When one Utah mother heard her preschool-age daughter had been touched by a classmate during a trip to a school restroom, she called the cops.
What some experts say should have been recognized as normal childhood curiosity about gender differences and body parts instead led to a police investigation and interviews with both children.
It's the kind of scenario that a new report published today in Pediatrics aims to help parents, pediatricians and others understand. The article is the work of the American Academy of Pediatrics' Committee on Child Abuse and Neglect.
The article is intended as a guide to help pediatricians distinguish normal sexual behavior -- which more than 50 percent of children will engage in before age 13 -- from behavior that indicates a problem or abuse.
It also offers guidance about "when to worry and what to do" for parents, who often find their children's sexual behavior "embarrassing and sometimes alarming," said Nancy Kellogg, a Texas pediatrician and lead author of the report, prepared over two years.
"This article does provide some reassurance that some of these behaviors are normal," Kellogg said in an e-mail interview.
The article outlines sexual behavior in children ages 2 to 6, which ranges from "normal, common" -- looking at and touching a peer's genitals -- to "rarely normal," such as daily displays of sexual behavior. What distinguishes them?
Inappropriate behaviors are "frequent, intrusive or abusive," the report said, and require a more comprehensive assessment.
The article notes that there is a correlation between sexual abuse and sexual behavior problems in children, but newer studies point to other sources of stress -- including family and environmental characteristics, such as neglect, domestic violence or parental illness, incarceration or death.
The report cites research that found 68 percent of children with sexual behavior problems witnessed intimate partner violence between caregivers. An analysis of 13 studies of sexually abused children found 28 percent had sexual behavior problems; other smaller studies report higher percentages.
Generally, problematic sexual behavior occurs when no one else is present and includes threats to "keep the secret," the report said. Studies show no single sexual behavior alone is a sign of a problem or abuse.
As for normal behavior, it occurs more frequently in preschool-age children, is transient and is easily redirected by a parent or caregiver.
Girls are as likely as boys to engage in sexual exploration; the behavior typically diminishes after age 5.
"Younger children are less aware of breaches in personal space and how their behavior may be construed as sexual or inappropriate," the report said.
Children new to a foster home or in child care settings may engage in a greater variety and frequency of disruptive sexual behavior, it said. Other triggers include the birth of a new sibling, seeing another child or adult in the bathroom or watching a mother breastfeed.
Children from families where nudity, co-bathing and less privacy in the bathroom and bedroom occur are more likely to openly engage in sexual behaviors, too.
The report says "most situations that involve sexual behavior in young children do not require child protective services intervention."
"Curiosity probably drives normal sexual behavior," said Cheryl Wright, chairwoman of the Department of Family and Consumer Studies at the University of Utah and an associate professor of early education.
Yet "most parents and [caregivers] are very uncomfortable with children expressing their sexuality," she said.
But how a parent or other caregiver reacts to normal sexual behavior is key.
"Small children may occasionally touch their genitals because there is irritation or for self-soothing reasons," Kellogg said. "If a parent suddenly says or shouts, 'Don't do that! That's dirty/disgusting/a no-no,' children may learn that genitals are shameful and anything relating to genitals should be kept secret.
"If a parent says, 'Why are you doing that? Did anyone touch you?' young children may say yes because they think the parent wants them to, even if sexual abuse has not occurred," she said.
Instead, a parent or caregiver should gently redirect the behavior if it is inappropriate or distracting -- such as when it occurs in a public place.
"Our teachers just try to intervene, disrupt the behavior, but nothing that shames or embarrasses," Wright said.
Normal, common sexual behavior in children ages 2 to 6 » Touching or masturbating, viewing or touching a peer's or sibling's genitals, showing genitals to a peer and trying to view peer or adult nudity -- all behaviors that are "transient, few and distractable."
Less common but still normal behaviors » Rubbing against others, touching a peer or adult's genitals and crude mimicking of movements associated with sexual acts. Behaviors may be disruptive to others, are transient and "moderately responsive to distraction."
Uncommon behaviors observed in normal children » Explicit imitations of intercourse, asking a peer or adult to engage in specific acts and inserting objects into genitals. Such behaviors merit further assessment to rule out sexual abuse.
Rarely normal behaviors in children ages 2 to 6 » Behaviors that involve children who are four years or more apart in age, are displayed on a daily basis, result in emotional distress or physical pain, include coercion or physical aggression, are persistent, and when the child becomes angry if distracted. These behaviors require immediate and effective intervention, the report said.
Source: The Evaluation of Sexual Behaviors in Children, Pediatrics
