Wednesday, December 14, 2005

Infant Masturbation May Be Mistaken For A Movement Disorder

News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

Dec. 12, 2005 — Infant and early childhood masturbation can be mistaken for a movement disorder, according to the results of a case series and review of the literature reported in the December issue of Pediatrics. The investigators provide guidance on management.

"Infantile masturbation (gratification behavior) is not commonly identified as a cause of recurrent paroxysmal movements," write Michele L. Yang, MD, from the Children's Hospital of Pittsburgh, Pennsylvania, and colleagues. "Extensive and fruitless investigations may be pursued before establishing this diagnosis.... In young children, unusual postures and movements can occur during masturbation and may lead the primary care provider to infer that seizures, abdominal pain, colic, or other neurologic or medical problems are present."

The authors reviewed the clinical history, examination, and home videotapes of 12 patients presenting to a pediatric movement disorders clinic with a suspected movement disorder who were determined to have postures and movements associated with masturbation.

Common features in these patients include onset after age 3 months and before 3 years, stereotyped episodes of variable duration, vocalizations with quiet grunting, facial flushing with diaphoresis, pressure on the perineum with characteristic lower extremity posturing, no alteration of consciousness, cessation with distraction, and normal examination and laboratory studies.

"The identification of these common features by primary care providers should assist in making this diagnosis and eliminate the need for extensive, unnecessary testing," the authors write. "Direct observation of the events is crucial, and the video camera is a useful tool that may help in the identification of masturbatory behavior.... What can be portrayed in the history as dystonia or seizures can appear differently on direct observation."

The authors note that once the diagnosis of masturbatory behavior is made, sexual abuse and perineal irritation should be ruled out.

Practical points for management of masturbatory behavior include videotaping the event in question, helping parents change their view of the child's behavior as a disease, educating parents that scolding or threatening is not appropriate, using redirection to engage the child's interest in other activities or toys, defining milestones in older children to end the behavior in public, and using the term "gratification behavior" instead of masturbation when discussing this behavior with parents who are easily offended.


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