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The type and frequency of normative sexual behaviors vary with the age of the child. 7 Children who have been sexually abused who develop sexual behavior problems are sometimes referred to as sexually reactive youth. In contrast, sexual behavior problems, also referred to as sexual acting out, and sexually abusive behavior generally refer to sexual behavior that is developmentally inappropriate, coercive, or potentially harmful emotionally or physically. The terms “sexual play” and “sexualized behaviors” generally refer to developmentally appropriate behaviors that are often observed in children with no known risk factors for abuse these are also referred to as normative sexual behaviors. Several terms have been used to describe sexual behaviors in children. Management strategies should focus on appropriate parental response to the behaviors, effective distraction from the behaviors in social settings, reviewing indications for further assessment, referrals for counseling if the behavior persists, and reporting to child protective services or law enforcement agencies (in accordance with state laws) when abuse is suspected. Physicians can be valuable resources for parents by providing anticipatory guidance about common sexual behaviors in children, and by differentiating age-appropriate normative sexual behaviors from sexual behavior problems. 5 However, sexual behavior that is developmentally inappropriate requires an evaluation of additional factors, such as conduct and behavior disorders in the child, and violence, abuse, and neglect in the home. Contemporary television and music provide more frequent exposure to sexual material there are an average of eight sexual acts per hour on television, an increase of more than fourfold since 1976. For example, recent technology, such as the Internet, chat rooms, and texting, has expanded the way children are exposed to sexually explicit information. Sexual behaviors can be prompted or modified by several factors: normal development, parent reaction to the behavior, changes in family stressors, and access to sexual material. For information about the SORT evidence rating system, go to. 4Ī = 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. 1 – 3 Because child sexual abuse has received considerable media attention, it is not unusual for parents to be concerned that sexual behavior means their child has been sexually abused. Sexual behaviors in children are common, occurring in 42 to 73 percent of children by the time they reach 13 years of age.
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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. Although age-appropriate behaviors are managed primarily through reassurance and education of the parent about appropriate behavior redirection, sexual behavior problems often require further assessment and may necessitate a referral to child protective services for suspected abuse or neglect.
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Children who have been sexually abused at a younger age, who have been abused by a family member, or whose abuse involved penetration are at greater risk of developing sexual behavior problems. Although many children with sexual behavior problems have a history of sexual abuse, most children who have been sexually abused do not develop sexual behavior problems. Such behaviors should be evaluated within the context of other emotional and behavior disorders, socialization difficulties, and family dysfunction, including violence, abuse, and neglect. Sexual behavior problems are defined as developmentally inappropriate or intrusive sexual acts that typically involve coercion or distress. Sexual behaviors become less common, less frequent, or more covert after five years of age. Developmentally appropriate behavior that is common and frequently observed in children includes trying to view another person's genitals or breasts, standing too close to other persons, and touching their own genitals.