This section of the website is written for you, parents and caregivers who are seeking resources and information on sexual development and problematic sexual behaviors in children aged 3-12.

Child Sexual Development

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Child development books and other educational materials typically do not cover sexual development. It’s a tough subject to discuss, much less understand.

Deciding when sexual behavior is normative and when it is problematic can be just as difficult.

Your child may have touched another child's private parts. Is it just “playing doctor"? Or is it a sign of something more serious? We want to help you answer questions like that, and we’re glad you’re here.

If you are concerned about your child's behavior, or just want to learn more about sexual development, take some time and read through our website to learn more and utilize our resources, graphs, and scenarios to help you.

Your child's sexual awareness starts early and continues to evolve throughout the preschool and school-age years. All aspects of childhood development – cognitive, language, motor, social, emotional, sexual – are interconnected. Understanding how your child's behavior changes as they grow can help you determine whether sexual behavior is typical or a cause for concern. Strive to be proactive and positive.

The following sections provide more details about the development of sexual knowledge and behavior in children. The “When is sexual behavior problematic?” section provides information on the differences between typical sexual behavior and problematic sexual behavior in more detail.


Sexual Development by Age

Click age group below for details about sexual development

Ages 0-6: Infants, Toddlers And Preschoolers

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Young children see the world through their eyes and are not good at taking other's perspectives. This is natural during this time of development. Children commonly act on what they want to do in the moment. For many children, thinking about consequences or the impact of their behavior on others is a skill that has not yet been practiced or developed. They want to do what they want, and they are focused on seeking pleasure. For example, if they're uncomfortable in their clothes, they may take them off without considering being nude in front of others. Preschool children often do not yet understand social norms regarding wearing clothing in front of others.

Since young children often don’t yet have the knowledge or context for what is safe and not safe to do with their body, it’s important to talk with your children about their body and how it changes as they age. Teaching safety rules around their body will support prevention of their own problematic behavior, and reduce risk of your child being hurt by someone else. Resources from organizations such as the How To Talk To Preschoolers About Anatomy & Body SafetySex Education Forum, and Kids 4 Kids provide steps on how to engage in these conversations.

Sexual Knowledge

Knowledge and expression about gender, sex roles, and sexual behavior evolves throughout children’s early years. Most children are assigned as male or female at birth based on physical characteristics. Children as young as 3 years of age can identify their own assigned gender (girl or boy). At first, children judge the differences between genders based on observable features found in the culture (such as hair length, cloth choices), although by age 3 or 4 years, many children are aware of differences in the bodies of most boys and most girls. Young children often have a limited understanding of pregnancy and birth. By age 6, however, they may know that babies grow in a womb and they may know the differences between birth by Cesarean section or by vaginal delivery, depending on what has been taught. What children know about adults’ sexual behavior and intimacy is influenced by what the children have seen and heard.

Preschool children mostly know about such things as kissing and cuddling. About one in five 6-year-olds knows something about more explicit sexual behaviors.

Children need support, love and care from family, friends, school and community to foster gender development and growth into happy and healthy adults.

The table below provides examples of preschool-aged children's general development and how they learn. The second column explains how this relates to their sexual development and behavior.

Preschool Children’s Development And Behavior

Preschool Children’s Development And Behavior
Typical Cognitive, Language, and Social Development in Preschool Children Typical Sexual Development and Behavior
Young children seek pleasure. They do not see themselves from other people’s viewpoints. They are not self-conscious. They often prioritize comfort. They will undress and run around nude in front of others. They may appear to not care about how other people feel because they don’t fully understand the impact of their behavior on others.
They are curious about the world, about how things work, and about how things are similar and different from each other. They are curious about physical differences of different bodies and how bodies change as people age. This curiosity includes wanting to see how other children’s body parts are different.
They learn through their senses, especially by using sight and touch. They learn through their senses, especially by using sight and touch, and thus may try to look at or touch other people’s private parts.
They have a rapidly growing vocabulary. They may use words related to urination (“pee-pee”) and defecation (“poo-poo”) when labeling their private parts. These words can be exciting to children who will use the words repeatedly, particularly with other kids. Young children will use the technical labels (such as vagina, vulva, penis, anus), if taught these terms.
They learn about behaviors by watching the people around them and imitating them. They imitate behaviors of other children and adults, and play “doctor,” “house”, or “parents” with other children.
Children want to avoid being punished by their parents. They try to avoid discomfort, including getting in trouble. They want approval, praise, and rewards from their parents. Whether or how often a child repeats sexual behavior is often related to how caregivers respond to the child’s initial sexual behavior. Calm, educational responses help children learn.
Preschool children have limited ability to plan and control their behavior. They have a poor understanding of the long-term consequences of their behavior. Children’s typical sexual behavior (such as curiously looking at another child) is unplanned. The behavior is impulsive, without much forethought.
Children often play make-believe. They often pretend to be something or someone else. They may play or dress up as various people (real and make believe, of different professions, roles, and genders) and of animals.

Sexual Behavior

Preschool-aged children are curious in general and tend to actively learn about the world through listening, looking, touching, and imitating. Preschool-aged children express their general curiosity about the world with questions. They also imitate behavior they have seen and they explore their own bodies and others’. Children ages 2 to 5 years old tend to look at others’ bodies and may be especially curious if those people are nude. Children that age do not tend to respect physical boundaries and may stand too close to other people. They often touch their own sexual body parts, even in public. Young children may also touch adult women’s breasts, particularly their mothers’. Dressing up and pretending to be others is not unusual throughout this developmental period. Some parents and caregivers may be concerned or confused if their child displays behavior that is not culturally typical for their sex assigned at birth (like a male child dressing up in girls’ clothing). We encourage families to remember that childhood is a period of learning and growth. In addition, providing affirmative and non-judgmental support of a child’s exploratory behaviors will allow for the best outcomes for your child, where they feel accepted and loved by their family regardless of their gender identity or expression.

Explore the American Academy of Pediatrics website for more about young children’s gender identity and expression. As well as, differences in sexual development.

Sexual play (showing one’s own sexual body parts and looking at or briefly touching other children’s body parts) is not unusual for preschool-age children. Sexual play is discussed in more detail below in the school-age development section. Culture and social context influence how often these typical behaviors occur.

Children as young as 7 months may touch and play with their own private parts. Infants and young children’s self-touch behavior appears largely related to curiosity and soothing feelings. From infancy on, children begin to explore the world. They learn about things that feel good and things that don’t. Various parts of the human body have a high concentration of nerve endings that make those areas very sensitive to touch. For example, the fingertips, mouth, anus, and genital areas are highly sensitive. Children discover the sensations in these areas during their normal exploratory behavior. Think of self-touch of private parts as a similar activity to when your child sucks her thumb or snuggles with a soft blanket. Even as infants, children are capable of sexual arousal; newborn baby boys can have penile erections. It’s an automatic bodily response, just like cutting a fresh onion can make your eyes water (even though you are not sad). These behaviors are very different from adult sexuality and self-stimulatory behavior. With young children, bodily responses are not a response to sexual fantasy - they are just something that feels soothing or good.

In contrast, sexually explicit, planned, or aggressive sexual acts are not a typical part of sexual development. Other rare sexual behaviors include putting objects in the vagina or rectum, putting one’s mouth on sexual parts, or pretending toys are having sex. See information about problematic sexual behavior here

In the first example of families provided in real world example section of this website, the two sons of the Cornelison family were demonstrating sex play. The children’s behavior was between two brothers of about the same age. They were not upset or angry. Instead, they were just curious. The behavior was not planned and happened when they were changing clothes. Neither child was pressured to do the behavior, although both were somewhat embarrassed to have been discovered. On the other hand, the sexual behavior of Ryan McFarland in the second example is of more concern due to the four-year age difference between him and his neighbor. The sexual behavior of Jerry Kastner in the last example is particularly concerning as he and his classmates used force with a younger student.

Ages 7-12: School-Age Children

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Children usually begin puberty during this age period. Puberty is a time in children’s lives in which their bodies change in many ways. Puberty brings many changes in children’s bodies, minds, emotions, and relationships with others. It is an important time of life, honored in many cultures through coming-of-age rituals or celebrations during adolescence, like Bar and Bat Mitzvahs, Quinceañeras, and others. It is also often a difficult time for youths as well as their caregivers as the youth grow in independence and their relationships with others adjust. Puberty usually begins for children around age 10. Some girls may begin to experience changes in their bodies as early as age 7 or 8. The physical process of maturation is designed for reproducing (of having children).

However, healthy development is much more than the physical changes and is about learning to express emotions, communicate, develop friendships, learn boundaries, and understand intimacy.

Resource highlight: How to talk with your child about their first crush


For females, early stages of puberty start with a growth spurt in height, followed by a growth spurt in weight. Breast development is typically the first physical sign of puberty. Menstruation often starts two-three years after the onset of breast development.

Males’ growth spurts often take place later than females. Body proportions change over puberty, starting with rapid growth in trunk and legs. Puberty begins when testicles and scrotum begin to grow, vocal cords get bigger, and voice deepens.

Throughout puberty, all children experience changes in skin (more oil and sweat), hair, and body odor. The specific age that a child enters puberty varies, depending on such things as nutrition, family genes, and weight. The progression with which a child moves through the stages varies as well. Such differences in the way children move into and through puberty can impact the social adjustment and behavior of young people. They tend to evaluate themselves by comparing to others’ development.

Children need support, love and care from adult caregivers and friends to manage these changes. Taking the time to listen, validate feelings, and encourage exploring interests and activities facilitates well-being. American Academy of Pediatrics provides additional resources on puberty here.

Sexual Knowledge

Children’s knowledge of pregnancy, birth, and adult sexual activity increases during their elementary-school years. By age 10, most children can have a basic and fairly realistic understanding of puberty, how “babies are made,” pregnancy, and childbirth. The accuracy of their sexual knowledge, however, depends in large part on the children’s exposure to correct information and educational material. Since parents often find communicating with their children about bodily changes and sexual matters uncomfortable, children frequently turn to other sources of information. They may learn inaccurate sexual information and troublesome values from other youth and from movies, magazines, song lyrics, the Internet, and television.

Sexual Behavior

By age 7 and 8, children begin to understand the rules of society and apply those rules to a variety of situations. Children this age start to understand that most sexual behaviors are not allowed. Children often apply social rules related to clothing during these years, too. They may become shy and more private about their personal grooming and dressing activities (such as bathing). School-age children’s sexual behaviors become more shaped by their friends and acquaintances than they were at younger ages. They tend to be hesitant to display any sorts of sexual behaviors when adults can see them. Children’s sexual behaviors continue to occur throughout this school-age period, but these behaviors are often hidden from view of others. Caregivers may not even know that such sexual behaviors are taking place.

School-age children are especially interested in the media and are likely to seek out television shows, Internet sites, movies, and pictures in publications that include nudity. This can lead to exposure to violent and explicit materials. If parents, caregivers, or other responsible adults are not available to correct misinformation, these youth may make choices of behavior based on this exposure. Consider accessing It’s Time We Talked and Digital Birds and Bees for more information.

Self-touch behaviors occur with increasing frequency during this developmental period. Interest in romantic relationships increases as children approach their teens, and interactive behaviors are initiated with the playful teasing of others. A small but significant number (about 7 to 10 percent) of children are involved in more explicit sexual activity, including sexual intercourse, by the age of 13.

Sexual Play Among Children

Normal child development involves some degree of behavior focused on sexual body parts and curiosity about sexual behavior. Sex play occurs between children of similar ages and abilities and who know and play with each other regularly, rather than between strangers. Sex play is often triggered by curiosity and occurs with people they are with. Since much of the time boys are hanging out with boys and girls with girls, sexual play often occurs between children of the same gender, and it may include siblings.

Researchers have learned a lot about childhood sex play through asking young adults about their own childhood experiences. Some things they learned are that sex play among children:

  • Occurs between children who know and play with each other already, including siblings and their friends
  • Is common (many of the adults reported at least one childhood experience)
  • May not be discovered by parents
  • Is seen as positive or neutral, if the behavior is true sex play (if it involves children of similar ages, and no force or aggression is used) and not between siblings during tween and teen years
  • Is not related to the children’s sexual orientation in adolescence or adulthood

Children who participate in typical childhood sexual play are basically being curious. They don’t obsess about sexual activity, or practice more advanced sexual behaviors, such as intercourse or oral sex. Intrusive, planned, forced, or aggressive sexual acts are not part of typical or normal sex play of children, but are, instead, problem behaviors.

In the first example of families provided in real world example section of this website, the two sons of the Cornelison family were demonstrating sex play. The children’s behavior was between two brothers of about the same age. They were not upset or angry. Instead, they were just curious. The behavior was not planned and happened when they were changing clothes. Neither child was pressured to do the behavior, although both were somewhat embarrassed to have been discovered. On the other hand, the sexual behavior of Ryan McFarland in the second example is of more concern due to the four-year age difference between him and his neighbor. The sexual behavior of Jerry Kastner in the last example is particularly concerning as he and his classmates used force with a younger student.

Tips to Remember
  1. Sexual development starts in infancy and continues throughout childhood.
  2. Most children are curious about the world including bodies and the differences in their bodies.
  3. Sex play can occur among same-age children.
  4. Sexual knowledge and behavior are influenced by culture, media, and their peers
  5. Children with developmental disabilities and medical conditions also develop sexually and benefit from knowledge, such as through sex education.
  6. Sexual behavior of children range from typical to problematic.
  7. If sexual behavior does not respond to parental intervention, it may be time to seek additional support.
  8. Sexual behavior that includes use of force, coercion, or aggression are highly concerning. Professional support is needed.
  9. Children of all genders can have problematic sexual behavior.
  10. Treatment can help prevent future problematic sexual behavior.

When Is Sexual Behavior A Problem?


It’s easy to view children as non-sexual beings until they are adults. However, sexual behavior can begin as early as infancy.

You may have heard parents of infants share that their child touches their private parts during diaper changes. Children have a natural curiosity – not only about their bodies but also about others’. That curiosity may even lead to touching each other's private parts or "playing doctor."

But when should you be concerned? Consider these characteristics.

  • The behaviors occur frequently, not just occasionally, and become preoccupying.
  • They happen between children of widely differing ages (such as a 12-year-old acting out with a 4-year-old) or between children of varying abilities.
  • The behavior is associated with strong, upset feelings, such as anger or anxiety.
  • They cause harm or potential harm (physical or emotional) to any child.
  • The behavior doesn’t change in response to typical parenting strategies like discipline.
  • They involve coercion, force, or aggression of any kind.
  • They use technology to coerce peers to do sexual behavior such as sending sexually explicit messages or photos

Some sexual behaviors in children may be harmful rather than just harmless curiosity. Guidelines are available for parents to help determine whether sexual behavior is problematic. Different types of sexual behavior problems include:

  • A child who sexually touches him or herself to the point it causes physical harm or damage (such as touching one’s own private parts so much that they become red, infected, and sore).
  • A child who constantly attempts to look at other people when they have no clothes on (such as looking underneath the bathroom stall at other children).
  • A child whose sexual interactions with other children involve inappropriate touching (such as with significantly younger children), oral-genital contact, and penetration.
  • Sexual behaviors involving use of force, coercion, or aggression.

Problematic sexual behaviors in children are not limited to any particular group of children. Problematic sexual behaviors occur in children across age ranges, genders, socioeconomic (income) levels, cultural groups, living circumstances, and family structures.

  • Some children with problematic sexual behaviors have parents who are married
  • Some have parents who are divorced
  • Some have abuse histories
  • Some have no history of abuse or other trauma
  • They are all children first.

They are children whose sexual behavior is problematic and potentially harmful. With supervision, guidance, and treatment, they can grow up and lead healthy and happy lives making good decisions.

Tips to Remember
  1. Sexual behavior of children range from typical to problematic.
  2. Be concerned if sexual behavior does not respond to parental intervention.
  3. Sexual behavior that includes use of force, coercion, or aggression are highly concerning. Professional support is needed.
  4. Children of all genders can have problematic sexual behavior.
  5. Treatment can help prevent future problematic sexual behavior.

What Causes Problematic Sexual Behavior?


Most believe sexual abuse is the primary cause of problematic sexual behavior. Having problematic sexual behavior is a red flag for sexual abuse. However, many children with problematic sexual behaviors have not experienced sexual abuse, as research has repeatedly demonstrated.

So, how does sexual behavior become problematic? Where does problematic sexual behavior come from then?

Vulnerabilities And Contributing Factors

Researchers have found a wide range of potential causes and contributing factors. These vulnerabilities reflect characteristics, situations, and activities or behaviors that may increase the risk of problematic sexual behavior.

  • Children with problematic sexual behavior may have been exposed to violence or neglect. Violence may be in their home such as domestic or child physical abuse. Violence may be in their community and schools.
  • Other scary or traumatic experiences may have contributed.
  • Many did not learn positive, healthy ways to handle their feelings and respond to conflict. They, in turn, act out.
  • Some children may act impulsively without thinking about the consequences. They don’t follow the rules or have difficulty listening to authority figures.
  • Some children do not have guidance from caregivers or other trusted adults about what behavior is ok and is not ok and not safe. The children may show sex play initially due to curiosity, and the behavior grows to be concerning and problematic.

Media is another factor. Children have many opportunities to see sexual behaviors and language on social media, television, and the internet. Many children who come in for treatment have shared that their behavior started because they wanted to try what they saw in movies or on the internet.

Social isolation and inadequate supervision can worsen unhealthy exposure. Children who lack consistent supervision may turn to television or video games for entertainment containing sexual content.

Some children struggle to understand the social cues of others. They have difficulty making friends on their own and may become curious about sexual behavior. They may act out with younger children who are playmates.

No single factor causes problematic sexual behavior in children. A myriad of vulnerabilities need to be considered.

The graphic accompanying this information shows how various factors can interact with one another and contribute to the development of problematic sexual behavior.

If you’re concerned about a child's behavior, seek help from a qualified professional who can provide appropriate guidance and support. See the our Caregiver Partnership Board’s Survival Guide for Caregivers

What If Sexual Abuse Is Suspected?

If your child tells someone that another person has touched his or her private parts, or if you suspect a child has been sexual abused, you need to make a referral to Child Protection Services. Some states require that all citizens report any suspected abuse of a child. Ongoing sexual abuse must be stopped to be able to help a child. If you think sexual abuse might have happened, and it has not been previously investigated by Child Protective Services, then you can report what you suspect so that the appropriate actions can be initiated. Reporting suspected abuse to the authorities can be a scary process for some parents. Parents may be concerned that they will be wrongly accused of abuse themselves. It is critical to stop ongoing abuse if it is occurring, and the first step is to call the authorities. Develop a team approach in working with Child Protective Services, express your desire to protect your child, and make sure the right services are provided.

Caregivers or authorities may suspect sexual abuse when children display problematic sexual behaviors. Results of an investigation of child sexual abuse at times can indicate that the findings are uncertain, meaning that authorities are not able to confirm that the child has been sexually abused, but they also cannot completely rule it out. Caregivers are understandably concerned about what to do when sexual abuse is suspected. In these situations, we caution caregivers against frequently questioning their child during or after an investigation of possible abuse. Questioning a child repeatedly can actually hinder the official process. In addition, it can cause distress and confusion in the child. If no evidence exists of ongoing sexual abuse or exposure to trauma or sexualized materials, children often can respond to treatment of the problematic sexual behaviors. Further, with education about child-abuse prevention skills, children may later reveal details of past sexual abuse, if it had occurred. Abuse-prevention skills help children understand what behaviors are okay and not okay. Those skills teach children that if someone touches their private parts, that person is breaking a rule. Children can also learn which adults to tell when these situations happen. (Abuse-prevention skills are discussed more thoroughly here) Caregivers are advised to be available to listen, but not to repeatedly question children about possible past sexual abuse.

Supportive And Protective Factors

Protective Factors That Prevent The Onset And Continuation of Problematic Sexual Behaviors

Families and communities have many characteristics that can provide protection for children. Identify those positive factors in your own life and connect with groups that support these messages for your children. Some protective factors include.


  • The ability of informed adults to talk openly to children about relationships, intimacy, and sexual-education matters
  • Close supervision and guidance of children
  • Opportunities for children to be involved in age-appropriate activities (for example, sports, boys/girls clubs, after-school activities, and craft activities)
  • Friends who are caring and who make good decisions
  • Warm relationships with caring adults
  • Clear, positive messages about modesty, boundaries, and privacy
  • Protection for your child from scary or traumatic events, including media coverage of such events as wars, bombings, or shootings and
  • Closely observing what your child watches on television and in the movies or is exposed to in music and on the Internet.

Impact Of Problematic Sexual Behaviors On Other Children

How Does Sexual Behavior Impact Children?

Children who experience sexual behaviors initiated by another child can have a wide range of responses. Some children function have no trauma symptoms, nor any other significant behavioral or emotional concerns. Other times children might experience responses that can include:

  • Re-enact the experience with peers, dolls or stuffed animals
  • Demonstrating sexual knowledge and sexual behaviors that are not typical for the age of the child
  • Anxiety (such as difficulty in separating from parents)
  • Anger, aggression, argumentativeness, and defiance
  • Symptoms of prolonged sadness, depression, or abrupt mood changes
  • Confusion about relationships with peers
  • Difficulty making and keeping friends
  • Nightmares and fears
  • Startling easily to loud noises or sudden movements, and
  • Avoiding anything that reminds them of the event

What Factors Influence How The Children May Be Impacted?

Sexual behavior among children falls on a continuum ranging from typical, to concerning, to problematic, to harmful Behaviors that fall in the typical end of the continuum, also referred to sex play, do not tend to lead to negative impact. For example, the sons in the first example family in the real world examples were involved in sex play. The boys described feelings of mutual curiosity and responded well to education provided by their parents. No negative impact would be predicted.

However, when a child demonstrates problematic sexual behavior (such as sexual behavior initiated by an older child who was aggressive), the experience can have a detrimental effect on the child. For example, the girl who was held down by Jerry in the last real world example may have a variety of trauma symptoms in response. She may have bad dreams, fears, clinginess or other symptoms after that abusive experience.

Factors that influence a child’s response to experiencing sexual behavior problems include:

  • The response and support by the parents and other caregivers following the incident(s)
  • The length of time in which the sexual behaviors take place (sexual behaviors that occur over a longer period of time are more harmful)
  • How many times the problematic sexual behavior happened (sexual behaviors that happen on multiple occasions)
  • The type and closeness of the relationship among the children (such as, whether they were  siblings, close friends, acquaintances, or strangers)
  • How scary the situation was for the child. Fear and worry may be related to age/size difference of the children, and the use of threats, coercion, aggression, or force
  • The type of sexual behavior, such as whether genital contact and penetration was involved
  • The child’s recent functioning (for example, children who were already struggling with depression, anxiety, or other concerns will have a more negative impact to the problematic sexual behavior than children who were happy, had friends, and were otherwise doing well)
  • The response and supports by the professionals who may become involved after the incident is discovered. Professionals may be from child protective services, law enforcement, school personnel, and behavioral health specialists. (Whether or not the assessment, investigation, safety planning, and treatment was provided in a child friendly, calm, and supportive manner can impact child response).

How Do I know How Best To Support My Child?

Research indicates that parental responses play a key role in a child’s response to experiencing problematic sexual behavior initiated by another youth. Specifically, remaining calm, and nurturing makes a difference for the children. Clearly communicating the belief in the disclosure along with developing and implementing a safety plan are key elements in a response that will be supportive to your child. Children who show symptoms of distress can be evaluated by a licensed behavioral health specialist (such as a psychologist, social worker, psychiatrist, or licensed professional counselor) with experience in child trauma to determine what supports and help would be best.

What Type Of Treatment May Be Helpful?

Short-term community-based treatment may be recommended to provide therapy and support to the child and caregivers. If the child is demonstrating trauma symptoms, Trauma-Focused Cognitive- Behavioral Therapy (TF-CBT) may be recommended. TF-CBT is a type of therapy for children who experienced a traumatic event, including problematic sexual behavior from other children. TF- CBT has been identified by multiple federal and state agencies as a “best/model practice” and is considered to be the gold standard treatment for these children. TF-CBT is an out-patient therapy for the child and their caregiver(s) that is typically completed in 12-24 sessions. Some of the things covered in sessions includes teaching children skills for relaxation, emotional expression, coping, problem-solving, and safety planning. In addition, directly addressing the trauma gradually is utilized to reduce anxiety and distress related to trauma memories. Caregivers learn methods for assisting their children with healthy coping and techniques for managing challenging child behaviors. Caregivers also participate in the sessions where the trauma is addressed to learn ways to communicate with their child about the traumatic experience and to enhance the parent-child relationship.

Information about providers trained in TF-CBT can be found here. Information about other evidence based treatments are available through the California Evidence-Based Clearinghouse. Local Child Advocacy Centers may be able to provide services directly or facilitate guiding caregivers to treatment options in their community (National CAC and National Children's Alliance).

Children respond best when their caregiver is calm, supportive, caring, and resourceful. It is important to note that caregivers have a range of responses themselves and may struggle with remaining calm and knowing how to be supportive. Seeking support through friends, family, professionals and resources helps to maintain the strength and patience needed to assist children with coping.

How Do I Support All The Children Involved When The Sexual Behavior Occurs Within The Family?

Caregivers of children who act out sexually with siblings (or other family members such as cousins, niece, etc.) often feel divided and unsure how to provide the right support to all their children. All of the children who are involved will need someone to listen to them and help them cope. Child victims need to know they are believed, they are not at fault, and they are safe. Children who initiated the problematic sexual behavior will need help understanding how their behavior was a bad choice, they are not inherently bad, and they can make respectful choices in the future. It is important that all children are safe and receive caring support for healing to take place.

The specific types of supports provided will differ widely depending on the circumstances, needs, resources, and responses. A variety of professionals, such as from child protective services, law enforcement, medicine, and behavior health, may become involved with the family. The process can be confusing and stressful for the caregivers. It is important for needs, wishes, and resources of all the family members are considered and that services be coordinated, preferably within a single or few agencies.

It is essential that all the children feel and are safe. How this occurs will differ by family and circumstances. Sometimes the children can remain in the same home with safety measures including close supervision in place. Sometimes children will need to live in separate homes while they receive therapeutic services. See Safety planning and living together, separation, and reunification sections of the website for more information. When family members have to be temporarily separated, planning for safe reunification should start early. Often family therapy prior to reunification facilitates the transition home.

How Many Children Have Problematic Sexual Behavior?

No one knows how many children have had problematic sexual behaviors during their lives. No specific entity or agency is in charge of these youths or tracks their behavior. Sometimes, Child Protective Services are involved with children with problematic sexual behaviors, especially when the children have been abused or neglected. At times, juvenile or family court could also be involved, especially with older children. Over the last two decades, child protective service systems and juvenile services have had more referrals of children with problematic sexual behaviors. We don’t know if these referrals represent a true increase in the number of children with problematic sexual behaviors, or if they represent a greater public recognition of and response to the problem, or a combination of both.

Advocating For Your Child


Deciding where to seek support for a child who has engaged in problematic sexual behavior can be a confusing process.

No single state or federal agency manages children with sexual behavior problems.

  • Sometimes child protective services (or child welfare) are involved.
  • Sometimes law enforcement is involved.
  • Some states have other agencies who oversee cases of children with sexual behavior problems.
  • Sometimes the only professionals involved are the therapists or other behavioral health professional providing services to the family.

Each state has different regulations, policies, and rules for governing how it will address cases of children who have demonstrated such problems. The information below provides general guidelines regarding these agencies.

No single state or federal agency manages children with sexual behavior problems. Sometimes child protective services (or child welfare) are involved. Sometimes law enforcement is involved. Some states have other agencies who oversee cases of children with sexual behavior problems. Each state has different regulations, policies, and rules for governing how it will address cases of children who have demonstrated such problems. The information below provides general guidelines regarding these agencies.

Child Protective Services

Every state in the union has child abuse and neglect reporting laws as well as Child Protective Services that are required to investigate suspected abuse and to protect children. Many children with sexual behavior problems, particularly preschool-age children, have experienced trauma, including child abuse. First and foremost, these children must be protected from further harm. Child Protective Services are provided by the state and are charged with protecting children from child maltreatment, including child sexual abuse, physical abuse, neglect, and emotional abuse. For children who are American Indian or Alaska Native, Indian Child Welfare is required to be involved in child protective matters.

In most states, child protective services address child abuse and neglect by a caregiver. In general (but it differs by state and jurisdiction), child protective services will investigate cases in which a child has demonstrated a sexual behavior problem when:

  • There is reason to suspect that one or more children involved in the sexual behavior may have also been abused by a caregiver
  • A caregiver has been aware of the sexual behavior problems and has not taken protective actions to prevent future sexual behaviors
  • A child with sexual behavior problems needs appropriate treatment, and the caregiver fails to enroll and participate in such services (particularly when the youth has demonstrated aggressive, coercive, and/or repeated sexual behavior problems) and
  • The caregiver is not providing appropriate protection and safety measures, due to such things as substance abuse or domestic violence.
  • The sexual behavior demonstrated by the child is considered harmful or abusive.

For information about reporting suspected child abuse and neglect see and

In these cases, Child Protective Services will conduct an assessment or an investigation. An assessment is designed to identify service needs of the family and link them with supports. An investigation is initiated in the more severe or risky cases, and is designed to determine if abuse or neglect has occurred so that needed safety measures can be taken. Assessments and investigations often include interviews of the children, caregivers, and other involved adults. The investigation may also include an assessment of the safety and risk factors in the home environment.

Some jurisdictions use Child Advocacy Centers to conduct interviews with the children. Child-Advocacy Centers are child-friendly environments and have specially trained interviewers who typically work in conjunction with child protective services, law enforcement, and district attorneys.

The results of the investigation and child protective services’ response can vary depending on the case, situation, and jurisdiction. Possible results and responses may determine one or more of the following:

  • Child abuse and neglect are not confirmed, but services are recommended. A specific treatment program may be recommended by child protective services.
  • The children involved in the sexual behavior problems were themselves victims of child abuse. If so, safety measures will be required. If the person who was the abuser is in the home (such as the father, the aunt, or someone else), that person may be required to leave the residence. Another option is that the child may be placed in foster care or in a kinship care home.
  • The caregiver “failed to protect” the children involved. These are cases in which child protective services believe that a caregiver knew about the sexual behavior problems or other risky situations and failed to act to protect the child. Responses can range from close monitoring and requiring services to the removal of the children from the home and the placement of the children in protective custody. Sometimes the state/Child Protective Services may remove all the children. At other times, just the child with the sexual behavior problems will be required to live in a home separate from his/her siblings. The caregiver would then be given a treatment plan to complete, to demonstrate that the caregiver has the capability to protect the children.
  • The caregiver was neglectful when failing to find and participate in needed mental health or behavioral health services for a child with sexual behavior problems. If the caregiver is required to follow through with services, but fails to, the child may be removed from that adult’s care and placed elsewhere to receive the required services.
  • Having Child Protective Services involved with your family can be somewhat intimidating, due in part to your level of uncertainty about what could happen. But the service’s goal is the same as your goal, which is to keep your children safe from harm. With education, advocacy, and support, a partnership can be developed with Child Protective Services to help your children. Here are some recommendations to help with this process:
  • Advocate that your children and family receive the types of treatment found to be most effective.
  • Develop a support network that will provide a safety team for your children and provide you with emotional support.
  • Directly address any personal matters that would interfere with your ability to provide the types of supervision and parenting your children need, such as treatment for depression, substance abuse, or violence in the home or community.
  • Advocate that all caregivers provide a safe and caring environment that meets the needs all children.
  • Advocate for a lawyer who knows your child’s rights and understands and supports the best interests of your children and you.
  • Communicate regularly with the Child Protective Services worker assigned to your family. If you have problems with communication with that person, contact the worker’s supervisor.
  • If you disagree with the findings of the Child Protective Services investigation, you can appeal. Every state is required to have an appeals process for caregivers.

Legal System

The legal system may become involved with families of children with problematic sexual behaviors in a variety of ways. If Child Protective Services are involved and confirm child abuse or neglect, then the children and caregivers will likely be involved in the court system. States refer to this court with different names, but often it is called Family Court. Cases involving Child Protective Services may include a treatment plan for the family that will be issued through the court. The family will be seen in court in front of the judge periodically (perhaps monthly, or every three or six months) until enough progress has been made that the case can be closed.

The juvenile justice system can also be involved with families of children with problematic sexual behaviors through law enforcement and juvenile services. This involvement may happen in cases where older youths (such as 11- or 12-year-olds, but sometimes younger) act out sexually with much younger children, particularly in cases where force, coercion, or aggression is used or in cases where the sexual behavior is explicit and intrusive (such as intercourse). In these cases, law enforcement may conduct an investigation that involves the interviewing of all children and adults potentially involved in the situation. Law enforcement will also conduct examinations of the scene or collect other evidence. States can charge juveniles with sexual offenses, but each state differs with regard to the age group to which juvenile statutes apply. Some states have applied juvenile statutes to children as young as 7 years old, but states more typically have an age limit of no less than 10 years of age.

After finding that a youth has committed a sexual offense, the legal system may respond to these cases in one of the following ways:

  • Postponing charging the child if the youth participates in services, and then dropping charges upon completion of the program
  • Charging the child with a sexual offense, placing the child on probation, and requiring service participation or
  • Charging the child with a sexual offense and placing the child in a juvenile facility

Some states are now placing youths (mostly adolescents) with sexual-offense histories on public sex offender registries on the internet. It is important for caregivers to educate themselves about the registry laws in their own state. The Task Force Committee on Children with Problematic Sexual Behaviors from the Association for the Treatment of Sexual Abusers reports that registering children and publicly labeling them as sex offenders for life puts the children themselves at risk of significant harm that can range from educational discrimination and rejection to ostracism and vigilantism. No broad public protection is provided by the registration of children because children with problematic sexual behaviors simply are not a high-risk group, especially if provided with appropriate treatment. The full report of the Task Force can be found on the publications page of their website (  


Family Testimonials

When a parent has a child who demonstrates problematic sexual behavior, many questions arise such as ones noted in these case examples. The four examples are fictional and are not intended to represent a specific people. Rather these examples illustrate the range of families impacted by problematic sexual behavior of youth. In the following webpages, these families’ questions are addressed as well as other questions parents and caregivers may have.

Tips to Remember
  1. Not all children with problematic sexual behavior have been sexually abused.
  2. If child sexual abuse is suspected, contact the authorities, including child protective services.
  3. Multiple factors may contribute to the development of problematic sexual behavior.
  4. Close supervision, open communication, sex education, good boundaries, and positive friendships are protective factors.

Finding The Right Treatment

finding the right treatment Treatment works!

When children with PSB and their caregivers participate in evidence-based treatments, they learn how to make healthy choices, their behavior improves, and PSB ceases. A 97% success rate was found in a 10-year follow-up study. Research has found that the most important components of treatment include


  • Active caregiver involvement in treatment as well as focusing on evidence-based parenting skills.
  • It is also recommended that treatments include specific rules around sexual behaviors, sessions to address developmentally appropriate sex education, and work on abuse prevention.
  • With the child, it is important that they are taught some kind of emotional expression, coping, and self-control skills.

See this newsletter from caregivers just like you that outlines what is most important in treatment (English and Spanish).

Although sexual exploration and play are a natural part of childhood sexual development, some children’s sexual behavior is more than harmless curiosity and requires specialized intervention. When sexual behaviors impact the safety or well-being of the child and other children, it is important for families to obtain support and treatment.

One of the most important supports is quality behavioral health treatments. Effective treatments do exist. When a child and his/her family can get this kind of treatment, it makes a big difference for all involved. The treatments can have positive results for a very long time. Consult a qualified treatment professional when

  • Your child demonstrates a problematic sexual behavior as described earlier
  • You are uncertain if the behavior was just "playing doctor" or was a problematic sexual behavior
  • Any child is distressed about the sexual behaviors of another child or
  • You have other serious questions and concerns about your child

The first steps of the behavioral health provider (therapist) should be to evaluate and assess the situation with your child and your family. This evaluation will help the provider determine if the behavior was a problematic sexual behavior, what other concerns or issues might need to be addressed, and what supports and protective factors are present in the family and community.

The evaluation will most likely involve an interview with you and your child (particularly if your child is 7 years old, or older). You and maybe your child’s teachers and your child, too, will have to complete an information checklist. Some other tests may have to be given to your child. If Child Protective Services or law enforcement is involved in the case, a summary of their findings will be helpful to the professionals. The professionals will often choose to postpone this evaluation until the completion of any Child Protection Services or law enforcement investigation, to prevent any interference with the process.

What Makes A Treatment Program Successful?

Different types of therapies for problematic sexual behaviors in children have been evaluated. We have learned about what types of treatment are helpful for children with problematic sexual behaviors and their families. The main characteristics of effective therapy for many children with problematic sexual behavior include

  • Outpatient treatment (where the child stays in the home and community)
  • Active and full participation in the treatment by parents and caregivers
  • Short-term treatment of approximately three to six months. Short-term treatment is possible if the family attends sessions regularly, actively participates in available services, and practices skills between sessions
  • Education for caregivers about how to apply rules about sexual behaviors
  • Enhance quality of family relationships
  • Teach parenting strategies that prevent and reduce behavior problems
  • Address sexual education topics with their children and
  • Support abuse-prevention strategies and skills

Find information about evidence-based treatments through the California Evidence-Based Clearinghouse, OJJDP’s Evidence Based Program directory, and the National Children's Alliance Fact Sheet. 

Learn more and find providers offering Problematic Sexual Behavior- Cognitive Behavioral Therapy.

Locate sites trained in Multisystemic Therapy for Youth with Problematic Sexual Behaviors (MST-PSB) operating under a valid program license from MST Associates.

Trauma-Focused Cognitive Behavior Therapy is an effective treatment for youth whose problematic sexual behavior is driven by trauma experiences.

Safer Society Foundation maintains a database of clinicians from around North America who work with sexual abusers, children with sexual behavior problems, and survivors of abuse.

The Association for the Prevention and Treatment of Sexual Abuse (ATSA) referral database promotes sound research, effective evidence-based practice, informed public policy, and collaborative community strategies that lead to the effective assessment, treatment, and management of individuals who have sexually abused or are at risk to abuse.

Search for a local Children's Advocacy Center located near you through the National Children's Alliance. Local Child Advocacy Centers may provide services directly or guide caregivers to treatment options in their communities.

When Do Children With Problematic Sexual Behaviors Require Inpatient Or Residential Treatment?

Most children with problematic sexual behaviors can be treated in the community while living at home. When children have sexually acted out with young children in the home, they may temporarily need to live with a relative or in another home so that safety and supervision can be established. Residential and inpatient treatment should be reserved for the most severe cases, such as children with

  • Intense psychiatric disorders, such as psychotic symptoms (like hearing voices)
  • Highly aggressive or coercive sexual behavior that recurs despite appropriate outpatient treatment and close supervision
  • Suicidal tendencies that include specific plans and specific plans to physically harm others

Children with any of the above characteristics should be evaluated by a qualified mental health professional to determine the need for a higher level of care, such as inpatient or residential placement.

Qualifications Of Therapists

Children with problematic sexual behaviors should be seen by a licensed mental health professional who has

  • Child development expertise (including sexual development expertise)
  • Knowledge of the different types of childhood mental health disorders
  • Familiarity with children who have multiple diagnoses, which is often the case with children with problematic sexual behaviors. The professional should be trained in the topics of ADHD, child maltreatment, child trauma, and conditions that affect self-control, with an understanding that larger social problems have an impact on children’s behavior, including their sexual behavior
  • Knowledge of current research and effective approaches for treating childhood mental health disorders and problematic sexual behavior and Knowledge of the many cultural variations that exist in parenting and childhood sexual behavior

Family Testimonials

When a parent has a child who demonstrates problematic sexual behavior, many questions arise such as ones noted in these case examples. The four examples are fictional and are not intended to represent a specific people. Rather these examples illustrate the range of families impacted by problematic sexual behavior of youth. In the following webpages, these families’ questions are addressed as well as other questions parents and caregivers may have.

Tips to Remember
  1. Effective treatment actively involves the parents and other caregivers.
  2. Most children with problematic sexual behavior can remain in the community and receive treatment.
  3. Inpatient or residential treatment should be reserved for children with serious mental health issues or whose sexual behaviors are not responsive to adult supervision and guidance.
  4. Ask therapists about their qualifications and experience serving children with problematic sexual behavior.
  5. Not all children with problematic sexual behavior have been sexually abused.
  6. If child sexual abuse is suspected, contact the authorities, including child protective services.
  7. Multiple factors may contribute to the development of problematic sexual behavior.
  8. Close supervision, open communication, sex education, good boundaries, and positive friendships are protective factors.

Child-Related Resources for Parents

National Children's Alliance Tip Sheet

Best Practices for PSB Treatment of Youth

National Children's Alliance

Addressing Youth and Children with PSB


California Evidence-Based Clearinghouse

Connect To Treatment

Short-term, community-based treatment often works. It's a treatment that involves therapy and support for both child and caregivers. Our Caregiver Partnership Board developed this tip sheet with their advice on what to look for in treatment(tip sheet in Spanish).

Getting The Most Out Of Treatment

Keep these key points in mind when selecting a successful treatment program for your family. Treatment should be focused on the behavior problem in a positive learning environment.

  • Therapy should not be based on adult treatment models.
  • The qualifications of the therapists are important.
  • Caregiver involvement is crucial.
  • A group setting can be helpful when focused on building positive behavior..
  • Respect and support are key.
  • Children should not be negatively impacted by treatment.

Your involvement in treatment is the key to the success of your child. Our Youth Partnership Board developed this tip sheet for caregivers.

When asked “how successful you could have been in treatment if your caregiver was not involved?” Their answer “Not at all.”

When you’re seeking treatment, find licensed mental health professionals or those who work under their supervision. These professionals should have experience working with children, child development, trauma, problematic sexual behavior, include caregivers in their services, and be familiar with current research.

Look for someone who participates in ongoing training and is a member of professional organizations such as the American Professional Society on the Abuse of Children (APSAC), the Association for the Prevention and Treatment of Sexual Abuse (ATSA) or National Association of Social Workers (NASW). Some states may also have additional certification requirements for those who treat adolescents with illegal sexual behaviors.

Find information about evidence-based treatments through the California Evidence-Based Clearinghouse and OJJDP’s Evidence Based Program directory. Below are some examples:

OU Problematic Sexual Behavior – Cognitive Behavioral Therapy. To learn more and find providers see:

Locate sites trained in Multisystemic Therapy for Youth with Problematic Sexual Behaviors (MST-PSB) operating under a valid program license from MST Associates.

Trauma-Focused Cognitive Behavior Therapy is an effective treatment for youth whose problematic sexual behavior is driven by trauma experiences.

Safer Society Foundation maintains a database of clinicians from around North America who work with sexual abusers, children with sexual behavior problems, and survivors of abuse.

The Association for the Prevention and Treatment of Sexual Abuse (ATSA) referral database promotes sound research, effective evidence-based practice, informed public policy, and collaborative community strategies that lead to the effective assessment, treatment, and management of individuals who have sexually abused or are at risk to abuse.

Search for a local Children's Advocacy Center located near you through the National Children's Alliance. Local Child Advocacy Centers may provide services directly or guide caregivers to treatment options in their communities. Visit

On Going Prevention And Education

Our Caregiver Partnership Board believes that they could have prevented their child’s problematic sexual behavior and that you can too. They developed this tip sheet to encourage you as caregivers to have important conversations with your children (tip sheet in Spanish).

  • Watch your child’s behavior including when they are on electronics.
  • Listen to their words and expressions of feelings.
  • Provide support and encouragement.
  • Share your knowledge and values.
  • Research information and teach yourself when you are also unsure.

Healthy development can be fostered.

Safety Planning

children #7

After parents determine that their child has indeed demonstrated problematic sexual behaviors, they may have a variety of reactions and responses toward the child. It can be helpful for parents to find healthy ways to become calm and provide support. Remember that with close supervision and appropriate treatment, children can get back on a positive path.

In many communities, therapy or other interventions may not be able to start immediately, but caregivers can start doing many things immediately to help prevent future problematic sexual behaviors.


Close Supervision Is Important When The Child Is With Other Children.

Children who have acted out sexually with other children need continuous visual supervision. Visual supervision means that you can see your child at all times when the child is with other children. Continuous visual supervision is difficult to maintain, however, so families often have to work closely with support systems (such as relatives, friends, and neighbors) to create such oversight. It is important that the supervision be done without fail to insure the safety of other children and to prevent the behavior from becoming a habit.


The Child With Problematic Sexual Behaviors Should Not Sleep In The Same Bed With Other Children.

We also advise that the child sleep in a room alone. Some families are not able to accomplish this arrangement, however, for financial or cultural reasons. Other ways to maintain appropriate monitoring may need to be put in place, such as not having your child with problematic sexual behaviors share a bedroom with younger children, having audio or video monitors, or having other safety measures in place. If your child has nightmares or sleeping problems, he or she can be comforted and put back in his/her own bed or allowed to sleep in your room in a sleeping bag on the floor (this applies particularly to younger children).


Communicate Clear Rules And Expectations About Privacy And Appropriate Sexual Behavior To All Your Family Members.

It is important that all members of the family know and observe these rules. All children and adults in the home should be included in a discussion of the privacy rules. Examples of Private Parts Rules and/or Sexual Behavior Rules


Have Privacy Rules In Place.

Caregivers should insist on privacy in the bedrooms and bathrooms. Families need to have clear rules in place about entering bedrooms (such as always knocking before entering). Parents can take steps (such as locking the door) to make sure that children cannot simply walk in and observe adult sexual activity.


Personal Self-Care Should Occur In Private

Once a child has demonstrated a problematic sexual behavior with other children, the child needs to bathe alone and should take care of personal self-care in the bathroom without the presence of other children. If the child is young enough to need help with washing, bathing, or using the bathroom, a parent or another appropriate adult should provide assistance.


An Adult Should Remain In Charge Of All The Children.

Children with problematic sexual behaviors should not be given any opportunities for assuming a role of authority over other children. This means that the child who has had problematic sexual behaviors should not babysit or be told to “watch” other children while a parent cooks dinner, runs a quick errand, etc.


Children Need To Be Protected From Sexually Explicit Media.

Sexually explicit materials, such as what is found in some magazines, videos and movies, computer files, video games, websites, shopping catalogues, and television programs, should not be available to the children in the home. Children need to be supervised closely while they are on the computer, cell phone, and other personal mobile devices to make sure that they are accessing appropriate material. Safety measures, such as parental controls, need to be in place for cable, satellite dish networks, and the Internet.


Parents and Other Adults Should Demonstrate Modesty In The Child’s Presence.

There should be no nudity, partial nudity, or explicit displays of sexual behavior by parents or other adults or teenagers in front of the child. It has become fashionable for some people in public to show underwear, bras, the upper section of the buttocks, and other private parts areas. These types of fashions are not recommended for families with children who have had problematic sexual behaviors. It is appropriate, however, for adults to show affection (such as holding hands, kissing, and hugging) to each other and the children.

Safety Implementation

The family, in consultation with therapists and other professions, will need to develop a safety and supervision plan to prevent any further problematic sexual behavior. See this Family Safety Plan example. 


Private Parts Rules And Sexual Behavior Rules

Throughout childhood, children learn safety rules. For example:

  • Don’t touch hot stoves.
  • Don’t run into the street.
  • Wear a safety helmet when you are on your bicycle.

Children with problematic sexual behaviors often do not have a clear understanding of safety rules about their own bodies. They do not understand the need to respect themselves and other people. It is important for all children, especially those with problematic sexual behaviors, to learn to follow safety and privacy rules, such as the Private Parts Rules or the Sexual Behavior Rules. The simple rules below can be integrated in your family’s safety rules.

Private Parts Rules or Privacy Rules (for Preschool-Age Children)

Sexual Knowledge

children #8
  • No touching other people’s private parts. (This includes kicking, hitting, biting, hurting, etc.)
  • No other people can touch your private parts. (The person doing the touching would be the one breaking the rule. Exceptions to this rule are for caregivers who may need to help with hygiene and for doctors who may need to check to make sure that all parts of a child’s body are healthy.)
  • No showing of private parts to other people. (Or: Keep your clothes on when other people can see you.)
  • No looking at other’s private parts. (Such as, do not look at others when they are going to the bathroom.)
  • No touching of private parts in public. (Or: Touching your own private parts when you are alone is OK.)

Sexual Behavior Rules (for School-Age Children)

children #9
  • It is not OK to show your private parts to other people.
  • It is not OK to look at other people’s private parts.
  • It is not OK to touch other people’s private parts.
  • It is OK to touch your private parts as long as it is in private and does not take too much time.
  • It is not OK to use sexual language or make other people uncomfortable with your sexual behavior.
Learning the Private Parts Rules was very helpful. The rules helped him understand what is acceptable and what is not. Also he knows who to go to if someone tries to break the rules with him. -Parent of a 6-year-old boy

Caregivers are often uncomfortable about teaching accurate labels for private parts. There are a variety of labels , in addition to “pee-pee” and “poo-poo,” such as “cookie jar,” “chicken,” or “peanuts.” We recommend that all children learn the correct names for body parts, including private parts. Some of the reasons to teach the specific names, such as penis, testicles, vulva, clitoris, vagina, breasts, and buttocks, are as follows:

  • It can be easier for children to report when someone has tried to touch their private parts if they know the correct words.
  • It gives the message that these are just parts of a child’s body, rather than something that is problematic.
  • It gives the message that body parts can be talked about directly with the caregivers, rather than being something hidden or vague (such as “down there”).
  • Other names for private parts can be confusing for the children.
  • Children can give more specific descriptions when they tell an adult about a physical problem (such as pain, itching, or other physical problems).

Caregivers may wish to use labels of body parts from languages other than English. For example, members of some American Indian tribes may prefer to use their tribal language when teaching about body parts.

It is important for a child to be able to describe what happened when he or she has been sexually abused. When children do not have accurate words for body parts, they are often unable to provide important details needed to protect them from abuse. Too often, young children can only report vague information, such as, “He hurt me down there,” and Child Protective Services and law enforcement are unable to accurately determine what happened. Help your children to become knowledgeable by teaching them accurate information about their bodies in age-appropriate terms. Help them to learn which adults they can talk to when they have questions or concerns about private matters.

One day while waiting in the checkout line at the grocery store, my 4-year-old son bumped into the basket and then started singing, ‘I hit my penis! I hit my penis!’ At first, I was mortified. But then I realized, it’s just part of his body, and I’m glad he knows the name, in case anything should ever happen to him. I looked at the checkout clerk and other customers, and they smiled knowingly—young active boys are just that way. Afterwards, I talked with my son about public and private language. -Parent of a 4-year-old boy

There can be downsides to teaching young and especially impulsive children the correct terms for private parts, because sometimes these children will use the terms in public. Teaching children public and private language as well as public and private behavior can help. The reasons for teaching the correct names, however, outweigh a little public embarrassment if your child talks about or asks about private parts in public.

Young children will benefit from information that they can see or touch. We have found it helpful for children to understand the general term “private parts” and to learn that these are the parts of our body that we keep covered when around other people, even when we are swimming. Our bathing suits cover our private parts.

It has helped Maria to learn more about her private parts, and why she should not show them or see others. -Parent of a 6-year-old girl
Learning the Sexual Behavior Rules helped him to realize rules of proper behavior in a manner any child can understand. -Parent of a 10-year-old boy

Pictures of children in bathing suits such as this one can help your child to visualize where his or her private parts are.

Here are some of the things you can do to help prevent future problematic sexual behavior, by using Private Parts Rules or Sexual Behavior Rules:

  • Develop specific rules for your family, worded in a manner that you are comfortable with. Name the rules something that you can refer to in public, to help remind your children to follow the rules, such as the Bathing Suit Rules, or Privacy Rules.
  • Rehearse the rules at home to help your child understand that these rules apply to home life as well as to group situations. Many rules in your children’s lives will differ, depending on where they are (for example, rules at the park are different from rules at Grandma’s house, which are different from rules at home). Your children need to learn that Private Parts Rules are always in place, no matter where they are.
  • Have a regular “family time” at home in which your family checks in about how things are going in general and ends with a fun activity. At these family times, periodically check to see if your children are able to recall the Private Parts Rules.
  • Praise your children for their positive behavior. When they are being good, let them know what they are doing well. For example, if your daughter has been getting into the physical space of her siblings (such as constantly wanting to hug and kiss them), praise her when she plays well with her siblings and leaves respectful spaces between their bodies.
  • Have an agreed-upon gesture or word that you can use when your children look like they are about to violate a Private Parts Rule. This approach is most useful for behaviors that are frequent. A caregiver may use a hand signal (such as pointing up) or a verbal cue (such as saying, “Remember the Bathing Suit Rule”). The cue should be decided with children before a caregiver uses it so that the children know what the cue means.
  • If your children come to talk with you before breaking a Private Parts Rule, praise them. Encourage them to talk with you any time they are struggling with the rules. Decide together what each child will do to obey the Private Parts Rules.
  • Encourage activities that make breaking Private Parts Rules unlikely for your children during times when they are most likely to act out. These activities can be:
    • ones that use energy, such as bike riding, running,
    • or playing catch (avoid body-contact activities, such as wrestling, tickling, or roughhousing)
    • ones that take concentration and that will distract your child (non-violent video games are sometimes good, as well as the game “Concentration,” or board games) and
    • ones that provides appropriate physical nurturing, like holding hands, stroking your child’s hair, or patting your child’s back (this kind of caring touch can help fill a need for physical contact in appropriate ways).
  • Use redirection, reminders, and distraction. For example, if your child looks like he might make a poor decision, redirect him to something he should be doing instead.
  • Let your child know what the consequences will be for breaking the Private Parts Rules. Not every behavior needs a time-out. Make the consequences relate logically to your child’s behavior, if possible. For example, if you catch your child watching an “R” rated movie on television, the consequence could be that he cannot watch television for the next couple of days.
  • Ask for support from others in your child’s life (daycare workers, babysitters, friends, teachers, and relatives) to reinforce the Private Parts Rules.
My 7-year-old son was playing with his same-age cousin. I heard him say, ‘Let’s play boyfriend and girlfriend.’ I knew that this could lead to a big problem. I grabbed some puppets, put them on my hands, jumped behind a chair, and started acting out a puppet show. They got so excited they wanted to make up their own puppet shows, and they played with the puppets for the next hour! Distraction really worked! -Parent of a 7-year-old boy

Respecting Other People’s Space: Teaching Good Boundaries

Children with problematic sexual behaviors often have trouble knowing when they have moved too closely into another person’s space or physical boundary. Getting into other people’s personal space causes them problems with other kids and with others at school and at home. For example, these children may have trouble keeping their hands to themselves, and may frequently touch the people around them. Or they may be the kind of children who run up and give a big hug and kiss to a stranger they just met, such as Summer in the third example. Not only is this behavior disrespectful of the other person, but it is also risky, because such children may be more vulnerable to being targeted by adults with intentions to harm them.

Thus, it is important for children to learn to respect other people’s physical boundaries and to protect their own. Such knowledge is especially important for children with a history of problematic sexual behaviors. The idea of “boundaries” is fairly difficult for young children to grasp. One method that makes it possible for a young child to visualize his or her “space” is to use a hula hoop. (If you use a hula hoop to teach boundaries, though, first allow your child to play with it, or the child will have difficulty paying attention.) If you do not have a hula hoop, demonstrate “space” by holding out your arms level with the ground.

  • Have your child sit in the middle of the hula hoop.
  • Explain that all people have “space” around them, and that they have the right to say who can be in the space and who can’t.
  • Explain that when someone else enters that space without permission, the person inside the space often feels uncomfortable.
  • Give your children words to use to ask before going into someone else’s hula space, such as, “May I give you a hug?” or “May I sit here?”
  • Give children assertive (not too aggressive or too passive) words to use to tell other people to step out of their hula space, such as, “Please move over.”
  • Teach children ways to greet people that do not involve hugging or sitting in their laps. They can hold out their hand and shake hands. Such greetings can be made more personal for special people, by using something like a high five.

Individuals in families, churches, and other cultural and community groups have their own greeting rituals and areas of comfort regarding physical space. Some groups remain at arm’s length when their members get together, while people in other groups stand right next to each other when talking, even though the people might have just met. Some church communities greet members with a hug and kiss on the cheek. There is no “right” response to managing these different community rules for all children with problematic sexual behaviors. With professional support, you can develop rules and teaching strategies that fit your own children. Older children often can learn different greeting rituals for different groups of people, whereas younger children or impulsive children may not understand why they can hug some people they know but not others.

Children need to know how to respond when they feel someone has gotten too close to them. Further, they should be taught to respect others’ wishes for greater physical space.

Guidelines To Follow If You Find Your Child Engaged In Sexual Behavior

By using the guidelines and rules above, and by keeping close visual supervision of your child, most problematic sexual behaviors can be prevented. If supervision becomes lax or if for some other reasons your child displays an inappropriate sexual behavior, the following list provides some guidelines for responses.

  • Try to remain calm and keep an even volume and tone of voice. Count to ten, take deep breaths, or use other strategies to help calm down. When you remain calm, it helps you to have better responses than when you react with strong emotions. When you remain calm, it helps your child to understand that it’s the behavior you don’t approve of, not the child.
  • If needed, have the children get dressed and go to separate areas of the home.
  • After you have all the children dressed and in a safe place, check your level of emotions again. If you are in control and at least somewhat calm, proceed with the steps listed below. If you continue to be very upset, find some outside source of support, such as a professional, a partner, or a friend. Continue to take deep breaths.
  • Once calm, evaluate the situation. Ask the children individually what happened. Keep the questions open ended so that they can tell you in their own words (rather than just by answering yes or no). Ask things like: What happened? Who thought of doing this? How did you learn about this?
  • Try to determine how problematic the behaviors were (when is sexual behavior a problem?).
  • If your child, who initiated the behavior, has been taught privacy rules, remind your child of the specific Private Parts Rule that he or she is breaking (for example, “Remember, no touching others’ private parts”).
  • If a consequence is necessary, provide it immediately in a firm, but calm manner, such as, “Because you tried to touch Tommy’s private parts, Tommy has to go home, and you can’t play with him for the rest of the week.”
  • After the consequence, help your child to think of things that he or she could have done instead of the sexual behavior, such as talking to an adult, playing with a toy, or drawing a picture.
  • Let your child know that you believe in his ability for self-control. Emphasize that he can try something different next time. “Next time you think about touching Susie’s private parts, you can play ____________ instead, or you can come ask me for help.” Give your child the words to say and practice them with him.
  • Determine if consequences are not necessary and redirect your child to another activity. If the behavior is okay when done in private (such as when a child touches herself), redirect her to her bedroom or to another nonpublic place.
  • Talk with the caregivers of the other children involved, if appropriate.
  • Praise your child during times when he or she displays positive behaviors.
  • Remember that children with problematic sexual behaviors always need close visual supervision when with other children.

Developing A Support Team: Communicating With Other Adults

Raising a child who has had problematic sexual behaviors can bring great stress paired with a sense of isolation to the caregivers. Children’s sexual behavior is a hard topic to talk about with other adults. It is important for you to have at least one other adult that you can talk to in private about your child’s sexual behavior and about your thoughts, feelings, fears, beliefs, and other related topics. Children are cared for by multiple adults (including teachers, parents of the children’s friends, neighbors, and relatives). These adults will need to know the appropriate level of supervision to provide. But no single rule can be applied to all children who have had a problematic sexual behavior. Decisions about who should be included in the support team will differ depending on the child and family situation and context.

A wider net of support is needed for children who

  • Have had frequent or impulsive problematic sexual behavior in a variety of settings (such as at home, at school, and at daycare), because they will need closer visual supervision
  • Have poor decision-making skills and combative behavior
  • Have demonstrated aggressive or demanding behavior or
  • Have significant developmental issues.

While it is important for you to have other supportive adults with whom to discuss the details of these situations, it is not necessary for all adults in your child’s life to know details about the behavior. In fact, in some cases, it may be harmful for certain adults to know the details of your child’s past trauma experiences and sexual behaviors, especially if those adults use the information to label and make fun of the child. Typically, the information that needs to be shared with other adults is that

  • Your child has a history of making poor decisions when unsupervised with other children. At times it also can be helpful to tell those other adults that things have happened in the past to the child, which have interfered with his/her ability to make good decisions with other children (such as abuse)
  • Visual supervision is needed to make sure all children are safe
  • A plan is needed to prevent potentially risky situations, such as having an adult always accompany your child to the bathroom and insure that he or she is not alone with other children and
  • Other safeguards may be needed in situations that typically have lower levels of supervision (such as playing on the playground).

Potentially Risky Situations

Over the years, we have found some situations more risky for a child who might be inclined to engage in a problematic sexual behavior again. By being aware of these potentially risky situations, you can better plan to avoid them or to incorporate safeguards and supervision to prevent future problematic sexual behavior. High-risk situations include the following:

  • Sleepovers
  • Contact sports, such as wrestling
  • Holiday times
  • Summer vacations (which are less structured than school environments)
  • Camping
  • Recess, when poorly supervised
  • Summer camps
  • Shared bathrooms at school, etc.
  • Cell-phone use
  • Unstructured, poorly supervised activities
  • Poorly supervised Internet, video game, or television time

The level of supervision and information provided to the supervising adults will differ depending on the needs of your child. Typically, until your child with problematic sexual behaviors has a long period of demonstrating good boundaries and decision making, and maintaining rules about sexual behavior (over a period of time of at least three months), the risky situations noted above should be avoided. If situations cannot be avoided while the children are continuing to demonstrate problematic sexual behavior, maintain visual supervision when your child is with other children.

Tips to Remember
  1. The safety of all the children is important.
  2. Teaching simple rules about boundaries and sexual behavior is helpful.
  3. Provide and arrange for close supervision.
  4. Work with family, friends, and professional support personnel to develop a plan to keep all children safe.
  5. Monitor media and technology, particularly access to the internet.

Promote Healthy Development

How can I prevent problematic sexual behavior and promote healthy development?

There are many protective factors that support healthy development in children. Protective factors reflect characteristics, situations, activities, and competencies (strengths) that may decrease the risk of problematic sexual behavior.

  • Healthy boundaries taught and supported
  • Protected from harm and trauma
  • Parental guidance and supervision
  • Open communication about feelings and sexual behavior with trusted adults
  • At least one friend who makes healthy decisions
  • Successful experiences and skills
  • Effective coping strategies

See handout for more information

For more information on how to talk to your child about safe touching, visit the 10 tips for parents to teach children about body safety and teaching safety rules.