School teachers or nurses often know or suspect that something is amiss with a child long before overt symptoms become apparent to others. School personnel have both moral and legal obligations to help students experiencing problems and to report suspected child abuse. However, incest persists because of the lack of dealing openly with it. Physical indicators of incest include unusual genital odors, difficulty in walking or sitting, and complaints of pain or itching in the genital area. Behavioral indicators include unusually seductive manners, unwillingness to undress, reluctance to go home after school, withdrawn or infantile behavior, overly sophisticated knowledge of sexual acts, and use of drugs or alcohol. Familial indicators include parental jealousy or overprotection of the child, isolation of the child and family members in the community, restrictive control of female children by the father, or a father with a history of frequent drinking or abuse of other family members. Prevention efforts should include efforts to create awareness, provision of training for lay persons and professionals, school health education programs, and programs to followup families that move frequently. Schools should be leaders in the efforts to deal with and prevent child sexual abuse. 21 references and guidelines for interviewing the child and parents, making reports and referrals, and counseling and followup.