In over 90 percent of child sexual abuse cases, the offender is known and trusted by the victim.  Grooming is the process used by the offender to recruit and prepare a child for sexual victimization. It starts when the offender targets a specific child.  While all children are at risk for victimization, certain factors make some children more vulnerable to sexual abuse than others.  For example, a child is especially susceptible if he or she feels unloved, has low self-esteem, has little contact with committed adults or regularly spends time unsupervised.

Sex offenders commonly engage children by spending time with them, playing games with them, showing them special attention or giving them gifts. Older children or teens may be offered drugs or alcohol.  Offenders forge an emotional bond through frequent contact, positive interactions and by conveying to the child or teen that they "understand" or can appreciate their interests and concerns.  They become adult friends or confidantes. 

In time, the emotional bond leads to non-sexual physical contact which can take the form of physical play such as wrestling, affectionate touching, giving back-rubs etc.  In this way the offender tests the child’s boundaries and gradually desensitizes the child to overt sexual touch.  Usually secrecy is introduced during the grooming process and as the child starts to become uncomfortable or fearful of the sexual activity, offenders typically use threats to keep the child from speaking up (e.g., if you tell, I will hurt you, you will get into trouble, no one will believe you).  Most child victims are caught in a web of fear, guilt and confusion as a result of sex offender grooming and manipulation.  Sadly, many child victims remain silent about their abuse.

Indicators of child sexual abuse are varied and should always be considered in the context of what else is happening in a child's life. Any one indicator, on its own, is but one sign that something may be impacting a child's well being.

Behavior Indicators

• Unexplained change in a child’s comfort level (either attachment to or fear of) around a family member, an adult close to the family or any person in a position of trust or authority for the child.
• Abrupt changes in performance in school or work.
• Abrupt changes in how the child socializes, either being out with friends or being in the house more often.
• For younger children, a sudden loss of skills, like a child who is toilet trained starts wetting the bed.
• Extreme avoidance of someone the child once liked or avoidance of a certain house or room in a house.
• Sexualized behavior, often in front of others; such as self-exposure, excessive masturbation, touching other people's private parts, sexually charged language. In older children or teens this might be seen as promiscuous behavior.
• Language and knowledge, especially specific details, which are not appropriate to the child’s age or has not been taught or shown in school or the child’s household.

Physical Indicators

• Bruises, scratches, irritation/itching around genitals that are not consistent with explanations of how they happened.
• Signs of any sexually transmitted diseases or infections such as crabs, herpes, gonorrhea, etc. for those who are not sexually active.
• Unexplained pregnancy.
• Tenderness or soreness around areas of penetration.
• Blood in stool or urine that is pervasive and not explained by other conditions. Underwear is often where proof of abuse may exist.

The speed and success of the child survivor's recovery depends, in large part, upon the degree to which these five factors played a role in the assault.

1. Degree of intimacy/acquaintance between the victim and offender
   
   Nearly all child sexual abuse cases involve offenders known to the child, such as by a caregiver or family acquaintance. The most highly reported cases of incest involve a father and daughter. The entire family unit is often dysfunctional in cases of incest.
   
   Assault committed by a relative or caretaker is often more traumatic to the child victim because the child's trust has been betrayed and sense of personal safety within the family is disrupted. The child may also feel betrayed by other family members (mother, siblings) who the child feels could have or should have intervened but did not.
   
   
2. The time over which the abuse occurs
   
   Long-term, repeated abuse (characteristic of incest) is more traumatic to the victim than a single incident of assault (characteristic of stranger assault) because the long-term abuse may involve extreme psychological pressure, causing confusion and guilt in the child. A child is more likely to report a one-time event to parents or other caregivers, who may then help the child understand what happened.
   
   
3. The relative intrusiveness of the abuse
   
   Incest situations generally involve abusive contact that progresses from lesser, though still traumatic contact (such as sexual talk, showing pornography, unwanted affection or contact) to more intrusive abuse (such as penetration) over time. The more intrusive the contact (such as penetration, oral sex, genital fondling) is the more traumatic it can be for the child.
   
   
4. The way in which the child was engaged in "sexual" activity
   
   Actual physical violence may increase the trauma of assault for the child, but a victim who was tricked into sexual activity may have a more difficult time recovering from assault later. As with adult victims who were not physically harmed, the child victim who was emotionally overpowered may not be believed as readily by others, and may feel that he or she could have done something to stop or prevent the abuse.
   
   
5. The response of the person to whom the child discloses the abuse
   
   If the person the child victim discloses the abuse to reacts with disbelief, anger, blame or indifference, it can re-traumatize the child and seriously undermine their recovery.