By Dr Kamal ‘Akl, Consultant Paediatrician & Paediatric Nephrologist

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While childhood masturbation is universal, it often causes parental concern. Yet it is normal, common and expected behaviour, from a medical perspective, requiring little intervention other than reassuring parents and offering a few tips.

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Salma’s mother takes her to the doctor because of vaginal itching; she worries that her two-year-old has a urinary infection. The consultation reveals that Salma has the habit of rubbing herself rhythmically against the floor and her face would flush. The doctor suspects Infantile Masturbation.

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What is Infantile Masturbation?
The term describes pleasure derived from genital manipulation by children between three months and three years. Self-stimulation of the genitals results in physiological changes, such as rapid breathing, quiet grunting, flushing and sweating.

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Many people prefer the term gratification since masturbation continues to be a societal taboo to talk openly about. From my perspective as a doctor, gratification is natural and part of normal child and adolescent development. It decreases with age to peak again during adolescence. I advise parents not to send the message to their children that masturbation is shameful. During gratification, a child discovers her or his body and why it is different from that of the opposite sex.

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Below the age of four, children touch their genitals for pleasure and may masturbate in public because they are not aware of social taboos. Between the ages of five to 13, children masturbate in private. However, it is not easy to diagnose in infancy and childhood, especially in females, as they usually rub against things and do not use their hands.

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Misdiagnosis
Infantile Masturbation is commonly misdiagnosed and treated as epilepsy and movement disorders, such as dystonia, dyskinesia, abdominal pain, or colic. However, contrary to epilepsy, the child remains conscious during the event. We come across Infantile Masturbation masquerading as urologic complaints. Symptoms include inflammation of the vagina associated with pain and increased urination. Delayed diagnosis results in parental anxiety, unnecessary procedures and expense, causing discomfort to the child and the family.

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As mentioned, masturbation is normal if it is private and not highly preferred over most other activities. It has been linked to family trouble such as parental separation and sometimes misinterpreted as a sign of sexual abuse. Some psychiatric disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), may be accompanied by excessive masturbation.

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How to manage it
Appreciating that it is a normal stage of your child’s development
Understanding that it should not be in public
Avoiding harm to the child’s self-esteem
Not scaring, scolding or shaming your child
Trying to keep your child busy with other tension releasers like back rubs and playing soothing music

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When should parents seek professional help?
If it becomes excessive (getting in the way of your child’s ability to get to school or be with friends or family or leading to self-injury)
If the child touches the genitals of others
If the child attempts sexual activity with animals