Sexual behavior in children: normal or not?

Sexual abuse is a problem of epidemic proportions in the United States. Given the scope of the problem of sexual abuse and the amount of media attention it receives, it is not unusual for parents or caretakers who witness a child exhibiting sexual behavior to become alarmed. Primary care providers, including pediatric nurse practitioners, may be the first professional parents contact with concerns regarding a child's sexual behavior. It is imperative that primary care providers understand childhood sexuality and respond appropriately when confronted with child sexual behaviors in their practice. Although the literature includes little research on the subject of normal child sexual development, certain guidelines have been identified to describe normal child sexual behaviors and those of concern. Case studies illustrate the response of two primary care providers when they are confronted with sexual behaviors in their patients. Implications for practice are discussed, with examples and guidelines provided for primary care providers to use when evaluating sexual behavior in their pediatric patients.