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For example, a three-year-old boy who touches his genitals several hours a day and cannot focus on other tasks is displaying a normative behavior with abnormal persistence and frequency.

In addition, the behaviors that are the least common among the list of normative sexual behaviors may require more extensive assessment to make sure there is no underlying sexual behavior problem.

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.

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.6Several terms have been used to describe sexual behaviors in children.

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Sexual behavior problems are defined as developmentally inappropriate or intrusive sexual acts that typically involve coercion or distress.

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.

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