Sexual and Sexualized Behavior in Children : Overview
Key Concept
There is no concept more important for parents and caregivers to understand than the fact that sexual/genital arousal is an autonomic impulse. Children experience genital sensations and react to them in different ways. An infant and toddler will touch their genitals as a form of self-soothing. As children get older the touch may be more intentional. By the time a child reaches adolescence, they should have a full understanding that genital feelings simply mean that their bodies are maturing and working correctly; genital feelings carry no emotional meaning. Ignorance of this fact carries multiple dangers; ephebophiles (offenders targeting teens) often convince victims that their genital feelings are actually emotional. Victims of any age can be lulled into thinking they were willing participants because of their bodily response, adding confusion and guilt to the victimization. Conversely, a sexually aroused adolescent with developmentally normal lack of impulse control and immature executive brain functioning may impose that arousal on a peer or smaller child, believing that the other person caused their arousal and is therefore a party to relieving it. Understanding autonomic sexual arousal is a key message in preventing victimization. In addition, parents/caregivers can be coached to be mindful to not inadvertently teach children to associate feelings of guilt or shame with genital arousal.Childhood Sexual Development: Normative, Cautionary or Problematic Behavior?
The following lists are adapted from The National Center for the Sexual Behavior of Youth https://www.ncsby.org/children.
Normative Sexualized Behaviors
- Voluntary, infrequent spontaneous
- Easily diverted when adults tell children to stop and explain privacy rules
- Interaction that involves sexualized body parts between children of the same general age and physical size (and power status)
- Interaction that occurs among children who know each other
- Not accompanied by strong uncomfortable or upset feelings
- May not be appropriate for the setting/location
Other than reassuring a parent/caregiver, normative behaviors require no intervention. Parents may use what they observed as an opportunity to share their values with the child.
Cautionary
- Not suitable for the location (e.g. school, faith community)
- Normative behavior, but more frequent than typical for the child’s age
- Not currently harmful or distressing to self or others
- Occurs despite adult intervention
- Typical sexual behavior, but technology is involved, such as taking pictures of private parts
Parents/caregivers should be coached to gently intervene using an educational tone rather than a punitive tone when advising the child to stop or modify these behaviors.
Problematic
- Causes harm or potential harm or distress to any child
- Involves strong upset feelings such as anger and anxiety
- Involves force, coercion or aggression
- Occurs among children of different ages or functioning
- Continues to occur despite intervention by caregivers or other adults
- Preoccupied with sexual content and topics
Parents/caregivers may need support to identify a properly trained professional. Contact your local Child Advocacy Center to identify an appropriately trained professional. Be aware that most evidence-based intervention models involve the family in the treatment process.
Physician’s roles:
When a parent/caregiver reports problematic sexualized behaviors
A pediatrician may ask some general questions to help gauge severity and ideology. The following list was adapted from Kellogg ND. Sexual Behaviors in Children: Evaluation and Management. AAFP. 2010.https://www.aafp.org/pubs/afp/issues/2010/1115/p1233.html.
General Questions to Ask
- When was the behavior first noticed? Have there been any changes or stressors in your family?
- Does the behavior involve other persons? If yes, what is the age difference?
- How often have you seen the behavior? Is the nature or frequency changing?
- Can the child be easily distracted from the behavior? How do you (parent/caretaker) respond to the behavior?
- Where does the behavior occur? Only in one location (e.g., school) or multiple locations?
- Is the activity disruptive, coercive or forceful?
- Does the child become anxious or fearful during the behavior? Has the child been diagnosed with emotional problems?
- Is there any violence going on in the home?
- Does the child have, or has had, access to sexual materials, acts or information including pornography?
- Has anyone spoken to the child about possible abuse?
If the behavior is deemed to be problematic, parents should be advised to seek support from an appropriately trained professional.
When offering anticipatory guidance to help parents/caregivers understand and promote healthy sexual development
Children grow and develop physically, socially and emotionally in predictable ways, and require different types of support at different ages.
At any age, children need to know
- Which behaviors are OK and which are not
- The correct name and functioning of their genitalia
- That parents can be a trusted source of information
For more information see: The New York Initiative to Prevent Child Sexual Abuse website: https://www.nypreventsexabuse.org/healthy-sexual-development and their handout Healthy Child Sexual Development.
When a family believes sexual abuse may have occurred
Parents/caregivers are generally devastated if they believe their child has been sexually abused; their trusted medical provider is often a first call. Offering them emotional support is, of course, critical.
In New York, as in most states, medical providers are mandatory reporters, which means a call should be placed to child protective services (CPS). For see the REPORTING chapter for more information on mandatory reporting.
If the alleged abuse is relatively recent, and the allegations imply that there might be physical evidence, the first genital exam should be completed by someone specifically trained in gathering forensic evidence. A child abuse provider can also determine if the condition they are seeing was caused by sexual abuse or a medical condition. For example, vaginitis can be caused by changes in the vaginal Ph, or overexposure to harsh cleansing products. For more information see the Triage chapter on referrals.
When a family believes their child or teen may be sexually attracted to children
A parent or caregiver may have observed concerning behavior in their child and trust their medical provider enough to seek advice. If a parent thinks that disclosing details of their concern might lead to legal intervention, they may present hypotheticals, or sketchy details. The Your Guiding Principles for professionals on the National Center for the Sexual Behavior of Youth website can be helpful: https://www.ncsby.org/professionals. The safety of all children is the primary consideration.
