Comforting behavior in girls mistaken for movement disorder

The comforting behavior of thumb-sucking wouldn't land a 1-year-old girl in a neurologist's office, but the twisting and unusual movements of the comforting act of infantile masturbation can lead parents and physicians to believe a child is suffering from a movement disorder.

An article published in December's Pediatrics describes a dozen cases of young girls who were referred to pediatric movement disorder clinics between 1997 and 2002 for evaluation of paroxysmal (episodic) dystonic posturing, which is characterized by involuntary muscle contractions that force the body into abnormal movements and positions. Many of the children were subjected to invasive testing and medication before neurologists discovered the dystonic-like symptoms were actually normal muscle contractions that accompany masturbation.

"Masturbation is a normal human behavior. It's not harmful to anybody," said Jonathan W. Mink, M.D., Ph.D., Chief of Child Neurology at the University of Rochester Medical Center's Golisano Children's Hospital at Strong, lead author of the article.

"But these children have had invasive procedures and have been treated with medication because their doctors either hadn't witnessed the movements or didn't recognize the behavior."

Mink theorizes that the cases studied were all female because boys' masturbation is more recognizable because of the tendency to have direct hand contact with the genitals. Girls don't necessarily directly touch the genitals when masturbating. An episode may begin in a car seat or high chair where straps place pressure on the genital area. Many of the episodes come on when a child is tired or bored.

By viewing the episodes video-taped by parents, Mink was able to determine that the children were not having seizures nor were they suffering from paroxysmal dystonic posturing. One child was distracted out of the episode with the promise of a cookie. Another stopped to play with a toy truck. Children having seizures or with dystonia cannot respond or be distracted out of an episode. Mink recommends pediatricians and pediatric neurologists ask parents to video-tape the episodes before performing invasive and often expensive tests that could be unnecessary.

Mink also cautions pediatricians and parents against making any assumptions about what masturbation means for the child in the long run. Children stumble on masturbation on their own. Masturbation does not mean that a child has been sexually abused, Mink said.

"It also doesn't portend any sexual deviancy later in life," Mink said. "It's such a common and normal behavior that it's nothing to worry about. It's not appropriate to punish children for it. They associate it with comfort, like thumb-sucking."

Some parents, after hearing that their children are masturbating and are not suffering from a disorder, feel relief, but they are sometimes embarrassed. Mink said he assures parents that as their children get older and more aware of what they are doing, they can talk about reserving the behavior for home or the bedroom.