Problematic Sexual Behavior in Children

Kids who play “doctor” on a playdate. A child who keeps putting their hand down their pants in public. Situations involving sexual behavior can crop up even in young kids, and parents wonder if it’s normal or something they should be worried about.

“Parents often hesitate to bring up sexual behavior in their kid, even to a clinician, partly because they are ashamed, or it feels awkward to talk about, and partly because they hope the behavior will go away on its own,” says Megan Ice, PhD, a psychologist at the Child Mind Institute.

Parents also don’t know what’s developmentally appropriate and how to recognize when it’s a symptom of something more serious. “There’s a typical level of curiosity about the body, or tweens and teens joking around,” Dr. Ice says, “and it’s hard for families to know when something rises to a level of concern.”

Being interested in the body is part of normal development in kids, but sexual behavior can be linked to other concerns. Parents sometimes worry that their child’s behavior can impact them socially — that they’ll get teased by other kids or won’t get invited over to play by other kids’ parents. Or they worry that sexual behavior is a sign the child has been molested.

Before jumping to conclusions, it’s important to listen to kids, says Dr. Ice. “I’m always on the side of being curious with kids, asking them questions in a nonreactive way in order to understand what’s driving the behavior.” Their answer may show that the behavior is innocuous, and you don’t need to get them evaluated. Or it may indicate that the behavior is a sign of a different issue than you originally suspected: “Some kids say inappropriate stuff or draw penises on the walls just to get a reaction,” she says. But you also might uncover information that makes you think the behavior is concerning or problematic, and then you’ll want to consult a mental health professional.

Here are some examples of sexual behavior at different developmental ages, from healthy to concerning to problematic.

• Healthy: Touches their own genitals during diaper changes, when going to sleep, or feeling afraid. Likes to be nude. Curious about watching other people going to the bathroom.
• Concerning: Touches own genitals repeatedly in public after being asked not to many times. Wants to be nude in public even when parents try to stop it. Interest in others’ bathroom functions lasts weeks or months.
• Problematic: Touches or rubs genitals so often that they hurt. Refuses to put on clothes and repeatedly exposes private parts to others. Won’t leave people alone in the bathroom or forces their way in.

• Healthy: Plays doctor and inspects others’ genitals. Plays house, acting as mommy or daddy. Kisses family members and familiar adults.
• Concerning: Frequently plays doctor even after being redirected. Imitates sexual behavior with dolls or stuffed toys. French kisses or kisses unfamiliar adults and kids, or is afraid of hugging and kissing familiar people.
• Problematic: Forces other kids to play doctor, take off their clothes, or have sexual contact with them. Talks or acts in a sexualized manner with unfamiliar adults.

• Healthy: Talks with friends about sex. Posts online about having a boyfriend/girlfriend. Self-stimulates genitals in private.
• Concerning: Talks with adults about sex and continues when asked to stop. Uses sexual language online. Masturbates in public or at inappropriate times, such as at school.
• Problematic: Says they are older than they are and initiates sexual conversation in person or online. Posts sexually explicit or violent materials online. Masturbates in front of siblings or in public.

Sexual behaviors that are problematic often have these elements in common, says Caitlyn Downie, LCSW, the Director of Trauma and Resilience at the Child Mind Institute:

• Frequency: The behavior may be healthy if the child engages in it every once in a while, but it becomes an issue when it happens very often. For example, a 3-year-old who touches their private parts once in a while is okay, but it becomes concerning if they do it multiple times a day.
• Social norms: The behavior might be fine when it’s private but not when it’s performed in front of other people.
• Persistence: If the child keeps doing the behavior even after the parent has talked to them about stopping it. “When they get redirected, do they continue to do it? That’s a red flag” that they might need help, says Downie.
• Aggressive or coercive: The child engages in the behavior with other people without their consent — say, touching their teacher or other kids inappropriately.

One thing to look for is sexual behavior that is not age-appropriate — say, a 4-year-old acting out oral sex with stuffed animals. “That type of thing is concerning regardless of persistence,” Dr. Ice says. “The child should not know what that is, so we would be concerned as to how they have learned that.”

But people need to take care not to pathologize behaviors that are just cultural differences. “Kids learn about appropriate boundaries from their parents, and a teacher might hear that a 5-year-old sleeps naked in bed with their mom and freak out,” Dr. Ice says. There might be differences in how physical affection is shown, for example, so it’s important to consider whether a child is touching others in a culturally normative way. The issue may not be problematic sexual behavior but learning to respect other people’s boundaries.

Problematic sexual behavior rarely occurs on its own. Kids usually show other signs of a mental health disorder that may be an underlying factor, explains Downie: “Often the child will have sleep or appetite problems, intense anxiety, or depressive symptoms — the persistent inappropriate sexual behavior isn’t usually isolated. It’s part of a larger inability to cope effectively.”

For example, some kids with ADHD, conduct disorder, or oppositional defiant disorder engage in problematic sexual behavior because they struggle with impulse control. “It’s not necessarily something the child is thinking about,” she says. “They’re feeling a certain way and then automatically, say, touching their genitals or touching a teacher or classmates inappropriately.” They might also engage in inappropriate behavior to get a reaction, like taking off their pants in the classroom so they get sent home.

Problematic sexual behavior can also be more extreme, such as a teenager abusing a younger sibling. In situations like this, it’s possible that the teenager themselves was molested or abused in the past. But that’s not always the case. Research finds that many children who engage in problematic sexual behavior have not been abused and that the converse is also true: Many children who have been sexually abused do not engage in problematic sexual behavior.

Ages 2–5: When parents explain to kids what makes a behavior appropriate or inappropriate, that’s often enough to help kids change. For preschoolers and kindergarten-age kids, you can explain what private parts are and the difference between “good touch vs. bad touch,” says Downie. “You want to use the correct anatomical language, even when kids are very young, so there’s no shame attached to those words.”

Ages 6–10: Elementary school-age kids will start to have more curiosity about their bodies and explore more. And with internet access comes the possibility that they will be exposed to inappropriate content such as porn — perhaps on a parent’s or older sibling’s computer. While you should take steps to avoid kids seeing porn (using parental controls, keeping devices in shared spaces), you can also use this as an opportunity to talk to them about online safety and risk, making clear that they can come to you with any questions.

If you think your child has seen porn, she says, you can look at their browser history to see what they’ve been exposed to: “It informs where their mind is at and what they think is appropriate or inappropriate.” Because kids mimic what they see, it’s important to expose kids to appropriate sexual intimacy, say, through a movie or show, Downie says. “Nothing crazy, just something so that their first exposure isn’t something inappropriate.” 

Ages 11–18: When kids reach the tween and teen years, parents should talk about consent and boundaries, says Downie. “Teens start to get involved in romantic relationships, or ambiguous relationships like being in the ‘friend zone,’” she says, and it’s important that they should never put pressure on someone to engage in sexual or romantic activity. They also need to understand that consent isn’t just about saying “yes” or “no” — there are nonverbal signs if someone is uncomfortable that they should look out for.

For all ages, you want to keep the lines of communication open, so kids know that they can come to you with questions and aren’t afraid that they will get into trouble if they do.

When kids are engaging in problematic sexual behavior because of impulse control issues, they can learn to recognize the feelings that lead to the problem behavior, says Downie. “‘If I’m feeling this way, I don’t need to do that,’ they realize. ‘I can do this instead.’” For example, they can swap out the problematic action for another one that’s more acceptable — say, putting hands into pockets instead of down their pants. Or a solution can be as simple as having the child wear a belt so that they can’t easily pull down their pants in the classroom.

If kids are using the problematic sexual behavior as a way to soothe themselves when they’re upset or angry, they can learn coping skills to help them tolerate distress and regulate their emotions, says Downie. That might involve cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT).

When the problematic sexual behavior involves other kids, the instinct is to isolate the child so it won’t happen again. But Dr. Ice says it isn’t always necessary to be so restrictive as long as there is close supervision to reduce access to online sexual content and control behavior in high-risk locations like bathrooms and changing rooms. “Similar to other behavioral issues like aggression, there often are warning signs that a child might engage in the behavior,” she says, so it’s possible to isolate them only at those times. Treatment involves helping the child learn to recognize the impulses, manage their emotions differently, and set and respect boundaries.  

Kids who engage in problematic sexual behavior often feel ashamed, so they can be secretive about it, says Downie. But it’s important to get them help to talk about it, to understand the root of what’s causing the behavior.

Similarly, parents who find their kids behaving inappropriately often feel ashamed, that it’s a reflection of something they did poorly, says Dr. Ice. They also might be afraid that this means their child will become a pedophile or be branded as a sexual predator. But research finds that most kids who have problematic sexual behavior do not go on to be adult sex offenders.

Nonetheless, families can have trouble finding clinicians for treatment because, unlike risk assessment and safety planning for suicide, problematic sexual behavior is not a standard part of training. “It’s similar to fire setting or cruelty to animals,” Dr. Ice says. “Many clinicians are afraid to treat these kids because they’re afraid someone will get hurt on their watch.” Also, engaging in sexual behaviors like touching their genitals in public can disqualify kids from taking part in group therapy and therapeutic camps, so families have to work on the sexual behavior separately or before they can access the other help they need.

When she talks to parents, Downie says to them, “This is a snapshot into your child’s life right now. And children have to be able to be curious while understanding limits and boundaries. When you put a label on a kid, that’s never going to be helpful to them. You want to acknowledge the behavior, so they’re not shamed. But you want to talk about it in a neutral way.”