המאמרים והחומר עליהם מתבסס המאמר על אוננות בגיל הרך.
הי ורד ותודה על הבקשה
אשמח לקבל ממך חומרים בנושא אם יש לך להעשרת המאמר הזה לתועלת ציבור המטפלים וההורים
Sexuality and Your Child: For Children Ages 3 to 7. Lynn Blinn Pike. Department of Human Development and Family Studies
University of Missouri Extension use science-based knowledge
By the age of three, your child will probably begin to ask you for information about sex. It will help if you take as much care in preparing yourself for your child's sexuality education as you do when preparing to teach him or her about health and physical safety.
Knowing what to expect at different ages can help you respond to typical questions young children ask. It also helps to know what behaviors you can expect.
Three to four years: Characteristics of sexual development
- Three- and four-year-olds are curious about where babies come from.
- They explore other children's and adults' bodies because of their curiosity. "Playing doctor" and pretending to be mommy or daddy become more common activities.
- They have increased interest in the differences between adults' and children's bodies.
- By age four, girls may become intensely attached to their fathers and boys to their mothers.
- Children begin to have a sense of modesty and can begin to understand the difference between private and public behavior.
- For many children, genital touching increases, especially when they are tired or upset.
- Three- and four-year-olds still have a concern about elimination and frequently use words that refer to bowel movements and urination.
Five to seven years: Characteristics of sexual development
- Children in this age group begin to have more contacts outside the family. Other children may bring up new ideas about sex.
- They have increased need for privacy while bathing and dressing.
- Five- to seven-year-olds often increase their use of sexual or obscene language (frequently to test parental reaction).
- They are more interested in what it means to be male or female.
- They give up wanting to "marry" mom or dad. Girls become closer to their mothers and boys to their fathers.
- Children in this age group become more reticent about asking questions.
- Masturbation continues to be common. Tell your child that this is not wrong, but it is something one does in private.
Parental concerns and questions
Q: What if my child masturbates?
A: Masturbation is normal, and most children fondle their genitals. Don't make your child feel guilty about being interested in his or her own body. However, by age four, a parent can help a child understand that this is a private behavior -- "It's OK in your room, but not in the grocery store."
Q: I found my child playing doctor with her friends. What should I do?
A: Because all children are curious, most children play "hospital" and "doctor." This can be a good opportunity to say to your child, "I know you are wondering about each others' bodies. Let's talk about what you want to know." It is also a good opportunity to say, "Your body belongs to you. You can tell someone, 'No,' if you don't want to be touched."
You also need to be aware of safety issues. Children may insert pencils, sticks or other objects in body openings and cause injury. Although it is normal for children of the same ages to engage in this exploratory play, there is cause for concern if one or more of the children is older.
Q: My four-year-old son likes to dress up in girls' clothes and play house. Will this lead to homosexuality?
A: No. This type of play is a way that children learn about the adult world. Preschool children actively try out many roles.
Q: My child frequently uses obscene words. How should I handle this?
A: You may want to check the child's knowledge about what the word means. Children often use a word without knowing what it means. When you explain what the word means, they often don't want to use it. Teach your child words that are OK to use when he or she feels angry or frustrated.
Many parents wish to discourage the use of obscenities. Talk about what the words mean with your child, and explain that these words may bother others.
Q: What about sex on television?
A: Many parents are concerned about how television portrays sexual issues and sexual behavior. Almost all programs and commercials convey sexual messages -- on sex roles, body image, how emotion is expressed, the meaning of marriage and family and how people communicate about sexuality.
You can use television to strengthen your communication with your child. Watch TV with your child and use the programs as a springboard for discussion. Use these opportunities to discuss sexuality and family values with your child. In addition, limit television viewing to programs you feel are appropriate for your child.
Q: Where do babies come from?
A: For younger children, use a simple answer such as, "Babies come from inside the mother. They grow in a special place called the uterus."
By age 5, children become intensely interested in where babies come from, and you may need to give a more detailed explanation. If your child is interested, you could describe intercourse and conception in simple terms.
Be an askable parent
Let your children know they can come to you with questions. Starting early with sexuality education can help you communicate with your child now and during the teen years. Some guidelines to help you become an "askable" parent are:
- Let your child know he or she can come to you for information.
- Be willing to repeat information until your child understands.
- Check out what your child already knows by asking what he or she thinks.
- Keep your answers simple. Think about what your child can and can't understand.
- Realize it's OK to say, "I don't know." There are many good books for you and your child to read together.
- Relax. You want to help your child understand that sexuality is a valuable part of human experience. Review the facts of reproduction if you need to.
- Have a sense of humor and make this learning experience fun for you and your child.
To become more comfortable talking about sex with your child, practice first. "Discuss" a topic with yourself in the bathroom mirror, talk with a friend or role-play with your partner, switching roles of child and parent.
For further information on sexuality, see the attached book list. Remember, you don't need to know all the answers, but you do want to be an askable parent. You want your child to come to you with questions about sexuality rather than seeking answers from friends or television.
Choose books carefully
When selecting a book on sexuality for your child, it is important that you read it first. A book may be more explicit than you thought, or you may find you need time to practice reading it aloud. Look for books that:
- Are written so that your child can understand it.
- Treat men and women equally rather than placing them in stereotypical roles.
Consider the author's background. For example, a minister may write from his or her religious perspective. A physician may focus on the physical aspect of sexuality rather than moral or emotional views.
Libraries are often good sources for borrowing books. If your library does not have a title, they may be able to obtain it through an inter-library loan.
Additional reading for parents
- Calderone, Mary and Eric W. Johnson, 1983. The Family Book About Sexuality. New York: Bantam.
- Calderone, Mary and James W. Ramey, 1983. Talking With Your Child About Sex. New York: Random House.
- Gordon, Sol and Judith Gordon, 1983. Raising A Child in a Sexually Permissive World. New York: Simon and Schuster.
- Ratner, Marilyn and Susan Chamlin, 1987. Straight Talk: Sexuality Education for Parents and Kids, 4-7. New York: Penguin.
Books for parents and children
- Gordon, Sol and Judith Gordon, 1982. Did the Sun Shine Before You Were Born? Fayetteville, New York: Ed-U Press.
- Gordon, Sol, 1979. Girls are Girls and Boys are Boys: So What's the Difference? 1979. Fayetteville, New York: Ed-U Press.
- Green, David, 1982. Sex on TV: A Guide for Parents. Santa Cruz, CA: Network Publications.
- Mayle, Peter, 1973. Where Did I Come From? Secaucus, New Jersey: Lyle Stuart.
Gratification disorder ("infantile masturbation"): a review
Archives of Disease in Childhood 2004;89:225-226
© 2004 BMJ Publishing Group & Royal College of Paediatrics and Child Health
A Nechay1, L M Ross2, J B P Stephenson3, M O’Regan3
Background: Little has been published on gratification disorder ("infantile masturbation") in early childhood.
Aims: To expand on the profile of patients diagnosed with this condition.
Methods: Retrospective case note review; Fraser of Allander Neurosciences Unit paediatric neurology outpatient department 1972–2002.
Results: Thirty one patients were diagnosed (11 males and 20 females). Twenty one were referred for evaluation of possible epileptic seizures or epilepsy. The median age at first symptoms was 10.5 months (range 3 months to 5 years 5 months). The median age at diagnosis was 24.5 months (range 5 months to 8 years). The median frequency of events was seven times per week, and the median length 2.5 minutes. Events occurred in any situation in 10 children, and in a car seat in 11. Types of behaviour manifested were dystonic posturing in 19, grunting in 10, rocking in 9, eidetic imagery in 7, and sweating in 6. Two children had been previously diagnosed as having definite epilepsy. In nine cases home video was invaluable in allowing confident diagnosis.
Conclusion: Gratification disorder, otherwise called infantile masturbation, is an important consideration in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of events often prevents unnecessary investigations and treatments.
Masturbation in Infancy and Early Childhood Presenting as a Movement Disorder: 12 Cases and a Review of the Literature. PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1427-1432. Michele L. Yang, MD, Erika Fullwood, MD, Joshua Goldstein, MD and Jonathan W. Mink, MD, PhD
Purpose. Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements. Extensive and fruitless investigations may be pursued before establishing this diagnosis. Sparse literature is available regarding masturbatory behavior as a whole, but literature available as case reports describes common features. The purpose of this case series is to describe consistent features in young children with posturing accompanying masturbation.
Methods. Twelve patients presenting to a pediatric movement disorders clinic with a suspected movement disorder were determined to have postures and movements associated with masturbation. We reviewed the clinical history, examination, and home videotapes of these patients.
Results. Our patients had several features in common: (1) onset after the age of 3 months and before 3 years; (2) stereotyped episodes of variable duration; (3) vocalizations with quiet grunting; (4) facial flushing with diaphoresis; (5) pressure on the perineum with characteristic posturing of the lower extremities; (6) no alteration of consciousness; (7) cessation with distraction; (8) normal examination; and (9) normal laboratory studies.
Conclusions. The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing. Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.
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Gratification disorder (also known as "infantile masturbation", despite occurring in children as old as 10, or sometimes benign idiopathic infantile dyskinesia) is a form of masturbatory behavior that has often been mistaken for epilepsy, abdominal pain, and paroxysmal dystonia or dyskinesia. Little research has been published regarding this early childhood condition. However, most pediatricians agree that masturbation is a normal and common behaviour in young children and should be recognized as such. Failure to recognize this behavior can lead to unnecessary and invasive testing. Thus, it should be noted that the use of the word "disorder" is somewhat malapropos, as an inability to experience sexual gratification would constitute sexual aversion disorder.
Infant Masturbation May Be Mistaken for a Movement Disorder
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Release Date: December 12, 2005; Valid for credit through December 12, 2006
Dec. 12, 2005 — Infant and early childhood masturbation can be mistaken for a movement disorder, according to the results of a case series and review of the literature reported in the December issue of Pediatrics. The investigators provide guidance on management.
"Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements," write Michele L. Yang, MD, from the Children's Hospital of Pittsburgh, Pennsylvania, and colleagues. "Extensive and fruitless investigations may be pursued before establishing this diagnosis.... In young children, unusual postures and movements can occur during masturbation and may lead the primary care provider to infer that seizures, abdominal pain, colic, or other neurologic or medical problems are present."
The authors reviewed the clinical history, examination, and home videotapes of 12 patients presenting to a pediatric movement disorders clinic with a suspected movement disorder who were determined to have postures and movements associated with masturbation.
Common features in these patients include onset after age 3 months and before 3 years, stereotyped episodes of variable duration, vocalizations with quiet grunting, facial flushing with diaphoresis, pressure on the perineum with characteristic lower extremity posturing, no alteration of consciousness, cessation with distraction, and normal examination and laboratory studies.
"The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing," the authors write. "Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.... What can be portrayed in the history as dystonia or seizures can appear differently on direct observation."
The authors note that once the diagnosis of masturbatory behavior is made, sexual abuse and perineal irritation should be ruled out.
Practical points for management of masturbatory behavior include videotaping the event in question, helping parents change their view of the child's behavior as a disease, educating parents that scolding or threatening is not appropriate, using redirection to engage the child's interest in other activities or toys, defining milestones in older children to end the behavior in public, and using the term "gratification behavior" instead of masturbation when discussing this behavior with parents who are easily offended.
The authors have disclosed no relevant financial relationships.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
- Describe common features in young children with posturing accompanying masturbation.
- Identify features that distinguish masturbatory behavior from neurologic conditions in young children.
Masturbation in childhood is a normal behavior, which most commonly begins at 2 months of age and peaks at 4 years of age and in adolescence. However, in young children, masturbation involving pressure on the perineum might not be recognized in the absence of genital manipulation. Children might demonstrate posturing and unusual movements while masturbating that can mimic medical conditions, including seizures, abdominal pain, and colic. In the March 2004 issue of the Archives of Disease in Childhood, Nechay and colleagues reported that of 31 cases of masturbatory behavior, most were referred for possible seizures and 1 was referred for dystonia. Some children have undergone magnetic resonance imaging (MRI), electroencephalography (EEG), intravenous pyelography, small bowel biopsy, gastrointestinal barium swallow, or antiepileptic treatment prior to determining the diagnosis of masturbation. Recognition of such movements as masturbation could prevent unnecessary tests and treatment.
The current study is a case series report to describe common features of posturing with masturbation in 12 children referred for paroxysmal dystonic events.
- 12 girls were referred to a pediatric movement disorders clinic for a 5-year period for evaluation of paroxysmal dystonic posturing. History, general examination, and neurodevelopmental examination were performed. Review of videotapes of the episodes provided by families showed that all children had dystonia-like posturing during masturbation. Each child was analyzed for age of onset, color changes, features of head and face, arm posture, leg posture, vocalization, pelvic movements, similarity from event to event, responsiveness during the episode, cessation with distraction, prior evaluation by neurologist, previous testing, and neurologic examination results.
- 5 representative case reports were described and a table including characteristic features of events for all 12 cases was included.
- No boys had been referred to the clinic for dystonic posturing during masturbation.
- Mean age of onset was 11 months; median, 9 months; and range, 3 months to 3 years.
- Duration of episode ranged from less than 1 minute to several hours.
- Some features were noted for all patients: quiet grunting or heavy breathing; stereotyped dystonia-like posturing of neck, arms, or legs separately or combined (staring, grimacing, neck twisting, arm twisting or extension, fists clenching, hip flexion or extension, thigh adduction, sitting on foot); and rhythmic pelvic movements.
- All responded to parents during the episode. No child had altered consciousness. Posturing stopped when the child was distracted by parent or another activity.
- All 12 had normal neurologic examination. 11 had previously been seen by a neurologist. 10 had previous testing including MRI, EEG, or metabolic testing. 4 had invasive diagnostic testing, including lumbar puncture or muscle biopsy. 8 previously had been treated with antiepileptic medication, benzodiazepines, anticholinergic medication, or levodopa.
- 8 (72%) of 11 patients had facial flushing. In 2 cases, there was no change; in 1 case, the face was not seen; and in 1 case, flushing was uncertain because of dark skin.
- 4 (33%) of 12 patients had diaphoresis.
- Episodes usually occurred in states of boredom, excitement, or anxiety. 1 patient continued to have masturbatory behavior at age 11 years, especially when anxious.
- Authors' recommendations include the following: videotape the event in question to determine diagnosis; reassure parents about this normal behavior; discourage scolding the child; redirect child's attention from the behavior; and assess for sexual abuse and perineal irritation.
Pearls for Practice
- Young children with posturing accompanying masturbation typically demonstrate vocalizations, facial flushing, rhythmic pelvic movements, arm posturing, and leg posturing that applies pressure on the perineum.
- Young children with posturing accompanying masturbation show no change in consciousness, can cease the behavior with distraction, and have normal neurologic examination compared with children with posturing due to neurologic conditions.