Every day, stories about children who have been sexually abused appear in newspapers and television news programs across the country. Most parents teach their children to be wary of strangers, but sadly, more than 90 percent of sexual abusers are not strangers.

They may be in positions of authority: Family members, coaches, teachers, religious leaders and political figures can be perpetrators of abuse. Older children who have been victims of abuse themselves may in turn abuse younger children.

Sexual abuse can be devastating to children, most of whom never report the abuse. For children who keep their abuse a secret, and for those who report it but are not believed, lifelong emotional, psychological and physical problems can be the result.

Most sexual abuse cases happen when one child is alone with one adult.

Avoid situations in which your child is left alone with an adult, and encourage group situations.

Child predators may use the Internet to meet children and lure them to a meeting place with the intent to sexually abuse them. Make sure to monitor children’s Internet use and teach them never to give out personal details such as their last name, address, phone number or school.

Children who have been abused are often reluctant to tell their parents about it. Abusers may manipulate children by threatening to harm them if they tell, by making them believe their parents will be angry if they tell or by confusing them about right and wrong. Abusers sometimes tell children that the abuse is just a game and that it is OK. Abused children often feel confused, ashamed and afraid to tell.

Parents need to start talking to their children at a young age about what is appropriate touching and what is not. Children need to understand that some adults – even friends or family members – might try to be alone with them and touch them inappropriately. Children need to know that their parents want to protect them from abuse, and that you will listen to them and protect them if they tell you about something that happened.

If you notice a change in a child’s behavior, emotions or school performance, pay attention. Some children react to sexual abuse by becoming withdrawn, depressed or anxious; others may act out with anger and aggression towards others. Some children may exhibit unusual sexual behavior. Some may internalize their emotions and suffer from headaches or stomach aches.

Certain physical signs may signal abuse. Unexplained bruises, bladder infections and rashes or sores in the genital area should be carefully evaluated by a health care provider. If a health care provider suspects abuse, it is mandatory that they report their suspicions to child welfare authorities.

If a child confides in you about sexual abuse, listen quietly and carefully. Tell the child that he or she did the right thing by telling you, and assure the child that you will take steps to protect him or her. Do not react with disbelief or anger; it is very rare for children to make up stories about sexual abuse.

To report abuse, call the Child Welfare office of your local Department of Human Services, or you can call a local law enforcement agency.

If you suspect a child is being sexually abused and need advice on how to proceed, there are several child abuse helplines that have staff specifically trained to deal with questions about suspected child sexual abuse. Call Darkness to Light’s helpline, (866) FOR-LIGHT to be routed to resources in your own community, or call the Child Help USA National Child Abuse Hotline, (800) 4-A-CHILD.

Kathryn B. Brown is a family nurse practitioner with a master’s degree in nursing from OHSU. Is there a health topic you would like to read about? Send ideas to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.dailyastorian.info