Q. I am concerned about the behaviour of my four-year-old daughter.
When she was around three years old, I found her lying down, rubbing her groin area against the floor.
Since then, I have found her doing the same thing on several occasions.
Lately, she would hide or lock herself in the room. I found out that she was rubbing herself on the floor again. Upon my questioning, she told me that she liked that "feeling".
No one had taught or showed her that action and she has not been touched inappropriately at school. She does not have Internet access.
I am worried that when she enters puberty or learns about sexuality, she may connect what she learns to this "feeling" and actively seek a promiscuous lifestyle to satisfy it.
Are preschoolers' bodies and sexual organs developed enough to experience arousal and orgasms?
Is there a specialist I can consult?
A. It is important for your child to be assessed by a paediatrician to explore the possibility of a physical condition or disorder, such as an infection of the genitalia region, epilepsy-related movement or a specific movement disorder.
Once those reasons have been ruled out, an opinion from a child and adolescent psychiatrist or psychologist may be sought.
The movements you described appear to be in line with infantile masturbation.
Masturbation in childhood was recognised as far back as 1909.
It can begin at the age of two months and peak around four years old. The masturbation may go unnoticed as the use of hands and fingers can be absent.
The child may assume a particular posture or lie prone in order to place pressure on the genital area. There can be rhythmic rocking of the body in such positions.
It may also take the form of rubbing the thighs together or lying prone with rhythmic pelvic thrusts.
In some children, vocalisations in the form of grunting may be made. Their faces may be flushed and they may be sweating. There may be a perceived sense of gratification and they may be upset or angry if interrupted.
As part of the assessment, the clinician may wish to explore the possibility of sexual abuse or trauma.
Most children with this behaviour have no prior history of abuse, but masturbation has been observed in some sexually abused children.
Skin irritation or infection in the genital area can result in rubbing of the genitals, and should be treated.
Infantile masturbation is often a normal occurrence in a child.
It should be viewed as a normal behaviour that arises from the child's random exploration of his own body.
It can be viewed as a harmless habit that falls in the same category as thumb-sucking.
Distract, don't punish
Scolding, threatening, or efforts to stop the behaviour forcefully may only reinforce the behaviour and possibly instil a sense of shame or wrongdoing as the child gets older.
Redirection and distraction with other engaging activities may be more useful than punishment.
If the child is old enough to comprehend things, then you can set boundaries of how such behaviour is not appropriate in public areas or at school. This can also be helpful in avoiding unwanted attention.
It may be easier to give the behaviour an innocuous name such as "stretchies" to encourage open communication and avoid making the matter seem taboo.
Lastly, it is important to recognise that such behaviours do subside as the child gets older and that most of the time, the overall development of the child would be normal.
Dr Vicknesan Jeyan Marimuttu
Associate consultant, child and adolescent mental wellness service, department of psychological medicine, KK Women's and Children's Hospital
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