Updated: Nov 8, 2020
By: Dr. Sakshi Tickoo (BOTh)
Like all forms of human development, sexual development too begins at birth. Sexual development includes the physical changes that occur as children grow, the sexual knowledge and beliefs they come to learn and behaviours they show. Parents often become concerned when a child demonstrates sexual behaviours, such as touching self or another child’s private parts. Such behaviours are not uncommon in developing children; most sexual play is an expression of child’s natural curiosity and should not be a cause for concern or alarm.
In general, 'typical' childhood sexual play and exploration:
Occurs between children who play together regularly and know each other well
Occurs between children of the same general age
Is spontaneous and unplanned
Is voluntary (the children agreed to the behaviour, none of the involved children seem uncomfortable or upset)
Can be easily diverted when asked to stop
Natural and healthy sexual exploration during childhood is an information gathering process. At a very young age, children begin to explore their bodies by touching, poking, pulling, and rubbing all their body parts, including their genitals. Hence, it becomes essential for children to learn about sexuality throughout the course of their life. The more information that parents have about psycho-sexual development, the better will they be able to respond to their child's behaviours.
Moreover, the child receives this information beforehand, unlike what they would have from wrong or unreliable sources. Table 1 provides parents with a guide on what behaviours they can expect to see - and how to introduce topics of sex education appropriate to the situation .
Note: The parent should keep in mind not to bombard children with information all at once. Let the situation - and the child’s questions - guide the lessons they share.
Unfortunately, not all parents feel comfortable discussing sexuality and/or may respond to behaviours by over-reacting, shaming, blaming and/or punishing the child . This is exactly where Occupational Therapists try to bridge the knowledge and communication gaps. Like every other activity of daily living (ADL), Occupational Therapists (especially, paediatric and school-based OTs) advocate for and bring these topics into discussion, to promote a healthy dialogue between the therapist, parent and the child.
The most frequent statements I have heard in practice by parents are:
“Addressing topics of sexuality with children would mean talking about sexual activity.”
“Talking about sex with children will just encourage them to become sexually active.”
Much to their amusement, these statements are mere myths!
Fact No. 1: Sexuality includes a lot more than just the activity of sex. Teach what the child needs to know in the situation. Provide them information appropriate to their needs and developmental level/age . When you talk honestly with your children about sexuality and sexual health, you can give them the knowledge and skills they need to keep safe and to make good decisions about expressing and conducting themselves.
Fact No. 2: In a survey conducted in 2009 (CHSS, Kent; Sept 2009), 8 out of 10 teens said it would be easier to delay sexual activity and prevent unwanted pregnancy if they were able to have “more open, honest conversations” with their parents on these topics. In fact, bringing up topics of sexuality and sexual health opens children to feelings of compassion and respect for all genders from a very tender age .
How to respond to these behaviours?
Children's understanding of genital exploration is that "it feels good", not that "I am doing something sexual". When children begin to explore, ask questions and/or experiment with their own bodies or with others, this is a sign to parents that they are curious and have questions .
Children will touch their genitals to explore their anatomy and sensations. Such touching may lead to “masturbation”. This normal childhood development via masturbation often serves to relieve tension, promote relaxation and comfort for children. As children begin to explore their bodies and experiment with their peers, parents may feel uncomfortable, embarrassed, or unsure discussing sexuality may seek professional help from Occupational Therapists to guide them through this process of development.
When responding to sexualised play between children:
Do not over-react: By staying calm and handling the situation without over-reacting, children will develop a positive sense of self and sexuality.
Ask questions: When talking to children about sexual behaviours, it’s important to maintain even tone of voice and ask open-ended questions as much as possible, so the children can tell what happened in their own words, rather than just answering yes or no. For example : What were you doing? / Why were you doing it? / How did you learn about this? / When do you feel like doing it? / How did you feel about doing it? The important thing is to let children know that you are ready to listen and to answer whatever questions they may have. Parents should also ask the children if they have any questions and be available to answer any that they ask.
Stop the behaviour: If children are masturbating in public or in front of others, explain them that it is inappropriate to touch their private parts in public and that if they feel they need to touch their private parts, they need to do it in private, hence "private parts". Children should not be told that it is "bad", "dirty", or "nasty", when found masturbating. When children are exploring their sexuality with other children, parents should explain them that when they are playing with their friends, they need to leave their clothes on and it is not okay to touch or show private parts .
Don't punish: Punishing sexual behaviours can lead to sexual inhibitions later on and hinder a child's sexual development. Tell children that their behaviour is not appropriate by being clear and direct without making them feel guilty.
Importance of Sensory Processing
Just because a behaviour is typical, it doesn’t mean the behaviour should be ignored. The scope of Occupational Therapy practice is not only limited to children showing normal developmental patterns. Occupational Therapists are equipped in helping children with behaviour problems, intellectual or physical disabilities grow with a sense of 'sexual being-ness' too. Quite often, children with social, communication and sensory difficulties can show obsessions, repetitive behaviours and routines via sexual behaviours .
In such scenarios, Occupational Therapists can help children with appropriate integration and modulation of sensations and adequate channeling of emotions, to avoid inappropriate genital stimming and/or proprioceptive seeking behaviours. Along with the parent, therapists can explore and identify the reasons and function of the behaviour, to gain an insight towards precursors...
Set boundaries: Set clear, consistent limits. Decide together a realistic target and put together a plan to reach that target, over a period of time. Consider what needs to be changed (the frequency or the duration of repetitive behaviour). If it is a mixture of both, focus on one aspect to change at first, to increase the chance of success and reduce anxiety. For example : Week 1: Decide on the plan and target, creating a visual support explaining the change. Week 2: Child is allowed to explore via touching for 10 mins, every hour. Week 3: Child is allowed to explore via touching for 5 mins, every hour and so on. The frequency can be later changed depending on the progress of the child.
Provide alternatives: Alternative activities direct the child behaviours into a more acceptable play activity. A balanced sensory diet is that which an occupational therapist develops specifically to meet the needs of the child's own nervous system. Its purpose is for the children to become more focused and meet their sensory needs. A sensory diet includes a combination of alerting, organising and calming sensorimotor activities, depending on the child’s needs.
Alerting activities benefit the under-sensitive children, who need a boost to become effectively aroused. Some examples are:
Crunching dry cereal, popcorn, chips, crackers, nuts, pretzels, carrots, celery, apples or ice cubes
Taking a shower
Bouncing on a therapy ball
Jumping up and down on a trampoline
Organising activities help regulate the child's responses. They include:
Chewing granola bars, fruit bars, dried apricots, cheese, gum, bagels or bread crusts
Hanging by the hands from a chinning bar
Pushing or pulling heavy loads
Getting into an upside-down position
Calming activities help the oversensitive child decrease hyper-responsiveness to sensory stimulation. They include:
Sucking a hard candy, frozen fruit, or spoonful of peanut butter
Pushing against walls with the hands, shoulders, back, buttocks and head
Rocking, swaying, or swinging slowly back and forth
Deep pressure massage
Support skills development. Self-regulation skills are any activities that will the help the child to manage their own behaviour and emotions. For example:
Use a traffic light system, or a scale of 1-5, to present emotions as colours or numbers (a green traffic light or a number 1 can mean 'I am calm'; a red traffic light or a number 5 can mean 'I am angry’ 
Use social stories to enhance comprehension of do’s and don’ts 
“Simon Says” to facilitate self-motor control
“What if” games and role plays
A combined effort by therapists and parents, focusing on children accessing accurate and complete information and support for healthy decision-making, is key for all kids and teens who will transition to adulthood .
Dr. Tickoo is an Occupational Therapist (BOTh) and Certified Personal Counsellor from Mumbai (India), currently working at a special school. She recently started a personal blog on Instagram- “Sex, Love and OT” (@sex.love.andot), to advocate, promote and share a positive word and information about scope of Occupational Therapy practice in sexual and mental health. She aspires to extend her research and education in the above said fields.
 A Survey of Teenagers’ Views of Sex and Relationships Education and Sexual Health Services in Kent: https://pdfs.semanticscholar.org/7632/6e0accc7f093095d8921aaf56340aafc10e6.pdf
 The National Traumatic Stress Network: https://www.nctsn.org/
 The Children’s Assessment Center, Grand Rapids, Michigan: Children’s Sexual Behaviour and Body Safety - A guide for parents
 Obsessions, Repetitive behaviours and routines: https://www.autism.org.uk/living-with-autism/understanding-behaviour/obsessions-repetitive-behaviours-and-routines.aspx
 Social Story-Masturbation: http://www.livingwellwithautism.com/yahoo_site_admin/assets/docs/masturbation_social_story.184124213.pdf
 Promoting Healthy Sexual Development and Sexuality: https://brightfutures.aap.org> BF4_HealthySexuality
Resources for parents & therapists:
Haffner, Debra W. (2008). From diapers to dating: A parent’s guide to raising sexually healthy children - from infancy to middle school, 2nd edition. New York: Newmarket Press. Includes techniques to identify and examine your own sexual values so that you can share these messages with children.
Hickling, Meg. (2005). The new speaking of sex: What your children need to know and when they need to know it. Kelowna, BC, Canada: Wood Lake Publishing, Inc. Author dispels misconceptions and unhealthy beliefs about sex, provides guidelines on how to talk with children at various stages of their development, and offers examples of how to answer tough questions.
Other books to consider: In case you’re curious (Alison Macklin), What’s happening to me? (Peter Mayle), It’s perfectly normal (Robie Harris & Emberley).
A ton of other Online Resources are available for parents & therapists including Committee for Children, Sexuality Information and Education Council, Planned Parenthood, and Sex Positive Families to name few.
Amaze.org is an animated video series that give provide parents and children with all the answers they want to know about sex, sexuality, body and relationships.
Books for Children:
Brown, Laurie Krasny. (2000). What’s the big secret? Talking about sex with girls and boys. New York: Little, Brown Books for Young Readers. For ages 4–8. This colourful book uses illustrations, cartoons, and very accessible text to explain the basics of anatomy, reproduction, pregnancy, and birth along with topics of feelings, touching, and privacy.
Hansen, Diane. (2007). Those are MY private parts. Redondo Beach, CA: Empowerment Productions. For ages 4–8. This short, easy-to-read book uses colourful illustrations and catchy rhymes to teach children that no one - relative, friend or neighbour - has a right to touch them in a way that makes them feel uncomfortable.