While internal injuries are seldom detectable without a medical exam, anyone in close contact with children should be alert to multiple injuries, a history of repeated injury, new injuries added to old, and untreated injuries. Mental Injury Injury to the psychological capacity or emotional stability of a child as evidenced by an observable or substantial impairment in the child's ability to function within a normal range of performance and behavior, with due regard to the child's culture. Mental injury does not include reasonable training or discipline administered by the person responsible for the child's care, or the reasonable exercise of authority by that person. The presence of the behaviors described above should be evaluated by a mental health practitioner to determine the etiology of the behaviors, since there may be factors other than mental injury that contribute to the development of a particular disorder. A person responsible for the child's care or a person in a position of authority has sexual contact with a child under the age of 18 that violates the criminal sexual conduct code, engages a child in prostitution, or engages a child in sexual performance.
Sexual contact includes fondling, touching intimate parts, and sexual intercourse.
Sexual abuse also includes the use of a child in production of sexually explicit works, or knowingly allowing a child to engage in the activities described in this paragraph. Since the sexually abused child may lack the outward symptoms of physical abuse, sexual abuse can be difficult to identify. Children often do not always know how to express or explain what has happened to them because they are afraid, confused or ashamed. Children may not be developmentally capable of understanding or resisting the contact. Possible indicators of sexual abuse may be a sudden change in behavior and signs of emotional disturbance.