Keypoints
What is known
– There is little information on the management of infantile self-gratification, especially in Africa context, leading to inappropriate management.
What is added
– This case reinforces the need for all pediatric practitioners to raise awareness about this diagnosis in order to prevent inappropriate treatment.
Introduction
Infantile masturbation or infantile self-gratification is a common behavioral condition that pediatricians should be aware of. It is characterized as stereotyped paroxysmal events, typically arising in female infants between the ages of three months and three years.1 These episodes are often misdiagnosed as epileptic seizures, leading to the unnecessary administration of antiseizure medication. The episodes occur mostly in specific circumstances, such as when the child is bored or seated in a car seat or highchair. Unlike epileptic seizures, they cease immediately if the child is distracted or engages in another activity, confirming the absence of a change in consciousness and the voluntary nature of the behavior. Sometimes, however, the child may appear upset, even irritated, when interrupted. Although physiological, this behavior may be more common in children with little affection or anxiety. Some authors suggest that perineal irritation and a history of sexual abuse should be ruled out.2–4 There are very few reports on self-gratification disorders in early childhood. In Africa, masturbation remains a taboo topic that is not openly discussed, and it is even more stigmatized when it occurs in infants. Due to misconceptions and lack of awareness, children in some African countries are more likely to be subjected to traditional treatment or even female genital mutilation in an attempt to reduce their libido and prevent sexual promiscuity later in life or as they get older.5 It is very important to educate parents about the benign nature of this transitory behavior, advising them not to repress the child but rather to gently distract them to stop the episodes.
Case report
A three-year-old girl, with normal developmental milestones, presented at our Neurology Outpatient Clinic with a history of paroxysmal events since eight months of age. One of the episodes was video-recorded by her mother, showing hip rocking and manual rubbing of the genital area, followed by contraction of the lower limbs, during the episodes. She had no loss of consciousness and was able to stop the episode when distracted.
She was initially assessed at another clinical institution, where the events were misdiagnosed as an epileptic disorder, and carbamazepine was prescribed, with no improvement. On average, the episodes occurred three-to-four times daily, almost every day. The child was also referred for psychological consultation. The case was discussed in depth. After our detailed assessment and observation of the home video recording, a diagnosis of self-gratification was made. Parents were advised to stop carbamazepine and were reassured about the benign nature of the episodes, which are expected to gradually disappear as the child gets older. Unfortunately, no further follow-up information is available.
Discussion
It is essential that all healthcare professionals, especially pediatricians, as well as the general community, recognize this condition in childhood as a benign behavioral phenomenon, addressing misconceptions, especially in the African context, in order to provide better medical assistance for affected children. However, it is essential that clinicians consider further research and evaluation by a child psychologist or mental health professional in cases with varied presentations and certain features, including excessive frequency or intensity of the episodes, particularly if they interfere with social or functional activities, as well as signs of emotional distress, anxiety, or behavioral disturbance. A few reports have indicated a high association of coexisting developmental delays or neurobehavioral concerns (e.g., autism spectrum disorder, regression, intellectual disability, compulsive sexual behaviors, or attention-deficit/hyperkinetic disorder) with self-gratification disorder,6 especially when the behavior persists beyond the typical age range (usually over five years of age). Clinical awareness of these signs would help guide pediatricians and general practitioners on when to seek additional support, avoiding both under- and over-pathologization.
While self-stimulation can still occur in healthy children as part of normal psychosexual development, in cases where the behavior persists beyond the typical age (four-to-five years) or where onset presents in older children (e.g., at age seven), prompt further assessment should be made for inadequate boundary-setting or social development, psychosocial stressors or emotional deprivation, and neurodevelopmental disorders (e.g., autism spectrum disorder). Also, any possible history of sexual abuse needs to be ruled out in each case. Referral to a child psychologist or a multidisciplinary team is advisable to ensure a safe and developmentally appropriate management and response.
Author contributions
F. Sambayeta: idea behind, and design of, the case report; data acquisition from the patient and literature; critical review of the article; and final approval of the version to be published.
Funding
There were no funding sources in this case.
Conflicts of interest
The author has no conflicts of interest to declare.
Ethical considerations
Protection of humans and animals. The authors declare that no experiments involving humans or animals were conducted for this research.
Confidentiality, informed consent, and ethical approval. The study does not involve patient identifiable personal data. All local protocols regarding access to and use of clinical records were followed. Oral consent was obtained from the child’s parents.
Declaration on the use of artificial intelligence. The authors declare that no generative artificial intelligence was used in the writing of this manuscript.
