Is there a boyfriend living with the little girl's mom? Relatives or friends visiting frequently? How is her brother's behavior? The first case seems normal. I also agree that the second case should be investigated for sexual abuse.
Our trees are bare, and covered with a light layer of snow. There are some evergreens. I dislike the cold. It's like "Snow Falling on Cedars". (That was a good book.)
my now 9 yo use to hump the bed post up until about age 7--well it was more like he would grab it and wrap his legs around it and squeeze. i finally asked him why he did it and after much coaxing he would admit it felt good. when i would find him doing it i would not make a big deal about it just tell him to get down and find something else for him to do. he got over it.
I agree. The first kid is normal- the second is probably normal but needs a little counseling to be sure. Never underestimate the things a kid can do to get attention from divorcing parents.
Even in the 3 year old-------just ignore it---it's not pathological . The Victorian mindset that still exists in America is the only thing that is truly pathological . I won't be surprised if I see a post on this topic that states " the family needs to pray more ." In the toddler years this is absolutely normal---but we can make it an eventual problem by overacting to it !! How many Peds would refer a 4-5 year old boy for "touching his penis" too frequently.
I agree that the first case sounds pretty normal.
I am a little worried about the girl using the toy as part of her behavior. Is she acting out something she has seen or something that has been done to her? In her case, I would think referral for a sexual abuse evaluation is appropriate.
The 2 year old is normal, and seems to be weaning off. The 3 year old is another story. The "humping" bothers me less than the apparent stress of the separation. This should be dealt with. She is at risk for abuse, but I don't hear of evidence.
Little girls in front of the TV humping Barbie until they flush and gasp, little boys pulling on their penises in the bath, etc., etc.,etc. Pretty much all normal and pretty much just need to be told that we are the only ones who play with our own private parts and private means we do it privately.
The worst one was a four year old girl getting pretty explicit all the time. I had been seeing her since birth. I sat down and asked mom what was going on. Mom explained that dad had been out of town on business for several months, mom had been on bedrest for two months for preterm labor then had the premie, grandparents had moved in to help and were fighting about grandpa getting friendly with a neighbor woman, and the long term baby sitter had had a seizure and been taken away by ambulance about a month earlier. We sent them all for counselling and family support and, as the stress dwindled, the humping dwindled and moved to privacy.
I am not too worried. In pediatric residency, one of my colleagues walked in on his two year old with "tickle me elmo" (the one that vibrated) in between her legs. We see kids in for referral for "seizures" and "stereotyped repetitive behaviors" all the time and the children are just self soothing.
Imagine my horror as a naive 20 year old day camp counselor when a 3 year old girl would self-stim shen she layed (lay?) down for rest time. When I mentioned it tio my supervisor, I was told that the parents are working with her to do it in private, and that I shouldn't give it any attention. THis 3 year-old figured out how to self-stim before I did!!!
Thanks for sharing all your personal and professional stories!
The first boy is the typical case that I don't really worry about. Parents just need some resassurance. I don't think it's necessarily a bad thing they videotaped it. Imagine the blackmail potential when that boy is a teen.
The second case I referred because there are many other stressors in the family's life: DV (dad hit mom in front of kids), mom finally left him and they are in a new place with new routines. The 5 year old brother is adjusting ok so far to all the changes. He's the one who found the girl with the Transformer telling his mom, "she is doing the no-no to my toy!" I don't highly suspect sexual abuse as she has been doing this since she could crawl. I think she is doing it more and now in public because of the recent changes. I think mom needs more support than I can provide.
This happens, usually normal. Once a kid got worked up bigtime for seizures--imagine the embarrassment when a fellow pointed out what was really going on. Anecdotally, I think it happens with smarter kids, if that's a consolation to the parents.
Notwithstanding Sermo Doc 14's kindly sharing his clinical experience, maybe a pediatric neurologic consultation on an outpt basis wouldn't be such a bad idea, just to play it 'safe', in either or both of these cases?
Definition of Behavior: Anything that is observed. The 3 year old has observed this herself somewhere and is now mimicking the same. Question is....where and why does she continue to do this? Is is exposure occurring on a regular basis?
Videos of very young children engaged in self-stimulatory behaviors are commonly shown in movement disorders conferences. It is always shocking to the uninitiated, but the conclusion is always the same: Normal behavior that will go away with time. No intervention needed. No further consultation necessary.
I agree with your assessment. The behaviors themselves are not too concerning. Kids discover what feels good and they do it. If they are doing it because it feels good - no worries. If, on the other hand, they associate it with some type of sexual behavior they have witnessed - another story altogether.
Your cases seem OK in that regard, though family separations are always difficult and therapy can always be helpful in those situations. Sounds like you were right on to me!
Man am I glad to hear that the general concensus is "normal behavior." When it comes to these sort of issues I often find overreaction by professionals as much as if not more than the lay public. I agree that counseling for the 3 year old is a good idea, but the whole family needs counseling not just the girl. Too much stress and no good outlet.
Sermo Doc 7 --- I find your response a bit troublesome. Not that your answer regarding the actual question is off base, per se, ....but that your unsolicited attack on anyone else's potential stance or view on the matter ("victorian mindset is still here" / "...pray more") seems almost socially pathologic, in that is seems "loaded", and ready to fire. What's up? Mom prayed too much when you were growing up? The Victorian period a tough period for you? Just curious...
I agree this is normal behavior. Doesn't need a neuro eval (even to "play it safe") for normal behavior. 2nd kid & family need couseling for stress anyway, and the couselor should be able to see if there are any red flags to raise the currently very low suspicion for abuse.
Agree w/ Sermo Doc 7 that over-reacting can be a worse error than the first (to paraphrase something from the New Testament). If the activity accelerates or becomes more public or specific (as in child #2), low-key "re-directing" +/- counseling (as you have done).
Agree w/ wfmcmd that Sermo Doc 7 seems a bit "edgy" when it comes to other people incorporating their religious ethics into their personal and professional lives. Where do you think ethics come from? That guy who writes the "ethics" column in the newspaper? Where did HIS ethics come from?
agree with Sermo Doc 7 & emilymd5 & cardboard cowboy and sgraves etc, kids realize early on masturbation feels good, and they lack the inhibitions of our puritanical society (which is the world's major producer of pornography, factor that). it is not uncommon for a 5 or even 6 year old to come down to your adult party fondling him/her self. While parents may tend to embarrassment, by itself, it is innocent; the parents should continue to encourage such activities in the comfort and privacy of their own rooms and not make an issue of a lot of nothing. Later, mommy and daddy can chuckle together, canoodle together, and enjoy together. Move on. Next.
Yes, and I agreed that the 2 yr old's behavior is normal.
I remember as a 5 yr old, my 5 yr old girl pal and I (I'm a female) were naked, showing our opened genitals to each other. Memories are present so many years later. I don't remember what else we did. Yeah, normal.
I think about a three yr old girl (I'm picturing her as my daughter) naked and masturbating with a Transformer toy in front of the family. I think this is some kind of stress reaction and a therapist should be involved. Asking more questions doesn't have to be an interrogation or "leading the child". If nothing funny is going on, that's great!
I have no children therefore no personal experience.
For any agegroup have always emphasized that sex is not a spectator sport, ie
any genital touching must be done without an audience.
Before med school I worked with DD adults and if we saw them with their hands
in their pants we quietly escorted to their bedroom and reminded them that there
was nothing wrong with putting their hands there but the venue was wrong. After
enough redirections most got the message. They were never shamed, just taught
that it was a private matter.
I worked in a prison also. For some reason the officers are obsessed with catching guys masturbating. Whenever a guy told me he was caught I would gently remind him that all he needed to do was save for the cover of darkness under the covers for maximum privacy and nobody would be the wiser (cuts down on chronic prostitis).
I once took care of a set of boy twins frequently. When they were at the cruiser stage, diaper changes got more complicated. One would always grab onto his penis like it was a gearshift so my solution to the problem was to undo his diaper and change the other one and as long as he was "entertained" he wouldn't get away. As soon as his diaper was back on he would forget all about it. Those two were taught by their parents quietly that it was ok to touch themselves as long as they had privacy but it wasn't a spectator event.
Bottom line: get over the victorianism and don't react but redirect toward privacy. For the girl be sure she doesn't hurt herself with objects.
Wouldn't worry too much about the boy or girl as long as I was satisfied with information gathered on the following points: Self soothing (and self exploration of genitals) is quite universal among children of this age group but each have different modes of accomplishing this, thumb sucking, rocking, repetitive noises, etc. When girls have open genital self soothing behaviors our society addresses it differently than when boys have identical behaviors as a rule. Adult reactions often lead little girls to believe their genitals are dirty or shameful, and boys "it's cute, look Virginia he's already sewing wild oats, we have boys with penis' exposed and streams of urine as bumper stickers and applique on the back pick-up truck windows in the mid-west. So, although it could be an over reaction to fear the sexual abuse, the fact is girls are sexually abused more often than boys ~25% vs 9% respectively, it bears closer examination. RED FLAG BEHAVIORS: IFeither child is self stimulating/soothing and also perpretrating sexual acts on other children, sexually explicit acting out, displaying developmentally inappropriate knowledge of sexual activities, or innapropriate play involving others (such as asking another to touch their genitals, asking to touch or attempting to touch an the genitals of another) question sexual abuse. Particularly in homes with substance abuse issues, multigenerational homes, or dysfunctional parenting (lack of supervision), or when older siblings, teenagers, or unrelated males (primariliy) are caretakers of the child (i.e. after school before the parent(s) get home from work). Please read up on child abuse if you have avoided doing so during your medical training. Be bold, ask explicit and pointed questions of the child and parent. You may be the only link to safety a child has.
Peace, Amazon Spirit - Child/Adol/Adult Psychiatrist
I once had a mother come to me with her 6mo old daughter because she said the child was rocking all the time, we sat her on the examination table the little girl rocked back and forth rapidly several times and then relaxed, the mother was shocked when I told her it seemed that the infant was masturbating, I agree with the general consensus, and especially Amazon Spirits' red flags.
Thanks for the information Amazon Spirit.
Maybe I was overreacting, but red flags regarding the three year old child were: Single mom who was physically abused by recently divorced ex husband. Also, the child was "humping in public" and this was a change in her usual behavior. I did a presentation on child abuse in residency because I saw so much of it. Residency was sickening in many ways, and my depression really flared at that time.
I don't understand people's jumping to conclusions about our attitudes. I wish people here would criticise our opinions rather than us personally. You folks don't know anything about us. We could be gay, straight, old, young, pretty, weird...How do you know?
I don't think I or some of the other docs are "Puritan" or "Victorian" to be concerned about the three year old girl (NOT the normally behaving boy).
surprised no one has considered possibility that masturbatory behavior could be red flag for later manic hypersexuality. any family history of such? other hyperness? interesting thread. thanks to all for thoughts.
Sermo Doc 39, pediatric bipolar hypersexuality is not something I'm familiar with. Do you have any clinical experience with this?
I found an interesting article associating shaken baby syndrome and hypersexuality. I guess it would make sense that damage to the amygdala or its pathways could alter sexual behavior as seen in Kluver-Bucy Syndrome. Perhaps others more schooled in this area could comment further:
Neurorehabil Neural Repair. 2000;14(2):155-8. Pharmacologic treatment of cognitive deficits and hypersexuality due to "shaken-baby syndrome".Schmidt JG, Schneider WN.
Department of Rehabilitation and Neurology, St. Mary's Hospital, Unity Health Systems, Rochester, NY 14611, USA.
OBJECTIVE: To describe the clinical effects of amantadine and propranolol in an agitated pediatric patient with cognitive deficits, hyperactivity, and hypersexualism secondary to "shaken-baby syndrome." BACKGROUND: Patients with shaken-baby syndrome can present with cognitive and behavioral impairments. CASE: A 9-year-old girl presented with cognitive impairments secondary to shaken-baby syndrome at 3 weeks of age. She was receiving many medications, including dextroamphetamine, methylphenidate, and clonidine, that were not effective in improving her cognitive status or decreasing her hypersexuality. She was weaned from stimulants and clonidine and prescribed amantadine 100 mg bid with improvement of attention, concentration, and cognition, although hypersexuality remained. She was then started on propranolol 10 mg tid and a gradual increase to 40 mg tid with amelioration of hypersexuality and hyperactivity and no unwanted effects noted. Self-weaning of propranolol was associated with the return of hypersexuality. The combination of amantadine and propranolol led to improvement of cognition and behavior, especially intellectual functioning and appropriate socialization with peers, respectively. CONCLUSION: Cognitive deficits and hypersexuality with hyperactive features due to shaken-baby syndrome may respond to the drug regimen of amantadine and propranolol.
This is normal sexual behavior. The second kid is probably acting out to some extent but the sexual stimulation is pleasurable and stress relieving. The activity has probably increased because of the increased stress related to the divorce. The problem here is one of society not accepting this kind of behavior in children (just like no one masturbated before Sermo Doc 17s and Johnson revealed the truth about that). I suspect that the therapist can help the child find more socially acceptable forms of stress relief or teach the child to do it in private (behavioral modification) and if no one panics time will "heal" this problem (the child will learn new techniques for stress relief from the therapist or out grow the behavior). Do not jump to the "sexual abuse" conclusion. And this is not "hyper-sexuality" it is just normal toddler behavior.
Sermo Doc 17's and Johnson....?? Very shaky ground, if this is our source of normal behavior. Their "studies" were terribly, no horribly, flawed in many ways. "The Truth" is something I would not consider as the message received from Sermo Doc 17's and Johnson's 'work'. Their truth, maybe...the THE truth, I think not.
normal behavior, my son does it all the time. he has been told that he can do "his thing" when he wants, but we limit the amount of time he does it and he can only do it behind closed doors. seems to work well for us. as for the transformer... poor Optimus Prime... minding his own buisness and all of a sudden gets humped
Our trees are bare, and covered with a light layer of snow. There are some evergreens. I dislike the cold. It's like "Snow Falling on Cedars". (That was a good book.)
I am a little worried about the girl using the toy as part of her behavior. Is she acting out something she has seen or something that has been done to her? In her case, I would think referral for a sexual abuse evaluation is appropriate.
The 3 year old is another story. The "humping" bothers me less than the apparent stress of the separation. This should be dealt with. She is at risk for abuse, but I don't hear of evidence.
The worst one was a four year old girl getting pretty explicit all the time. I had been seeing her since birth. I sat down and asked mom what was going on. Mom explained that dad had been out of town on business for several months, mom had been on bedrest for two months for preterm labor then had the premie, grandparents had moved in to help and were fighting about grandpa getting friendly with a neighbor woman, and the long term baby sitter had had a seizure and been taken away by ambulance about a month earlier. We sent them all for counselling and family support and, as the stress dwindled, the humping dwindled and moved to privacy.
The first boy is the typical case that I don't really worry about. Parents just need some resassurance. I don't think it's necessarily a bad thing they videotaped it. Imagine the blackmail potential when that boy is a teen.
The second case I referred because there are many other stressors in the family's life: DV (dad hit mom in front of kids), mom finally left him and they are in a new place with new routines. The 5 year old brother is adjusting ok so far to all the changes. He's the one who found the girl with the Transformer telling his mom, "she is doing the no-no to my toy!" I don't highly suspect sexual abuse as she has been doing this since she could crawl. I think she is doing it more and now in public because of the recent changes. I think mom needs more support than I can provide.
Your cases seem OK in that regard, though family separations are always difficult and therapy can always be helpful in those situations. Sounds like you were right on to me!
It upsets many adults that even very young children are sexual and can have orgasms.
Teach kids to keep it private (a culturally acceptable compromise).
Agree w/ wfmcmd that Sermo Doc 7 seems a bit "edgy" when it comes to other people incorporating their religious ethics into their personal and professional lives. Where do you think ethics come from? That guy who writes the "ethics" column in the newspaper? Where did HIS ethics come from?
I remember as a 5 yr old, my 5 yr old girl pal and I (I'm a female) were naked, showing our opened genitals to each other. Memories are present so many years later. I don't remember what else we did. Yeah, normal.
I think about a three yr old girl (I'm picturing her as my daughter) naked and masturbating with a Transformer toy in front of the family. I think this is some kind of stress reaction and a therapist should be involved. Asking more questions doesn't have to be an interrogation or "leading the child". If nothing funny is going on, that's great!
For any agegroup have always emphasized that sex is not a spectator sport, ie
any genital touching must be done without an audience.
Before med school I worked with DD adults and if we saw them with their hands
in their pants we quietly escorted to their bedroom and reminded them that there
was nothing wrong with putting their hands there but the venue was wrong. After
enough redirections most got the message. They were never shamed, just taught
that it was a private matter.
I worked in a prison also. For some reason the officers are obsessed with catching guys masturbating. Whenever a guy told me he was caught I would gently remind him that all he needed to do was save for the cover of darkness under the covers for maximum privacy and nobody would be the wiser (cuts down on chronic prostitis).
I once took care of a set of boy twins frequently. When they were at the cruiser stage, diaper changes got more complicated. One would always grab onto his penis like it was a gearshift so my solution to the problem was to undo his diaper and change the other one and as long as he was "entertained" he wouldn't get away. As soon as his diaper was back on he would forget all about it. Those two were taught by their parents quietly that it was ok to touch themselves as long as they had privacy but it wasn't a spectator event.
Bottom line: get over the victorianism and don't react but redirect toward privacy. For the girl be sure she doesn't hurt herself with objects.
Peace, Amazon Spirit - Child/Adol/Adult Psychiatrist
Maybe I was overreacting, but red flags regarding the three year old child were: Single mom who was physically abused by recently divorced ex husband. Also, the child was "humping in public" and this was a change in her usual behavior. I did a presentation on child abuse in residency because I saw so much of it. Residency was sickening in many ways, and my depression really flared at that time.
I don't understand people's jumping to conclusions about our attitudes. I wish people here would criticise our opinions rather than us personally. You folks don't know anything about us. We could be gay, straight, old, young, pretty, weird...How do you know?
I don't think I or some of the other docs are "Puritan" or "Victorian" to be concerned about the three year old girl (NOT the normally behaving boy).
Have a good weekend.
I found an interesting article associating shaken baby syndrome and hypersexuality. I guess it would make sense that damage to the amygdala or its pathways could alter sexual behavior as seen in Kluver-Bucy Syndrome. Perhaps others more schooled in this area could comment further:
Neurorehabil Neural Repair. 2000;14(2):155-8.
Pharmacologic treatment of cognitive deficits and hypersexuality due to "shaken-baby syndrome".Schmidt JG, Schneider WN.
Department of Rehabilitation and Neurology, St. Mary's Hospital, Unity Health Systems, Rochester, NY 14611, USA.
OBJECTIVE: To describe the clinical effects of amantadine and propranolol in an agitated pediatric patient with cognitive deficits, hyperactivity, and hypersexualism secondary to "shaken-baby syndrome." BACKGROUND: Patients with shaken-baby syndrome can present with cognitive and behavioral impairments. CASE: A 9-year-old girl presented with cognitive impairments secondary to shaken-baby syndrome at 3 weeks of age. She was receiving many medications, including dextroamphetamine, methylphenidate, and clonidine, that were not effective in improving her cognitive status or decreasing her hypersexuality. She was weaned from stimulants and clonidine and prescribed amantadine 100 mg bid with improvement of attention, concentration, and cognition, although hypersexuality remained. She was then started on propranolol 10 mg tid and a gradual increase to 40 mg tid with amelioration of hypersexuality and hyperactivity and no unwanted effects noted. Self-weaning of propranolol was associated with the return of hypersexuality. The combination of amantadine and propranolol led to improvement of cognition and behavior, especially intellectual functioning and appropriate socialization with peers, respectively. CONCLUSION: Cognitive deficits and hypersexuality with hyperactive features due to shaken-baby syndrome may respond to the drug regimen of amantadine and propranolol.