Sexual and Sexualized Behavior in Children : 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.
