child

WHEN A 3-YEAR-OLD TOUCHES HERSELF TOO MUCH

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A 3-YEAR-OLD TOUCHES HERSELF TOO MUCH
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I have a 3-year-old daughter who I believe is masturbating. I have Dr. Brazelton’s book “Touchpoints” and I read about it in “Challenges to Development” and my husband and I have used his advice.

We even took her to the pediatrician to have her checked out and we didn’t get any help as to how to handle this. I have talked to her about it and she does it in inappropriate settings. I don’t know what to do. I think it has become a pattern. I want to take her to someone to be evaluated to see if she is hypersensitive as Dr. Brazelton mentions. I am a stay-at-home mother and she has only been watched by my mom and sister so molestation I think is not the problem. I need some professional help, but I want to make sure we take the right next step.

A. There are a number of reasons why children this age repeatedly touch their genital areas. They may have a urinary tract infection, a skin rash or even pinworms (which would lead them to scratch their behinds). Presumably your child’s pediatrician checked her for these kinds of causes. Any prolonged itching or discomfort in the genital area can set off this kind of behavior.

Even more common than these is the natural inclination of young children to explore their bodies, including the sensations that touching themselves stir up. This often begins when diapers come off, and rather suddenly children have more access to their genitals. Later, at age 3 or 4, they become interested and able to identify differences between their bodies and other peoples’ bodies.

At these ages, they may also start touching their genitals as a way of checking on themselves, understanding their differences: “Is that the way my body is supposed to be? Is everything there that is supposed to be there?” This kind of touching usually occurs at the normal times for being naked – bath time, bathroom time, getting dressed and undressed. It doesn’t interfere with other normal interests and activities.

For many young children, touching their own genitals can become a way of self-soothing, for example, relaxing when feeling anxious, or when trying to fall asleep. Gentle, neutral reminders should be enough to tell them that this is a private activity for alone times in their own rooms. The frequency of such self-touching may increase when a child is under great stress – for example when a new sibling is born, or when separated from parents.

Children who touch themselves repeatedly, as if preoccupied or driven, who appear unable to respond to such reminders, and who seem so compelled by this behavior that it competes with other activities, may be signaling that there is another kind of problem.

You mention the possibility of sexual molestation. Children who have been sexually abused, that is, touched in sexual ways by adults or children who are several years older than they, or shown pornographic material, may display sexual behaviors that appear preoccupying, that interfere with their play and their peer interactions, or that are adult-like in quality.

Obviously, adult-like sexual behaviors displayed by young children are stronger evidence of sexual abuse than self-touching, which is common and normal in young children.

Children who have been sexually abused may also appear fearful when with adults who remind them of the abuser, or near the place where it happened, or simply when they are separating from the adults who they can still trust. They may also appear distressed at bedtime and bath time, when they must confront the vulnerability of their own bodies. Or their behavior may suddenly and radically change – irritability and aggression are common examples, although they certainly aren’t specific to sexual molestation.

It is possible, as you seem to be thinking, that a young child simply becomes over-focused on touching her own genitals, far more focused than children just learning about themselves, or self-soothing at limited times, in limited situations.

Some experts have termed this behavior “infantile self-stimulation” or “gratification disorder,” although little is known about it, or its causes.

In some cases, it is thought, these children may lack other kinds of stimulation. For example, such behavior may begin at the time of weaning, or with the birth of a sibling, which decreased the child’s physical contact with parents.

Certainly, engaging such a child in ordinary kinds of physical play and normal cuddling, all of which is deeply involving and rewarding, may help. Avoid emotional reactions, too, since making a big deal of the behavior may inadvertently reinforce it. It is hard to tell from your question whether your child’s touching herself is within the normal range or not. Your observation that she does it in inappropriate places, and won’t stop when you ask her, are causes for concern.

We would urge you to return to the pediatrician to reconsider the possible causes and help determine whether the behavior requires more attention, or less.

If there are no other causes for self-touching that she can’t limit to alone times and that disrupts her other activities, then a cognitive-behavioral psychologist experienced in treating small children may be able to help you see how you can avoid reinforcing this behavior, and encourage other ones instead.

The idea is not to make her stop, but to help her get this behavior under control. But she mustn’t be made to feel bad about herself or her body with any approach that you take.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to his passing, Dr. Brazelton was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE PURPOSE OF TIME-OUT

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE PURPOSE OF TIME-OUT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Could you please send me guidelines for time-outs?

My son-in-law put my grandson, who is almost 5, in time-out for a couple of hours and when he ran an errand my daughter let him play and his daddy made him go back and sit.

He’s a sweet boy, and after we spank him or give him a time-out, he always apologizes.

Even the next day when we’re playing or watching a movie, out of the blue he says, “Mamaw, I’m sorry I upset you or threw a fit, etc.” He’s a very good boy. My sister and I and his grandmother tell him we love him even when he messes up. And that we have to correct him but that doesn’t mean he’s not a good kid.

A. Guidelines for time-outs? First, time-outs are not punishments, and should not be used as punishments. If they are, then of course the child will try to avoid them. This is one reason why some parents find they don’t work.

Time-outs require that a child actively cooperate to come to a quiet place to sit, calm down, think, get ready to apologize and come up with some better ways of handling himself or approaching a problem. This is an awful lot to ask a child to do if at the same time he is being made to feel that a time-out is bad, scary, uncomfortable and shameful.

Time-outs should not be presented as if the child were being banished forever to outer space. What child would ever go along with that? Instead, the child needs to be reassured that a time-out does not mean a rupture in the relationships with parents, just a quiet time to settle down and think things over before coming together again. If time-outs have come to mean punishment in your household, them it may be time to call them something different and to do them differently.

One family we know says “time to sit on the calming-down couch.” Stuffed animals and books are welcome there too.

Second, time-outs are for learning. Time-outs can be used when a child becomes overwhelmed by strong feelings – frustration, disappointment, anger, which have been expressed in misbehavior, for example yelling, hitting, talking back, being rude and disrespectful, and breaking things.

Children are not born knowing how to handle these feelings, and it is our job to help them learn. Once parents understand that time-outs are a special time in a quiet place for a child to learn to settle down and regain control, then they can help children understand their purpose.

At first, parents may need to help children calm themselves, offering them a cool washcloth to wet their faces, or their favorite stuffed animal to squeeze. These are not rewards for misbehavior. They are examples of strategies for learning how to get back in control. It can also help to remind the child of the ways he has successfully settled himself down in the past. “You might need to make a mad face and not talk to anybody for a little while. Let me know when you’re calmed down, and then we can talk.”

Once a child is calm, the next step is for him to work on recognizing his role in what went wrong. This doesn’t mean everything is always his fault. But he might be helped to see that he did have trouble controlling his strong feelings, and then did something he knows he shouldn’t have. Or that he did something he didn’t know there is a rule about – but now he does.

Now he’ll be ready to apologize, and then be forgiven, a critical step to protect self-esteem that is important to include. Forgiving does not mean that his misbehavior is acceptable, but that parents recognize his potential to learn and grow.

There seem to be a number of questions within your question.

First, about the different ways your son-in-law and daughter discipline your grandson: Time-outs don’t work when they are too long because they can’t be enforced. How can any adult get a 5-year-old to sit quietly in one place for an hour or more? (How many adults can do that themselves?)

Discipline strategies that don’t work are bound to lead to conflict between parents, which in turn undermine whatever other discipline they may try. Parents’ agreement on when to discipline and how to discipline is at least as important, if not more so, than on the specifics of what they decide. Children need parents to discipline together, although it often seems that they actively make this even more difficult than it is to do so.

Second, what, if anything, can you do, as the grandmother? Taking sides certainly won’t help. Understanding that parents usually have strong feelings about discipline, and that it is expectable for them to discipline differently – even though this causes problems – may be the key.

Then your role is not to give specific advice but simply to encourage that they share their ideas and listen to each other so that they can arrive at a shared understanding. But your children aren’t likely to listen to your advice as a grandparent. So mostly what you can do is to love and cuddle your grandchild – while trying as hard as you can to avoid turning him against either parent.

Finally, what effects is this having on the child’s image of himself, and what can be done about it? It does sound like he may be struggling with the feeling that he is a bad boy. When children feel this way, they often misbehave more and more, as if they’ve come to believe the worst about themselves.

Discipline that focuses on teaching, not punishment, and that gives a child a chance to apologize, make reparations and be forgiven, can help. Spanking won’t, since it can feel to a child like it is an attack on his “badness.” Instead, effective discipline makes the child feel that he has the potential to learn and grow and improve his behavior.

See our book “Discipline: The Brazelton Way.” Da Capo Press 2003.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Prior to his passing, Dr. Brazelton was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.