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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.