Title: Clinical Report—The Evaluation of Sexual Behaviors in Children | American Academy of Pediatrics
Headings: Clinical Report—The Evaluation of Sexual Behaviors in Children
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Clinical Report—The Evaluation of Sexual Behaviors in Children
Abstract
INTRODUCTION
DIFFERENTIATING NORMAL SEXUAL BEHAVIORS FROM SEXUAL BEHAVIOR PROBLEMS
Types of Sexual Behaviors
Age
FACTORS THAT AFFECT FREQUENCY AND TYPES OF SEXUAL BEHAVIORS
Situational Factors
Environments in Which Sexuality Is More Open
Family Dysfunction and Stress
Children With Developmental Disabilities
Abuse and Neglect
Comorbid Diagnoses
CLINICAL ASSESSMENT AND TREATMENT
PARENTAL GUIDANCE
CONCLUSIONS
COMMITTEE ON CHILD ABUSE AND NEGLECT, 2008–2009
LIAISONS
STAFF
Footnotes
REFERENCES
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Subjects

Content: 9 Fewer than 1.5% exhibit any of the following: putting the mouth on genitals, asking to engage in specific sex acts, imitating intercourse, inserting objects into the vagina or anus, and touching animal genitals. 9 Such behaviors do not necessarily imply the child has been sexually abused but do merit further assessment. Among normative study samples of children, all 38 sexual behaviors that were studied were observed in at least some of the children, 10, 11 which suggests that there is no single sexual behavior that is a pathognomonic sign of sexual behavior problems or abuse. Normal sexual behaviors usually diminish or become less apparent with redirection and admonishment from the parent, and although such behaviors may result in feelings of embarrassment in the child, feelings of anger, fear, and anxiety are uncommon. 7
Sexual behaviors that involve children who are developmentally dissimilar or use of coercion and control by 1 child are abusive. 12 Distinct developmental differences occur when children are at least 4 years apart in age or cognitive abilities. Children who are fewer than 4 years apart in age may still engage in abusive sexual contact when 1 child uses physical force or threat of harm against the other child. Abusive behaviors generally occur without other witnesses, and threats to “keep the secret” are common. Abusive sexual behaviors require immediate and effective intervention.