Tuesday, September 9, 2014

Is it Normal or Not: Considerations for Childhood Sexual Behavior

Is finding children "playing doctor" or exploring each other bodies normal or not?
Finding two boys age 5 in the school bathroom exploring each other genitals is not purely indicative abuse or related to sexual orientation, but rather behavior that is well within the realm of normal range of sexual development for their age. As early as 3 years of age a child becomes interested in the bodies of others (Rogers, 2009). It is indicated that during the age of 3-5 yrs the sexual behaviors rate of occurrence and of variety increases before seeing a decline as children learn social behavioral rules concerning sexual behavior (Rogers, 2009). Studies indicate that more than 50% of children will engage in some form of sexual activity before the age of 13 (Kellogg, 2009). Since childhood education and instruction on the healthy sexual behavior and development by parents and schools can influence the decline inappropriate childhood sexual behavior situations involving child sexual behavior should first be should be differentiated from situation with abnormal sexual behavior for the age and then handled appropriately for the situation.
Many things can contribute to sexual behavior in children starting when recognition of physiologic gender differences occurs during pre-school years and contributes to curious “viewing and touching of other children's genitals” (Kellogg, 2009). Many other individual things such as family attitudes toward nudity and sexuality and exposure to “sexual acts or materials” including the degree of supervision and related exposure to stressors such as violence, parental absence, death, or illness and abuse all can affect type, duration, and frequency of sexual behaviors in children (Kellogg, 2009). However, simply being new to shared bathroom experiences and suddenly seeing another’s privates such as in a new school setting can also influence childhood sexual behaviors. There is a positive correlation between times spent in child care and more sexual behaviors indicating that simply more time outside parent supervision can provide children with more opportunity to explore sexual behaviors with other children (Kellogg, 2009). 
Nevertheless, sexual behavior in children should be examined in the context in which it happens with each child to help differentiate between normal sexual behavior and sexual behavioral problems. Once addressed by parents and teachers normal sexual behavior usually declines after the age of five, so persistent sexual behavior especially after proper instruction on appropriate childhood behavior with others should be examined more carefully (Kellogg, 2009). Although childhood sexual behavior can be indicative of sexual abuse it is very likely that this would also be reflected in the child involved in other manners such the co-morbid depression, anxiety or other internal representations of abuse such as withdrawal or/and externalizing symptoms such as “aggression, delinquency, and hyperactivity” (Kellogg, 2009). Clear sexual behavior that indicated an advanced understanding of sexual behavior for their age such as “mouth on genitals, asking to engage in specific sex acts, imitating intercourse, inserting objects into the vagina or anus, and touching animal genitals” would also warrant further examination (Kellogg, 2009). However, none of these acts still mean a positive correlation to sexual abuse. One study indicated that amongst a normative study sample of children that included the study of studying 38 sexual behaviors seen in children that all were observed in at least some of the children indicating that there is no single sexual behavior that is a “pathognomonic sign of sexual behavior problems or abuse” (Kellogg, 2009).
Because sexual behavior is normal in all children seeing sexual behavior in any childhood gender group setting should is not indicative ones sexual orientation, but is usually demonstrative of rather normal sexual development. Research generally supports the notion that children recognize their own sexual orientation from a very young age (KidsHealth, 2014). Many persons report understanding their sexual orientations by the time they are in middle school as they enter adolescence (KidsHealth, 2014).  Sexual orientation is considered part of personal natural state of being or nature (KidsHealth, 2014). There is no evidence that any behavior including early sexual behavior is associated with sexual orientation or a change in their natural orientation (KidsHealth, 2014).
Upon discovery of children engaging in childhood sexual behavior care givers should address the situation to stop said sexual behavior with caution as to not scare or shame children but rather to inform them of the correct way of playing with other children (Rogers, 2009). After said sexual behavior is stopped having a discussion with the involved children privately about normal sexual curiosity and age appropriate behavior with others can help prevent future sexual behavior (Rogers, 2009). Providing after thoughtful evaluation the situation seems within realm of natural or normative childhood sexual behavior not all sexual behavior needs to be reported to the doctor or health care professional (Rogers, 2009). However, because their actions speak volume of the underlying sexual curiosity speaking with the child about age appropriate social behavior and sexual development to provide them with age appropriate information is important to thwart future unwanted sexual behavior. Observation of future play between children involved in childhood sexual should be included to ensure the behavior does not continue unaddressed and unusual sexual behavior for the age is not present (Rogers, 2009).Parents of the children involved in childhood sexual behavior should always be informed so they may have talks with their children that include their own cultural values about sexuality and practice.
The article “Adolescent Sexuality and Disability” (2002) viewed childhood sexuality as a normal part of human development. The article reviewed the psychosexual development of children and asserts that all children including those with visible and non-visible disabilities develop sexuality (Greydanus, Rimsza, & Newhouse, 2002). A very large point of the article was that being disabled may delay maturation in some cases it does not stop the sexuality development process (Greydanus, Rimsza, & Newhouse, 2002). In fact, some adolescent with disabilities, like for example those with non-visible or non intellectual disabilities, may even be equally or even more so sexually active than non-disabled peers (Greydanus, Rimsza, & Newhouse, 2002). Therefore, sexual education and sexual health care such as appointment for gynecology is equally important in children with disabilities and should not be ignored (Greydanus, Rimsza, & Newhouse, 2002). Failure to educate a developmentally, mentally or physically challenged adolescent can result in many unwanted affects such sexual dysfunction, unwanted pregnancy, STD’s, sexual abuse, and even inappropriate sexual behavior (Greydanus, Rimsza, & Newhouse, 2002).   
All humans are sexual beings including those developmental or intellectual challenges and disabilities. Therefore, appropriate child sexuality development is something that needs to be considered by every parent, childcare work, and/or health care professional working with children. During middle childhood (5- 10) children may begin to explore family values into sexuality and family, friendship, and other human relationship are at the core sexuality development during this age (Bright Futures, 2014). As early as age 7- 10 sexual maturities can be rated by health care professional (Bright Futures, 2014). Therefore, if parents are not comfortable speaking or adequately informed about sexuality related concepts such as puberty, proper hygiene, disease prevention, and rights to privacy concerning one’s body can and should be addressed with a health care professional and developmentally proper advice given. Proper education from parents and appropriate care givers such a councilors, doctors or even the school nurse concerning age appropriate sexual behavior and development can discourage children from acting sexually in social situations as well as avoid unnecessary shame for sexual curiosity and development. Additionally, by providing proper instruction on normal and abnormal sexual behavior for the child including safety, hygiene, culture and family sexuality beliefs and values the child is more likely to engage in sexual practices that are safe and culturally acceptable as well as avoid sexually transmitted infection and know when and how to report sexual behavior that is unwarranted.

Bright Futures. (2014). Guidelines for Health Supervision Of Infants, Children and Adolescents: Promoting Healthy Sexual Development. Bright Futures. Retrieved from http://brightfutures.aap.org/pdfs/Guidelines_PDF/9-Promoting-Healthy-Sexual-Development.pdf
Kellogg, N. D. (2009). Clinical Report: The Evaluation of Sexual Behaviors in Children. Pediatrics. Vol. 124 No. 3 pp. 992 -998 (doi: 10.1542/peds.2009-1692) Retrieved from http://pediatrics.aappublications.org/content/124/3/992.full
KidsHealth. (2014) Sexual Orientation. The Nemours Foundation. Retrieved from http://kidshealth.org/parent/emotions/feelings/sexual_orientation.html#