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A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.For information about the SORT evidence rating system, go to In contrast to normative sexual behaviors, sexual behavior problems typically involve other persons (but still may include solitary behaviors) and sexual contact.Developmentally inappropriate behavior can be defined as behavior that occurs at a greater frequency or at a much earlier age than would be developmentally or culturally expected, becomes a preoccupation for the child, or recurs after adult intervention or corrective efforts.17 For example, a child touching an adult's genitals or breasts would be age-inappropriate for an 11-year-old, but may be age-appropriate for a four-year-old.The type and frequency of normative sexual behaviors vary with the age of the child.8 Sexual behaviors in infants are rare, with the exception of hand to genital contact.
It can be challenging to discern whether sexual behaviors have escalated because of stress or whether one parent's perception and interpretation of the behavior has changed because he or she suspects the other parent has abused or neglected the child.
These other behaviors mirror normal psychosocial development and the emerging importance of peer relationships.
Sexual behavior can be solitary or involve other persons, and may or may not involve sexual contact 8 Children do not necessarily engage in sexual behaviors for sexual gratification; curiosity, imitation of observed sexual behaviors, attention-seeking, and self-soothing are other reasons children may behave sexually.711 In general, sexual behaviors that are solitary (e.g., touching one's own genitals) or that do not involve contact (e.g., trying to view another person's genitals or breasts) are common and frequently observed.8 Common, age-appropriate sexual behavior can become a sexual behavior problem if it is disruptive or coercive.
When parents present to a physician's office because of concerns about their child's sexual behavior, several issues typically arise: parent anxiety, the extent to which the behavior is disruptive in the home or school setting, the origin of the behavior, and effective management of the behavior.
Sexual behaviors in children are common, occurring in 42 to 73 percent of children by the time they reach 13 years of age.1A detailed history, including family stressors and changes, the child's access to sexual materials or acts, violence between the parents, and risk factors for abuse and neglect, assists in determining management and safety strategies for children with sexual behavior problems.
In general, sexual behaviors in children two to five years of age are of a greater variety and are more common compared with the behaviors in children older than five years.9 Once the child becomes aware of social rules regarding sexual behaviors in public, those behaviors become more covert.