or may have been, sexually abused. The Response Pathway sets out what you can and should do at different points along the response and will help professionals understand the roles of other professional colleagues. If the practitioner is unsure, they should discuss the case with their safeguarding lead or within supervision.

Link to CSA Response Pathway

6. Forensic medical pathway

6.1 Medical examinations can have lots of benefits to a child if sexual abuse is disclosed or suspected, not only in identifying forensic and evidential findings but also providing a holistic assessment of the health and wellbeing of children. This can be beneficial for non-recent sexual abuse, as well as recent sexual abuse, as it can include addressing unmet general, mental and sexual health needs, assessing risk (including for self-harm and suicide) and providing feedback and reassurance from health professionals to children and carers.

6.2 It’s important that all professionals who work with children prior to a possible referral for a medical examination have the knowledge and confidence to provide information and advice to children and non-abusing parents and carers. Professionals are encouraged to watch this short evidence-informed film which is designed to help professionals from multi-agency backgrounds better understand the role and purpose of a medical examination in situations where child sexual abuse has been disclosed or suspected. It is applicable to any setting in which children may be seen for a medical examination, and is relevant to both recent and non-recent cases of child sexual abuse.

Understanding medical examinations for child sexual abuse concerns (The CSA Centre)

The below film can be used to explain to children what to expect from their forensic medical:
What to expect at your appointment at the Children and Young People's Clinic, GNCH - with subtitles

To organise a forensic medical, professionals should follow the below regional referral pathway:
CSA Regional Referral Pathway

More information about Forensic Medicals can be found on the Child Sexual Abuse Response Pathway: The child has a medical assessment/examination | CSA Centre

7. Support Services (Please note the below pathways are still currently under development)

ARCH
General Enquiry
admin@archteesside.org
Referral Enquiry
referrals@archteesside.org
E-mail Support
support@archteesside.org
General/Referral Enquiry
01642 822331

Barnardo’s Sunrise Therapy
sunrisetherapyservice@barnardos.org.uk
01642 300774

HALO
info@haloproject.org.uk
01642 683 045

8. Useful Information, Resources and Links

The CSA Centre has developed additional resources and guides to support professionals in identifying and responding to child sexual abuse: