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Publication: Pediatrics for Parents
Date published:
Language: English
PMID: 36054
ISSN: 07306725
Journal code: PDFP

You are standing in line at McDonalds, tired after a long day at work, with David, your 3-year-old son, strapped in his stroller. Gazing off for a few seconds as you wait your turn to order, your focus suddenly snaps back into place as the teenage boy in front of you is snickering and pointing to your son; other heads are turning as well. Alarmed, you look down and to your horror, David has pulled his newly earned "big boy pants" outward and has his hand thrust down into the so-called "private parts." What do you do? How worried should you be?

Sexual behavior in children can elicit a range of responses from their parents, from embarrassment to anger to concern. While most sexual behaviors are normal, it is important for clinicians and parents to recognize situations that require a more comprehensive evaluation by a physician or a specialist.

Sexual behaviors encompass a variety of activities including touching and looking at genitals, and talking about sexual topics. Sexual behaviors may involve one or more children. The types and frequencies of normal sexual behaviors vary significantly with the age of the child. Children younger than six years are more likely than children ages 6-12 to be observed touching their genitals, and trying to touch and view other people's genitals or breasts. Children six and older still engage in sexual behaviors, but rarely in view of others, and show progressive interest in the opposite sex and in discussing sexual topics with peers.

In general, children's sexual behavior tends to parallel their development: curiosity and exploratory behavior in younger children includes interest and discovery of body parts, including their genitals and the physiologic responses from genital touching, and increase in peer activities and socialization includes interests in different levels of relationships, including sexual. Periodic increases in these normal behaviors may occur when the child enters daycare, has a new sibling, or experiences stress.

Sexual behavior that is inappropriate for the child's age or development, or that causes emotional distress or physical pain, is not normal behavior. Examples of behavior that merit an evaluation by a professional include: one child forcing or threatening another child into a sexual act; sexual behaviors involving two children four or more years apart in age; normal sexual behavior that is abnormally frequent, disruptive to others or difficult to distract or stop; asking an adult to perform a sexual act; and actual insertion of objects into the genital or rectum. Possible causes for these abnormal sexual behaviors, also known as sexual behavior problems in children, include aggressive behavioral disorders, such as conduct disorders or oppositional defiant disorder, family violence, exposure to harmful pornographic or other sexual acts, and child abuse and neglect.

What should a parent do? When the behavior is normal for the child's age, gentle redirection when necessary (i.e., in the classroom or in public) is appropriate; if the parent becomes angry or distressed, then the child may become confused (genitals are "bad") or amused (good way to get mom's attention, pronto, and fun to watch her face turn red!).

When normal behaviors increase in frequency or number, the parent should consider any recent changes that may be contributory: new sibling, new daycare arrangements, access to sexual material in the home, nudity, and recent Stressors such as parent strife or separation. As the child adjusts to such changes, the behavior should change as well. If the sexual behavior is abnormal, then the parent should consult with a professional, remembering that abuse or neglect of their child is just one of several possible causes. In fact, only 28% of sexually abused children develop sexual behavior problems. If a child tells you he has been abused, or you suspect abuse or neglect, a report to your child protection agency or law enforcement is required by law.

So what should our mom at McDonald's do? A gentle distracter, such as lifting David up out of the stroller, or giving him a toy to busy his hands would work best. No need to worry, as you know this is normal behavior for a 3-yearold. And ignore the smirks (or tell the teenager that he probably did the same thing when he was that age!).

Author affiliation:

By Nancy D. Kellogg, MD

Author affiliation:

Dr. Kellogg is a professor of pediatrics and Division Chief of Child Abuse at the University of Texas Health Science Center at San Antonio. She has worked in the field of child maltreatment for more than 20 years and has authored many articles and book chapters. Dr. Kellogg has been the recipient of numerous awards for her clinical work, teaching, and leadership.

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