A nurse is providing education to a group of school teachers on how to identify and report suspected cases of child maltreatment. The nurse explains that some of the common indicators of sexual abuse in children are:

Choice A Reason: Child abuse and neglect can occur in any family, regardless of socioeconomic status. Poverty is not a cause of child abuse and neglect, but it may increase the stress and challenges faced by families.
Choice B Reason: Children with disabilities or special needs are more likely to be abused or neglected than children without disabilities. They may have increased dependency, communication difficulties, or behavioral problems that make them more vulnerable to maltreatment.
Choice C Reason: Parents who were abused or neglected themselves are more likely to repeat the cycle with their own children. This is because they may have learned abusive behaviors from their own parents, have unresolved trauma, or lack positive parenting skills.
Choice D Reason: Child abuse and neglect can cause physical, psychological, and social problems for the child. The consequences of maltreatment can vary depending on the type, frequency, duration, and severity of abuse or neglect, as well as the child's age, developmental stage, resilience, and coping skills.
Choice E Reason: Child abuse and neglect cannot be prevented by increasing social support and resources for families alone. Prevention requires a comprehensive approach that involves multiple levels of intervention, such as individual, family, community, and societal factors. Prevention also requires raising awareness, changing attitudes and behaviors, strengthening laws and policies, and improving services for children and families.

The correct answer is D. All of the above are common indicators of sexual abuse in children.

Choice A Reason: Difficulty walking or sitting may indicate that the child has been subjected to genital trauma or anal penetration.

Choice B Reason: Frequent urinary tract infections may indicate that the child has been exposed to sexually transmitted infections or has poor hygiene due to lack of care or supervision.

Choice C Reason: Changes in behavior or mood may indicate that the child is experiencing fear, anxiety, depression, anger, guilt, shame, or confusion as a result of the sexual abuse.