Normative sexuality development in childhood: Implications for developmental guidance and prevention of childhood sexual abuse

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Normative Sexuality Development in Childhood:
Implications for Developmental Guidance and
Prevention of Childhood Sexual Abuse
Sandy K. Wurtele and Maureen C. Kenny
Human sexual development is conceived as a process, begun at conception and con-
tinuing throughout life. Infants, children, teens, and adults are all sexual beings. Indeed,
“sexuality is a central part of being human” (SIECUS, 2004, p. 15). Although we know a
great deal about sexual behaviors in adolescence and adulthood, childhood sexuality is a
rather neglected field in sex research. A cursory glance at contemporary college-level lifes-
pan developmental textbooks demonstrates solid coverage of sexuality during adolescence
and throughout adulthood but scant attention to this topic during any of the prepubescent
phases. Even studies of adolescent sexual behavior do not begin assessing participants
until age 12 or later (Zimmer-Gembeck & Helfand, 2008). In contrast, there is a growing
literature on problematic sexual behaviors during childhood, but unfortunately very few
articles or books about normal childhood sexuality. As Lagerberg (2001) observed, “the
sexual development of normal children is neither fully explored nor understood” (p. 368),
and children’s sexuality remains “a relatively uncharted area” (Friedrich, 2003, p. 107).
Why is there a paucity of research into normative sexuality development in child-
hood? Freud’s (1965) concept of latency led to a denial of childhood sexuality for most of
the twentieth century. Western society is profoundly ambivalent about human sexuality
and continues to view children as innocent and asexual, lacking any sexual desires,
thoughts, or erotic interests (Heiman, Leiblum, Esquilin, & Pallitto, 1998). As a research
topic, children’s sexual behavior is challenging to study, especially in the United States.
Much of the work in this area has come from the Scandinavian countries where attitudes
toward sexuality are more permissive (Sandfort & Rademakers, 2000) and perhaps where
institutional review boards and funding agencies place fewer restrictions on studying this
topic. Parents are often reluctant to participate in studies of this topic, and children’s
capacities to provide self-report are limited. Much of younger children’s sexual play hap-
pens in private or is viewed only by people who have opportunities to observe them in inti-
mate situations or on a regular basis, while older children have been socialized to conceal
their sexual activities. Retrospective reports have also been used to assess the frequency
VOLUME 43 NUMBER 9 MAY 2011
Copyright © Love Publishing Company, 2011

with which young adults remember engaging in sexual
behaviors as children (e.g., Goldman & Goldman, 1988;
Haugaard, 1996; Haugaard & Tilly, 1988; Lamb & Coakley,
1993; Reynolds, Herbenick, & Bancroft, 2003; Ryan,
2000a). Given the difficulty inherent in remembering events
of early childhood, retrospective investigations are of lim-
ited use for describing sexual behaviors during this phase of
childhood.
These methodological factors contribute to the paucity of
research on normative childhood sexuality. Yet there is great
need for such information. Over the past 2 decades, we have
seen increased attention devoted to problematic sexual
behaviors due to research demonstrating a significant asso-
ciation between childhood sexual abuse (CSA) and subse-
quent sexualized behaviors (e.g., Kendall-Tackett, Williams,
& Finkelhor, 1993). Since “abnormal” sexual behavior is
regarded as a potential indicator of abuse, it is important to
understand what is considered “normal” childhood sexual-
ity. In addition, children and adolescents with sexual behav-
ior problems, many of whom offend against other children,
are a growing national concern (Longo, 2003). In an age
when CSA is increasingly on our minds, it is important for
counselors, teachers, and parents to understand what are
healthy sexual development and common sexual behaviors
and which behaviors are uncommon, potentially harmful, or
might signal a child is being sexually abused or is at risk for
abusing other children.
Our primary goal in this article is to review what is
known about normative and nonnormative sexual behavior
and knowledge among children 12 years and younger. Sec-
ond, we review what is known about contextual influences
on children’s sexual behaviors. What is deemed “normal”
sexual behavior is determined by social, cultural, and famil-
ial contexts (Elkovitch, Latzman, Hansen, & Flood, 2009;
Frayser, 1994; Friedrich, Sandfort, Oostveen, & Cohen-Ket-
tens, 2000; Heiman et al., 1998; Pithers, Gray, Busconi, &
Houchens, 1998). Third, we use these findings to offer sug-
gestions for how parents and other adults can provide sexual
abuse prevention education while simultaneously promoting
children’s healthy sexual development. Children who do not
know about these two topics—sexuality and body safety—
are more vulnerable to sexual abuse (Wurtele & Berkower,
2010). Finally, we will offer guidelines for parents, child-
care providers, teachers, and counselors about how to
respond to normal and problematic sexual behaviors. Par-
ents and professionals working with children frequently ask
questions about the normality of children’s sexual behav-
iors. They often want to know whether the behaviors are
typical and to be expected, or are an indication that the child
has been sexually abused. More importantly, they want to
know how to address children’s sexual behaviors. We will
provide guidance on responding to sexual behaviors and
suggest ways adults can help children grow into happy,
healthy sexual adults.
NORMATIVE SEXUAL BEHAVIORS
IN CHILDHOOD
The outline of sexual development and educational needs
is organized in the following way. The age range 0 –12 years
has been divided into four age groupings: 0–2, 3–6, 6–9, and
9–12. When considering sexual behaviors, any demarcation
of specific age categories is somewhat arbitrary and com-
mon behaviors overlap considerably, especially at the ends
of each phase. As with any domain of development, there is
substantial variability between children even of the same
age. Thus, the age groups should not be seen as rigid divid-
ing lines in the course of children’s sexuality development.
For each age group, a general description of high- and
low-frequency behaviors is provided. This is followed by
tables listing Common Behaviors, Concerning Behaviors/
Signs, and Educational Implications. The Common Behavior
2 COUNSELING AND HUMAN DEVELOPMENT MAY 2011
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section describes high-frequency behaviors that may be
observed in children who are on the path to healthy sexual
development. Concerning Behaviors/Signs describe low-
frequency behaviors or clinical signs, suggesting a child
requires redirection, adult intervention, additional sexuality
education, possibly assessment by a mental or medical
health professional, or in some instances reporting to child
protective services.
It is important to note that the presence of concerning
behaviors does not always indicate that a child has been sex-
ually abused. A substantial minority (about 20–40%) of vic-
tims of CSA show no clinical symptoms (Bahali, Akçan,
Tahiroglu, & Avci, 2010; Kendall-Tackett et al., 1993). In
addition, many children who demonstrate problematic sex-
ual behaviors do not have documented histories of sexual
abuse (Silovsky & Niec, 2002). Research has found a num-
ber of other explanations for the presence of such concern-
ing sexual behaviors. These include factors such as the
child’s exposure to sexually explicit material, overt sexual-
ity in the home, opportunities to witness sexual activity,
level of stress in the family, parental absence from home,
family violence, child physical abuse or neglect, extent of
cobathing and cosleeping with siblings or parents, maternal
attitudes toward sexuality, and time spent in daycare
(Friedrich, Fisher, Broughton, Houston, & Shafran, 1998;
Kellogg, 2010). In addition, children’s sexual behaviors are
affected by the size of the family, the neighborhood in which
they live, the age of their siblings, and their level of sexual
interest, along with parental, religious, societal, and cultural
norms and values regarding sex and sexuality (Johnson,
2009). Repeated exposure to incomprehensible sexual stim-
uli (e.g., confusing sexual images in media) can also
increase the likelihood that children will act out what they
have observed. Although little is known about cultural con-
texts that influence children’s sexual behavior, some
research has found higher rates of sexual behavior reported
by parents in other countries (e.g., Larsson, Svedin, &
Friedrich, 2000). Our review, however, will primarily focus
on research conducted in the United States.
For each age range, we will also provide readers with
developmental guidance on how parents and caregivers can
foster the sexual development of their children and how pro-
fessionals working with children can respond to children’s
sexual behaviors. Guidance is offered for how adults can
teach “sexual manners” to children in ways that are consis-
tent with family and cultural values. Through sexual social-
ization, children learn what their society considers desirable
for a male or a female to be or to do and which sexual
behaviors are to be exhibited in public versus in private.
Finally, a summary will be provided for each age range, to
serve as a quick reference to problematic and normative
behaviors for children.
Infancy and Toddlerhood (Birth to Age 2)
With regard to sexual development during gestation,
males and females are anatomically similar until the 3rd
month after conception (Fogel, 2011). During the 2nd
month, male fetuses produce large amounts of androgens,
primarily testosterone, which cause the Wolffian duct sys-
tem to transform the primitive gonads into the vas deferens,
prostate, seminal vesicles, epididymis, and testicles. By the
3rd month of development, this continued action causes the
development of the external genitalia (penis and scrotum).
In contrast, the absence of large levels of testosterone in
females results in the shrinkage of the Wolffian duct system
and the Mullerian duct system develops into the female
reproductive system (King, 2009). So, interestingly, male
and female embryos are identical during the first few weeks
of development. Unless there is a high level of testosterone
at a critical stage of prenatal development (7th week post-
conception), nature has programmed everyone for female
development.
Infants and toddlers will typically develop a capacity to
trust and a sense of autonomy through interacting with sen-
sitive and loving caregivers. Being held, touched, kissed,
hugged, and snuggled allows babies to experience positive
physical sensations associated with being loved. Indeed,
Harlow’s (1973) research confirmed that through such nur-
turing touch and body contact, human beings learn to love
from a very early age. Frayser (1994) notes that this non-
verbal communication between caregiver and infant
becomes a critical component of a child’s attitude toward his
or her body, gender, and sexuality. Breastfeeding is one of
the first social contexts within which the infant experiences
intimacy (Frayser, 2003). This type of intimacy and emo-
tional attachment between infants and parents can be the
early foundation of more mature forms of physical intimacy
that will develop later as part of healthy sexuality. By pro-
viding care in response to the infant’s needs rather than
according to the parent’s agenda, parents can model and fos-
ter the development of empathy; the lack of which is a com-
mon characteristic of individuals who abuse others (Ryan,
2000b).
During the first few months of life, infants begin to dis-
cover their bodies. A boy discovers his penis between 6 and
8 months and girls typically discover their vulvas at 10–11
months (Martinson, 1991). Babies often explore their geni-
tals during diaper changes or bathing. This type of touching
is not masturbation in the adult sense, but it is learning that
when certain parts of the body are touched or rubbed, some-
thing pleasurable occurs. When pleasant sensations occur,
children may seek to repeat the behavior. Young children
also touch, fondle, and rub their own genitals as a means of
self-soothing and will often do this when going to sleep or
when tense, excited, or afraid. Infant boys regularly have
3

penile erections when awake (while coughing, stretching,
urinating), and during sleep and girls’ vaginas are thought to
lubricate just as often as boys have erections (Haffner,
2004). These are spontaneous, natural responses to touch,
friction, or the need to urinate.
Redness, soreness, or reports of genital discomfort may
alarm parents and caretakers into concerns that CSA has
occurred. Kellogg, Parra, and Menard (1998) report that in
most cases where girls are brought to a physician with gen-
ital symptoms, the explanation is a normal finding or some
nontraumatic disorder. Some children, particularly girls,
may be prone to recurrent bladder infections, more com-
monly called urinary tract infections (UTIs) which may
have a number of causes, including the repeated use of soap,
bubble baths, and shampoo which can irritate the urethra
and wash away the protective mucus layer.
Toddlers exhibit much curiosity about their own bodies
and other people’s genitals, especially their parents’ genitals
(Schuhrke, 2000). Children begin to learn the differences
between males and females and start identifying themselves
as either boy or girl. This awareness is called gender iden-
tity. By the time they are 2 or 3, most children can identify
themselves and the people around them as either female or
male.
Implications for Sexuality Education/
Developmental Guidance
One of the best ways parents can keep their children sex-
ually safe and healthy is to have frequent discussions with
their children about sexuality starting when they are tod-
dlers. Often the easiest place to start sexuality education is
by teaching children the correct names for their genitals. By
age 2, most children know the names of their nonprivate
body parts, but very few learn the names for their genitals.
Kenny and Wurtele (2008) found that while approximately
90% of both English- and Spanish-speaking preschoolers
knew the correct names of their nongenital body parts, very
few children (only 10%) knew the correct terms for penis,
breasts, and vulva. Slightly more children (25%) knew the
correct term for buttocks, but none of the Spanish-speaking
children knew the correct terms for breasts, penis, or vulva.
Children in this study did no better than children in surveys
conducted in the early 1990s (e.g., Wurtele, 1993; Wurtele,
Melzer, & Kast, 1992), suggesting that little progress has
been made in parents’ efforts to teach their young children
the correct terms for the genitals. Teaching proper names for
all body parts helps children develop a healthy, more posi-
tive body image. As Honig (2000) stated, it gives children
“naming power” just as they have the power to name other
things in their environment (e.g., toys, books, characters,
etc.). Indeed, several experts have recommended that par-
ents teach their young children the correct names for the
genitals (American Academy of Pediatrics, 2011; Honig,
2000; Wurtele, 2010). The teaching of genital body parts
also allows for a discussion of the differences between boys
and girls.
This knowledge also provides the necessary foundation
for CSA prevention education. Successful disclosure of abu-
sive incidents relies partly on the child’s ability to describe
inappropriate activities involving the genitals and to cor-
rectly label the genitals. When children disclose CSA using
incorrect or idiosyncratic terminology (e.g., “She touched
4 COUNSELING AND HUMAN DEVELOPMENT MAY 2011
TABLE 1
Infancy and Toddlerhood (Birth to 2 years)
Common Behaviors Concerning Behaviors/Signs Educational Implications
• Explores own body, including genitals
• Spontaneous, reflexive sexual
response (erection, lubrication)
• Enjoys touch (hugs, cuddling)
• Enjoys nudity (likes to take off clothes
and walk around naked)
• Since learning is primarily through
touching at this age, may want to
touch others’ private parts
• Self-stimulation as a form of self-
soothing and self-comforting
• If toilet training is beginning, may
show an interest in others’ bathroom
behavior
• Stands too close to people
• Irritation/inflammation of penis/vulva
• Physical trauma to genitals, sexually
transmitted infections (STIs) (signs of
possible sexual abuse)
• Child is resistant or fearful of touch
from caregivers
• Provide ample warmth, affection,
touching, and love
• Teach correct names of body parts,
including genitals
• Help child understand differences
between boys and girls
• Encourage androgynous roles/activities
while also helping children understand
their own gender
• Allow child to explore own body; usu-
ally after age 3, they are old enough to
understand that even though it feels
good, self-touching should be done in
private (do not shame or punish child
for sexual exploration or stimulation)

my weiner,” or “He kissed my VJPJ.”), they may not be
understood and are thus unlikely to receive a positive, sup-
portive response to their disclosure. In contrast, disclosure
using correct terminology is more likely to be understood,
resulting in a more positive outcome for a child (e.g., by
ending the abusive situation and obtaining therapeutic assis-
tance for the child). Furthermore, children who lack sexual
knowledge may be more vulnerable to sexual abuse. Some
sexual offenders avoid children who know the correct
names for their genitals, because this suggests that the chil-
dren have been educated about body safety and sexuality
(Elliot, Browne, & Kilcoyne, 1995). One convicted offender
(who had assaulted 75 children before he was caught)
reported that when children knew the correct terms for their
genitals, he would leave them alone (Sprengelmeyer &
Vaughan, 2000).
At this age, children learn through hands-on exploration
including their own body parts. During diaper changes a boy
may grab his penis or a girl may touch her vulva. Not only
can parents allow their babies to touch their genitals during
diaper changes, they can use this teachable moment to name
the body parts (“That’s your penis.”). Once a boy discovers
his penis, he may touch it or hold it, often in public. Usually
after age 3, children are old enough to understand that even
though it feels good, self-touching should be done in pri-
vate. Caregivers can help children begin to comprehend the
difference between public and private behaviors and that
certain behaviors, such as picking one’s nose or touching
one’s genitals, are best done in private.
Should toddlers ask where babies come from, it is best to
offer simple answers or information. A response such as,
“From the mommy’s belly” may be all that is needed to sat-
isfy the child’s curiosity at this age. Keep language simple
and comprehensible to the child. However, parents are dis-
couraged from providing inaccurate information such as
“God [or the stork] brought you to us” or “We got you at the
hospital.” This erroneous information only impedes later
sexuality discussions.
Summary
Most children from birth to two years will be curious
about and evidence some exploratory behavior toward their
genitals and at the later end of this age range, may even
desire to look at their genitals or those of another while that
person is urinating or undressing. As children move into toi-
let training, their inquiries about private parts usually
increase. Both genders will touch their genitals for pleasure
and this behavior should not be shamed or discouraged.
Boys will experience erections and girls may have vaginal
lubrication, both of which have a purely biological basis. A
primary educational goal for this age range is the teaching of
proper terms for all body parts including genitals to lay the
foundation for subsequent sexuality education. Responding
to questions regarding pregnancy and sexuality honestly but
simply is encouraged. Physical contact with young children
is encouraged; a warm, safe, loving environment is critical
to the child’s feeling of safety and security.
Early Childhood (Ages 3–6)
By age 3, children have become quite familiar with their
own bodies. Children in this age group tend to play together,
and their natural curiosity about bodies now extends to other
children’s and adults’ bodies, particularly their genitals. This
is the phase of life when overt sexual behaviors are most
likely to be observed. Friedrich, Grambsch, Broughton,
Kuiper, and Beilke’s (1991) administration of the Child Sex-
ual Behavior Inventory (CSBI) to over 1,000 mothers of
children aged 2–12 years showed that sexual behaviors
reach a peak from 3 to 5 years and then decrease in fre-
quency until puberty. High-frequency behaviors as reported
by parents include exhibitionism (e.g., showing genitals to
others, wanting to be naked), voyeuristic behaviors (e.g.,
looking at people undressing, toileting, or while nude),
behaviors related to personal boundaries (e.g., standing/sit-
ting too close to others, cuddling with familiar people), and
self-stimulating behaviors (e.g., touching genitals in public
and at home). From this list, solitary, self-stimulating behav-
iors are most frequently observed (Elkovitch et al., 2009).
Nearly all young children touch and explore their geni-
tals. They do so by using their hands, objects (e.g., toys,
stuffed animals, blankets), or by rocking against a stuffed
animal or rubbing against furniture. Preschool children may
experiment by sticking their fingers or other objects in their
vagina or rectum; usually this causes pain or discomfort, and
the behavior stops. Boys engage in genital touching more
often than girls. For example, in Friedrich et al.’s (1991)
normative sample of children, 67% of 3- to 5-year-old boys
and 55% of girls were reported by their mothers to engage
in genital touching at home; 39% of boys and 19% of girls
touched their genitals in public (Larsson et al., 2000).
Preschool teachers report observing a lower frequency of
genital touching than do parents (Larsson & Svedin, 2002;
Lindblad, Gustafsson, Larsson, & Lundin, 1995; Lopez-
Sanchez, Del Campo, & Guijo, 2002). For example, only
5% of a sample of preschool teachers reported observing 3-
to 6-year-old children engaging in genital touching, as com-
pared to 43% of the parents of these same children (Larsson
& Svedin, 2002).
As children begin interacting with other children, they
become more social and often physical in their interactions.
They may begin mimicking adult affectionate behaviors like
kissing and hugging or holding hands. In many cultures,
kissing and hugging between familiar adults and children is
encouraged and is a frequent part of greetings and goodbyes.
5

For example, children may be encouraged to kiss grandpar-
ents goodbye and extend this to others in their life. Children
in this age range may express emotions physically (hug
someone when they are happy, or hit someone/something
when they are angry) and may seek hugs and kisses from
familiar people. An awareness of appropriate physical
boundaries is not yet formed at this age, so children will
often stand or sit very close to familiar people.
Preschool children also display curiosity about adults’
bodies and bodily functions. They may want to watch
grown-ups going to the bathroom or touch an adult’s geni-
tals. In particular, children who are breastfed, or witness
younger siblings being breastfed, may be accustomed to
such close contact with a woman’s breasts and may try to
touch them when being hugged or held. Interestingly, Mar-
tin and Luke (2010) found that mothers allowed their daugh-
ters (age 3–6 years) to see them naked more than their sons.
These authors suggest that these opportunities to view their
mothers’ bodies may prompt girls to ask questions of their
mothers as to why their own bodies look different from their
mothers and thus provide more opportunities for mothers to
provide daughters with sexuality information.
Touching their mothers’ breasts or attempting to touch
other women’s breasts is a common behavior among young
children both at home and at preschool (Friedrich et al.,
1991; Lindblad et al., 1995; Rosenfeld, Bailey, Siegel, &
Bailey, 1986). Almost half of the children in Friedrich et al.
(1991) touched their mothers’ breasts, and in a survey of
preschool staff, 36% of preschoolers attempted to touch a
woman’s breast (Davies, Glaser, & Kossoff, 2000). Parents
of 2- to 4-year-olds reported that 90% of children had
recently touched their mothers’ genitals and/or breasts and
approximately 60% had touched their fathers’ genitals
(Rosenfeld et al., 1986). These findings are confirmed in a
study by Davies and colleagues (2000) who interviewed 58
preschool staff regarding their observations of sexual behav-
ior among preschool children. The preschool staff com-
monly observed children exhibiting curiosity about genitals
including children touching their own genitalia, attempting
to touch a woman’s breasts, looking at another child’s geni-
tals, and showing their own genitals to others.
Preschoolers are especially interested in the physical dif-
ferences between boys and girls. Given the opportunity,
young children will play games that allow for sexual explo-
ration with other children. “Sex” play is a very common
phenomenon among this age group (e.g., playing “doctor”
or “mother and father,” exposing parts of one’s body to each
other, the “I’ll show you mine if you show me yours” game)
(Rutter, 1971; Sandnabba, Santtila, Wannas, & Krook,
2003). In a longitudinal study of early childhood peer sexual
experiences, Okami, Olmstead, and Abramson (1997) found
that almost half of the sample had engaged in sex play
before age 6. These games usually occur between children
(cross-gender but mostly same-gender) with children close
in age (Lamb & Coakley, 1993). In their sample of 3- to 6-
year-old Swedish children, Larsson and Svedin (2002)
found that 37% of boys and 48% of girls were reported by
their parents to engage in “doctor” games. Similarly, more
girls were observed playing “doctor” than boys in a Finnish
day care (52% vs. 35%; Sandnabba et al., 2003). These
activities are normal ways for children to explore physical
differences between males and females in the same way they
explore gender roles and adult behaviors (e.g., playing
house).
Given that sexual play is quite common in children
between the ages of 3 and 6 years, it is important to under-
stand the scope of this behavior. Typical characteristics of
sexual play at this age are the following:
• Appears exploratory and spontaneous (unplanned, can
occur in the context of other play)
• Occurs from time to time (infrequent)
• Is mutually consented to (one child does not always
initiate it), and not coercive
• Happens between children who play together often
and are very familiar with one another (siblings,
cousins, or friends)
• Occurs between children who are similar in age and
developmental level
• Is fun, playful, and light-hearted and not accompanied
by high levels of fear, anger, aggression, coercion, or
anxiety
• Behavior ceases when caregivers intervene and ask
children to stop
• Children engaging in this play can be easily diverted
to other activities
• Appears voluntary between all children (no child
reports being upset or uncomfortable with it)
Concerning behaviors at this age range include the follow-
ing (Davies et al., 2000; Gil, 1993; Heiman et al., 1998;
Hornor, 2004; Johnson, 2009; Kellogg, 2010; McKee et al.,
2010; Okami et al., 1997; Wurtele & Berkower, 2010;
www.aap.org):
• Sex play involving children of different age (4 years
apart), size, status (actual or perceived power), devel-
opmental level, and between children who do not
know each other well
• Type of sexual activity (repeated object insertion into
vagina and/or rectum, oral–genital contact, imitation
of adult sexual activities, sexual behaviors with ani-
mals)
• Dynamics of play (play is frequent, intense, and may
have a compulsive quality; coercion, threat, bribery,
6 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

aggression, or dominance accompanies the sexual
activity)
• Causes harm to child or others; results in emotional
distress or physical pain or injury
• Behaviors that appear to resemble adult sexual activity
(imitating or attempting vaginal or anal intercourse
with another child, oral–genital contact, tongue kissing)
• Behaviors are frequent, persistent, and child becomes
angry if distracted from them
• Unable to redirect child from the behavior (i.e.,
behaviors continue even after requests to stop)
• Interferes with normal childhood activities
• Uses physical and/or emotional coercion to convince
another child to engage in sex acts
• Child convinces (through intimidations or threats) the
younger child to keep the activity a secret
In summary, normative sexual play is consensual; there is no
emotional or physical coercion involved, and it is usually
carried out with children of similar age, size, and status.
Normative sexual play is usually spontaneous and includes
pleasure, joy, laughter, embarrassment, and varying levels of
inhibition and disinhibition (Shaw, Lewis, Loeb, Rosado, &
Rodriguez, 2000). In contrast, problematic sexual play
involves dominance, coercion, threats, force, aggression,
compulsivity, secrecy, and advanced sexual behavior.
Wurtele and Berkower (2010) noted that it is just as impor-
tant for adults to respond supportively to children’s “nor-
mal” sexual behaviors as it is for them to respond to prob-
lematic sexual behaviors. Children and adolescents with
sexual behavior problems are a growing national concern
(Longo, 2003).
Children this age have lots of curiosity about sexual top-
ics, and many will ask endless questions about bodies and
bodily functions (“How come my sister doesn’t have a
penis?”), breasts (“Why are your breasts so much bigger
than mine?”), reproduction (“Where do babies come from?”),
pregnancy (“How did the baby get in her tummy?”), and
birth (“How does the baby get out?”). Their interest in sex-
uality can also be seen during play, as they may include gen-
itals when drawing nude figures or undress dolls to see their
genitals. Children may also be very interested in the breed-
ing behavior of animals. As children learn about baby ani-
mals, they may inquire about where they come from, how
they are made, and so on. Observation of animals mating
(on television, in printed materials, on a visit to a farm or
zoo) may also spark questions about reproduction. They
may be acutely aware of the gender of animals and inquire
whether the dog has a penis or vulva, once taught these
names.
As children become aware of social rules regarding sex-
ual behavior and language, they may test the boundaries and
family rules by using what preschool teachers often call
“toilet talk” (Chrisman & Couchenour, 2002). These authors
describe how one preschooler zipped through the entire
classroom chanting, “Poopy, poopy, poopy.” Soon all the
students were echoing “poopy” and laughing uproariously.
Preschoolers frequently use words that refer to bowel move-
ments and urination, often talking about “poop” and “pee.”
As they are exposed to other children and learn from them,
they may purposefully use words that they know are not cor-
rect (e.g., the 6-year-old child who returns from school and
informs his parents that breasts are really “boobs” because
his best friend told him this).
Between ages 4 and 6, many children begin developing a
sense of modesty and start expressing a desire for privacy.
Even in homes where nudity is common, children often go
through a “modesty stage” where they seem uncomfortable
changing in front of their parents or walking around naked
(Haffner, 2004). Parents should encourage children to seek
privacy while bathing or dressing and again refer to private
versus public behavior. Johnson, Huang, and Simpson
(2009) asked 500 mental health and child welfare profes-
sionals for maximum acceptable ages for siblings to jointly
engage in certain family practices related to hygiene, affec-
tion, and privacy. These guidelines are provided in Table 2.
As children age, they begin to have more contacts outside
the family and thus interact more with peers under adult
supervision (e.g., at preschool, lessons, classes, during play-
dates). As children form relationships with others outside
their family, they begin to learn to recognize some peers as
friends and others as people they don’t like. Friendship pref-
erences develop, and children begin talking about who is
their friend and who is not, often using terms such as “nice”
7
TABLE 2
Guidelines for siblings engaging in certain
family practices, given in years*
Same-gender Mixed-gender
Activity siblings siblings
Bathing 5 4
Showering 6 4.5
Sleeping in same room 14 6
Sleeping in same bed 8 5
Changing clothes
(including underwear) 10 5
Using toilet together 7 5
* Maximum acceptable ages.
Source: Adapted from “Sibling Family Practices: Guidelines for
Healthy Boundaries,” by T. Johnson, B. Huang, & P. Simpson, 2009,
Journal of Child Sexual Abuse, 18, pp. 339–354.

and “mean” to describe peers. In fact, some preschoolers
may even describe having “boyfriends” and “girlfriends” of
the same or opposite gender. Their activities with these spe-
cial friends are usually limited to hand holding, hugging,
and kissing and are based on their notions of adult relation-
ships. Preschoolers may become very attached to a parent,
of the same or opposite gender, often expressing desires to
“marry” that parent when they grow up.
By preschool, most children have developed a strong
sense of being a boy or girl. This awareness, which develops
by age 2 or 3 (Kohlberg, 1966), is called gender identity, our
internal sense of being male or female. Most children do not
develop a sense of gender constancy, or full understanding
of the permanence of their gender (e.g., a girl knows she will
always be a girl) until age 6. The majority of children are
very proud of being whatever gender they are and are secure
in their gender identity. For a small minority of children,
their sense of who they are as a person does not match their
physical body; a psychiatric condition referred to as Gender
Identity Disorder (GID). The exact prevalence of GID is
unknown; however, a fair amount of cross-gender behavior
is present in young children. Möller, Schreier, Li, and
Romer (2009) reported that cross-gender behaviors are seen
in up to 6% of young boys and 12% of young girls. Persis-
tent signs of GID should be closely monitored and may
require professional attention.
Children also begin to associate certain behaviors, called
gender roles, with being male or female. Maccoby (1998,
2002) has described how play themes and play styles differ
by gender, beginning at age 3, resulting in two distinct sub-
cultures or social worlds of boys and girls. Girls typically
engage in themes related to family, school, adornment, or
nurturance, whereas boys are more likely to act out themes
of action, heroism, and danger. Girls prefer to play inside
and in pairs, show greater cooperation and concern for their
partners’ needs, and play in close proximity to adults. Boys
tend to play in large groups, outside, are more physical
(rough-and-tumble play), and avoid proximity to adults. As
Chrisman and Couchenour (2002) cautioned, the differences
found in the play of girls and boys should not lead to stereo-
types such as “boys don’t like to play house” or “girls don’t
like physical play” (p. 44). Instead, preschool children
should be encouraged to explore a full range of play.
Preschool boys may dress up in girls’ clothes or a girl may
pretend to be a “daddy.” These cross-gender behaviors are
only of concern if they are accompanied by gender confu-
sion (e.g., a boy insists he really is a girl).
Although children often mimic adult-like behaviors (e.g.,
talking on cellular phone, house cleaning, cooking, or typ-
ing on computer keyboard), displaying adult sexual behav-
iors is infrequent. Adult-like sexual behaviors (e.g., putting
mouth on others’ genitals or a doll’s genital area, trying to
insert penis into vagina/rectum, asking to engage in sexual
acts, masturbating with objects, inserting objects in own or
others’ vagina/rectum, imitating sexual behavior with other
children or dolls, tongue kissing) as well as intrusive or
aggressive sexual behaviors (e.g., forcing child to take off
clothes and play “doctor”) are very rare in this age group
(typically less than 3% in community samples; Friedrich et
al., 1991) and in less than 2% of preschool samples from
England and Finland (Davies et al., 2000; Sandnabba et al.,
2003).
Implications for Sexuality Education/
Developmental Guidance
This stage of development presents ample opportunities
for fostering children’s sexuality development and to teach
body-safety rules to prevent sexual victimization. A primary
goal for this age group relates to teaching personal bound-
aries and body ownership. Helping children understand that
their bodies belong to them and that they are in control of
and responsible for their bodies is an important message to
communicate starting at this age. Most important is to help
children understand how the public/private distinction
works in their culture (McKee et al., 2010). Children can
learn that private parts are to be kept private and should not
be touched by others or shown in public. This rule helps
children understand the need for privacy when dressing, toi-
leting, and bathing. Teaching children that no one should
touch their private parts, except a doctor or parent to keep
them clean and healthy, begins to establish boundaries and
teaches children about body safety. Without being taught,
few young children naturally know that it is wrong for other
people to touch or look at their genitals (Wurtele & Owens,
1997).
There are bound to be many teachable moments during
these years, since preschool-age children are naturally
inquisitive. Bathing and toileting offer multiple teachable
moments to use proper terms for the genitals (“Did you
wash your penis?” or “Be sure to wipe front-to-back, from
your vulva toward your anus”) (Wurtele, 2010). Children at
this age will also engage in self-touching, since it feels
good. This may happen when a child is watching television
or is excited or bored. Caregivers can use this occurrence as
a teachable moment and say, “I know touching your penis
feels good, but we only do that in a private place, like a bed-
room. If you want to watch TV with the family, you are
going to have to stop.” Instead of punishing their children
for normative sexual behaviors (like self-touching), care-
givers can use redirection or gentle distraction. Curiosity
about parents’ bodies is common at this age too, and chil-
dren may seek out opportunities to view their parents naked.
Wurtele (2010) cites the example of a young girl who
wanted to take photos of her father while he was showering.
8 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

9
TABLE 3
Early Childhood (3–6 years)
Common Behaviors Concerning Behaviors/Signs Educational Implications
• Plays consensual “sex” games with
similar-age peers, usually motivated by
curiosity about physical differences
between boys and girls (involves show-
ing or touching private parts)
• Understanding of genitals limited to
elimination functions; most are
unaware of sexual functions
• Exhibitionism (e.g., enjoys nudity,
shows genitals to an adult or other
children, not embarrassed about
nakedness)
• Voyeurism (e.g., Tries to view
peer/adult nudity; watches opposite-
gender parent urinate; is interested in
seeing others naked)
• Touching/rubbing of genitals in pub-
lic/private
• May put something in own genitals or
rectum one time for curiosity or explo-
ration
• Touching genitals/breasts of
parents/siblings/peers
• Physical intimacy (cuddling and romp-
ing)
• Stands/sits close to familiar persons
• Awareness of differences between
boys and girls; able to make distinction
based on genital differences
• May use slang terms for genital body
parts
• Asks about genitals, reproduction
• Wants privacy in bathroom or changing
clothes
• Modesty
• Interested in socializing with similar-
aged children
• Claims to have “boyfriend” and “girl-
friend”
• Plays house, acts out roles of mommy
and daddy
• Enjoys being a “boy” or “girl”
• By end of this period, majority have
well-developed sense of gender iden-
tity, but not all children understand that
they will always be that gender
• Plays “sex” games after being told not
to
• Forces or coerces peers to take off
clothes and play “sex” games
• Any penetration of others’ genitals/rec-
tum with fingers or objects
• Oral contact with another child’s geni-
tals
• Asking to be touched in his or her gen-
ital area
• Engages in sexual activities with ani-
mals
• Shows genital areas to adults
• Persistent nudity or sexual behavior in
public after having been given privacy
guidelines
• Touches an adult’s genitals
• Excessive masturbation, touching, rub-
bing of genitals (causes trauma or irri-
tation to genitals)
• Continues to touch/rub genitals in pub-
lic after being told not to
• Masturbates with objects
• Leaves fun activities to masturbate
• Makes groaning or moaning sounds
while masturbating or engages in
thrusting motions while masturbating
• Uses coercion, force to put objects or
fingers in vagina or rectum of self or
other person
• Regularly hugs adults he or she does
not know well
• Sexual play with dolls
• Provocative behavior with adults
• Advanced sexual knowledge
• Seems obsessed with sex
• Excessive questions or talk about sex-
uality
• Becomes upset (aggressive, fearful)
when denied privacy
• Consistently prefers to play with much
younger children
• Fearful of or aggressive toward oppo-
site-gender people
• Attempts advanced sexual behaviors
with peers (e.g., tongue kissing)
• Attempts or simulates intercourse or
oral–genital contact (humping)
• Believes she or he is the opposite gen-
der or he or she wants to be the oppo-
site gender
• Drawings, games, or fantasies that
involve inappropriate sexual activities
or depict advanced sexual knowledge
• Teach children rules about keeping cer-
tain parts of the body private and
keeping their clothes on while playing
• Help children understand physical dif-
ferences between boys and girls
• Teach rule to keep private parts cov-
ered up when in public
• Respect other people’s privacy (teach
child to observe closed doors and
knock before entering bathrooms and
bedrooms)
• Let children know that it may feel good
to touch parts of body, including your
penis or vulva, but that self-touching of
genitals is something they should do in
private (“It’s OK in your room, but not
in the grocery store”)
• Discuss concept of boundaries and
personal space
• Teach that they are in charge of or in
control of their own bodies. “Your body
belongs to you” or “You are the boss
of your body” (Wurtele, 2007). Teach
body-safety rules about not touching
anyone else’s private parts or letting
anyone else (except parents/doctors)
touch their private parts (“No one has
the right to touch your private parts.”)
• Teach children difference between OK
and not OK touches (avoid use of good
and bad touch)
• Provide age-appropriate sex education
• Teach accurate names for body parts
• Teach rules about personal safety while
at home and out and about
• Explain that these rules apply to
friends and relatives as well as
strangers
• Begin to teach assertiveness skills
• Practice “what if” role plays (What if
someone tried to touch you?) empha-
sizing the need to tell about unsafe
touch requests and that unsafe or “not
OK” touching is never the child’s fault
• Stop cobathing and cosleeping (sib-
lings and parent–child). If siblings want
to continue joint bathing, remind chil-
dren not to touch each others’ genitals.
• Encourage self-care (during bathing
and after using the toilet). Use these
moments to reinforce the concept that
no one else is allowed to touch his or
her genitals.

The parent used this as a teachable moment by reminding
the child that private parts are to be kept private and that no
one should ever take pictures or movies of her while she is
naked. This intense interest in body parts and functions pro-
vides parents with ample opportunities to share their cul-
ture’s notions about boundaries (both psychological and
physical). As part of sexual socialization, family members
define and set limits regarding which areas of the body can
and cannot be touched and clarify which activities should be
done in private versus public.
If children are seen displaying sexual behaviors during
this stage, parents and caretakers may follow a number of
guidelines. Most important is to stay calm and not react in
haste. For example, the parent or caretaker who walks in on
two 6-year-olds playing “doctor” can say, “Hey, it looks like
you two are checking out one another’s private parts. It’s
okay to be curious about private parts, but you know we
don’t show our private parts to other people. Let’s get
dressed and talk about this.” The use of open-ended ques-
tions (e.g., What game were you playing? How did you
learn about this game?), can be utilized at this time to gain
more information and to understand the activity from the
child’s perspective. Seeing the behavior from the child’s
point of view will help parents understand that the behavior
is not erotically focused but is more likely to be motivated
by curiosity. An opportunity like this, although potentially
uncomfortable for the parent, can serve as a perfect teach-
able moment for discussing healthy boundaries and rein-
forcing body-safety lessons. (“Remember our rules about
private parts? No one is allowed to touch or look at your pri-
vate parts, and it’s not okay for you to look at or touch some-
body else’s private parts. This means you should never
touch your friend’s private parts, and your friend should
never touch yours. It’s okay if you want to play the doctor
game, but just keep your clothes on.” [Wurtele, 2010]). It is
also helpful to determine what might be motivating the
child’s sexual behavior. If the behavior is related to curios-
ity, then provide information that is appropriate to the
child’s age and developmental level. (“If you’re curious
about how boys’ and girls’ private parts are different, I have
some picture books we can look at. Would you like to do
that?” See Appendix A for age-appropriate resources).
By 6 years of age, most children have a limited but grow-
ing fund of sexual knowledge. Most children by this age
understand the physical and anatomical differences between
boys and girls. They begin to respect the privacy of others
and may knock on doors before entering and close their own
doors while undressing or toileting. They may even request
privacy, by asking the parent to leave the bathroom while
they are showering or dressing. Children begin to under-
stand that some touching is not okay; in addition to touches
that feel bad (hitting, kicking, biting), they may not want to
be hugged or kissed by relatives as frequently, and they
begin to express their own desires. Most children enjoy
being a boy or a girl and begin to embrace activities or hob-
bies often associated with that gender. Parents and care-
givers can continue to model appropriate behavior and share
positive messages about both genders.
Parents’ and caregivers’ major roles in this stage are to
continue to reinforce concepts that have already been dis-
cussed as well as continue to be open to sexuality discus-
sions. As much as parents are comfortable they may begin to
provide age-appropriate explanations for reproduction and
birth as the child’s curiosity grows. Children may have
greater understanding of where babies come from, particu-
larly if there has been another child born into the family.
Although their understanding of adult sexual functioning is
limited, they may begin to learn basic concepts of procre-
ation and reproduction such as the egg and sperm and that
babies grow inside the mother.
Martin and Luke (2010) found that mothers of young
children (aged 3–6 years) talk more to daughters than sons
about romantic relationships, reproduction, and moral issues
around sexuality, suggesting that they may need encourage-
ment and guidance from counselors in also holding these
discussions with their sons. Also, since children in this age
are spending more time with others outside their home, they
may begin to bring home slang terms or incorrect terminol-
ogy learned from peers. Particularly if a child is in daycare,
he or she may be exposed to children who vary in their sex-
ual knowledge and behavior. Debra Haffner, author of From
Diapers to Dating, tells of 6-year-old David asking his
father, “Dad, do you and mom f***?” She recommends
calmly asking “Where did you hear about that?” followed
by “What do you think that means?” (These types of ques-
tions will give parents an idea of what their children are
really asking, and help give an indication of what their chil-
dren are ready to learn.) Then give the child a short, simple
answer and ask him not to use those words again. Haffners’
suggested response: “That’s not a very nice term for adults
making love. It’s a word that most adults don’t like, and I
hope you won’t use it again.” (p. 130)
Summary
According to Friedrich and colleagues (1998), sexual
behavior in children peaks at around age 5 for both boys and
girls and then tapers off for the next 7 years. Most
preschool-age children are naturally inquisitive about their
environment and the people in it. They begin to recognize
gender differences and may experiment with touching their
own genitals as well as those of other peers and adults.
When this behavior occurs within the context of mutually
agreed-upon play, with close-in-age siblings or peers, it
should be understood as normative, although it still provides
10 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

the opportunity for teaching about private parts, boundaries,
and appropriate touching. There are many sexuality and pre-
vention concepts that can begin to be taught to children in
the preschool age. The concept that a child is the “boss” of
his or her body and no one has the right to touch him or her
in any way, particularly not their private parts, is an impor-
tant concept to convey to children (Wurtele, 2007). In addi-
tion, the idea that touching oneself may feel good and plea-
surable can be discussed, and parents can emphasize rules
related to privacy and private spaces in the home. Parents
may wish to participate in sexuality education programs or
parent support groups or enroll their children in sexual
abuse prevention programs which often begin to be offered
at this age (see Kenny & Wurtele, 2010 and Wurtele &
Kenny, 2010a for program guidelines).
Early Elementary School Children (6–9 years)
Freud (1965) described middle childhood as a period of
“latency,” when sexual drives are dormant and children
show little interest in sexual issues. Based on their surveys
of four societies—the U.S., England, Sweden, and Aus-
tralia—Goldman and Goldman (1982) concluded that there
is no latency period in sexual development as Freud hypoth-
esized. Although school-age children do engage in less overt
behavior at this time (Friedrich et al., 1991), they continue
to be very interested in sexual issues. But because they have
developed a sense of modesty and are aware of social stig-
mas and the taboo nature of sexuality, they are less likely to
engage in sexual behaviors where they can be observed by
others, particularly adults. Even with this inhibition, moth-
ers still observe their children exhibiting sexual behaviors.
For example, 13% of 6- to 9-year-old boys were still touch-
ing their genitals in public, 40% did so at home, 20% tried
to look at people nude, and 14% were very interested in girls
(Friedrich, 1997). Girls also exhibited sexual behaviors:
Twenty percent had been observed touching their genitals,
and 14% were very interested in boys. In the Kaeser, DiS-
alvo and Moglia (2000) study of kindergarten, first- and sec-
ond-grade students, fewer sexual behaviors were noted by
teachers in second-grade students, whereas sexual behaviors
were more frequent among the younger students.
Curiosity about physical differences continues during
this phase. They continue to sneak peeks at siblings or par-
ents when undressing or bathing and may need to be
reminded about the privacy rules. Kindergarten, first-, and
second-grade teachers report observing a fair number of
voyeuristic behaviors (e.g., peeking under the bathroom
stall at other students) (Kaeser et al., 2000). Sex play also
continues throughout these early elementary-school years.
Children often compare genitals with same-aged peers and
show interest in touching the genitals, breasts, or buttocks of
other same-age children. When they have the opportunity,
children engage in both opposite-gender and (mostly) same-
gender sex play. Some try inserting objects in their own gen-
itals/rectum and do this out of curiosity or exploration. The
major difference between sex play of preschoolers and this
age group is that children take better care to ensure they
won’t be discovered. Reynolds et al. (2003) reported that
58% of their sample of college women and 64% of men
recalled engaging in sexual games during elementary
school, but only 24% of these experiences were ever dis-
covered by adults.
Although developmentally children begin to gain greater
independence and autonomy from caregivers, physical inti-
macy is still important to 8- and 9-year-old boys and girls
(Rademakers, Laan, & Straver, 2000). Children at this age
enjoy romping with family members and peers and also like
to cuddle with people along with toys, dolls, and stuffed ani-
mals. Children say that cuddling (hugging, kissing, and sitting
on someone’s lap), made them feel “safe, nice, cheerful, fun,
kind, and comforted” (Rademakers, Laan, & Straver, 2003, p.
123). Caregivers are encouraged to meet children’s needs for
cuddling, as this physical contact is still important and desired
by children and critical to their sense of safety and security.
During the early grade-school years, children are busy
making friends and developing their social skills. Children
begin to choose their own friends and begin spending more
play time with their peers. The preference for same-sex and
similar-aged playmates, friends, and school groups contin-
ues throughout this period. Children in this age range also
tend to maintain a fairly rigid separation between males and
females. This is the age when many children start to make
comments about the opposite gender. Maccoby (1998)
reported that in middle childhood boys increase their use of
inappropriate language, often talking about girls’ bodies,
ridiculing girls (e.g., teasing about breast development), and
uttering sexually explicit terms or making demeaning com-
ments. Although the two sexes tend to remain separate dur-
ing this period, they seem to be very aware of each other,
and both boys and girls tease each other about having
boyfriends and girlfriends or being “in love” (Chrisman &
Couchenour, 2002). As evidence that sexual interests are not
dormant during this time, Wallis and VanEvery (2000)
describe elementary-school playground kissing games
involving girls chasing boys for kisses and boys chasing
girls for kisses. These types of games are evidence that chil-
dren do exhibit (hetero) sexual behaviors in public settings
and that schools are not “asexual.” These teachable moments
also provide opportunities for school staff to draw attention
to the public/private distinction, sexual diversity, and also
respectful sexual behaviors.
It is common at this age for children to turn to peers,
media, and other sources (e.g., the internet) for information
about sex. Almost half of children ages 6–9 use the internet
11

daily for an average of 28 minutes (Kotler, 2010). They
begin to view websites, movies, or television shows, and to
listen to music that often has sexual content. Children may
ask fewer questions about sexuality from their caregivers,
but they still have lots of curiosity and need information
about sexuality. They begin to understand more complex
ideas with regard to sexuality and begin to comprehend
intercourse as an activity apart from making a baby.
By 7 or 8 years of age, most children will have developed
an established sense of gender identity and gender con-
stancy. The process of gender role socialization is height-
ened during this period. While cementing their self-concept
of gender as male or female, children often show a strong
preference for gender-typed clothing, toys, and activities
(Martin & Ruble, 2004).
They also like playing games with children their own age
that involve sexual behavior (such as playing “family”) and
simulating roles of mothers and fathers. As they move
through this age, children give up on wanting to “marry”
their mother or father and turn their attention outside the
family. Gender role identification is generally stabilized dur-
ing this age, as girls become closer to their mothers and boys
to their fathers. According to Bussey and Bandura (1984),
children begin modeling their behavior after same-sex role
models around the age of 6, due to a desire to behave in a
way that is consistent with his or her gender. Children
engage in greater gender-stereotypical behavior and activi-
ties than before, leading to a gender divide.
As they move out into a more social world, children will
learn (often incorrectly) about sexuality from their friends.
Children giggle with their friends about “private parts,” tell
“dirty” jokes, and search through books and the internet for
“sex stuff.” Parents may see an increase in children’s use of
sexual or obscene language, often done to test parental reac-
tion. In fact, Kaeser et al. (2000) found that the most com-
mon “sexual” behavior observed by teachers of kinder-
garten, first-, and second-grade children was sexual
communication (students making sexual comments verbally
or in writing to each other). Jokes about bodily functions—
such as burps, farts, urination, and defecation—are common
as well and produce uproarious laughter.
In contrast to earlier ages, children ages 6–9 show a
decrease in overt sexual behaviors including behaving like
the opposite sex, playing with their own private parts in pub-
lic, playing with their own private parts too much, thinking
about sex too much, or wishing to be the opposite sex
(Meyer-Bahlburg, Dolezal, & Sandberg, 2000).
Implications for Sexuality Education/
Developmental Guidance
The American Academy of Pediatrics (2011) recom-
mends that parents help their children understand healthy
sexuality because lessons and values learned at early ages
are likely to remain with them as they grow to adulthood.
According to the Sexuality Information and Education
Council of the United States (SIECUS), “parents and care-
givers are—and ought to be—their children’s primary sexu-
ality educators” (SIECUS, 2004, p. 13). During these mid-
dle childhood years, it is important that parents and
caretakers continue to provide information about sexuality,
even if a child does not ask for it. At these ages, children
may ask fewer questions but still have lots of curiosity and
need information about sexuality. Parents can utilize teach-
able moments or opportunities that occur every day to intro-
duce sexual topics or review concepts previously discussed.
For example, watching television as a family can provide
many opportunities to discuss sexual topics.
Although parents are the primary sexuality educators of
their children, research has shown that parents often feel
inadequate in discussing many sexual topics. In El-Shaieb
and Wurtele (2009), two topics (masturbation and noctur-
nal emissions) were difficult for parents to talk about with
their children, and 25% of parents indicated that they
would never discuss these two topics with their children. A
large body of research has revealed that parents and their
children commonly have difficulty talking with each other
about sexuality. In addition, many Latino cultures have a
taboo against discussing sexuality, and parental communi-
cation regarding sexuality is often lacking (Kenny &
McEachern, 2000). Thus, there may be a need for educa-
tional efforts outside the home as well. It is important that
schools provide sexuality education programs, which most
parents (91%) favor (Chappell, Maggard, & Gibson,
2010).
Parents can also utilize a variety of books that assist with
discussing sexual matters. These books can be read with
children, or children can look at them on their own, as many
children feel more comfortable exploring or reading them in
private (See Appendix A). Caregivers are encouraged to
check back in with children after they have had some time
to read to answer questions or clarify any information.
As children age and are in contact with more diverse
individuals, they may begin to come into contact with indi-
viduals with different sexual orientations. For example, a
child may return from school talking about Cate and her
“two mommies.” This provides an opportunity for parents to
explain differences in sexual orientation. Sexual orientation
refers to “whether an individual is more strongly sexually
attracted to members of his or her own sex, the opposite sex,
or other sexes” (Goldberg, 2010, p. 127). Counselors may be
able to provide guidance to parents as they explain these
concepts to their children. When adults model and expect
appreciation of differences and similarities, it will be more
natural for children to adapt these attitudes as well.
12 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

Summary
Children between the ages of 6 and 9 years generally
show a decrease in overt sexual behavior, and relationships
are centered around same-sex friendships and identifica-
tions. Children begin to formalize their sense of self as a boy
or girl. They remain affectionate with parents, but peers are
often included in their displays of affection (i.e., hugging,
kissing, holding hands), as they begin to move away from
the family as their primary influence and toward peer
groups. This shift may also contribute to the use of vulgar
terms or inappropriate references to sexual material, which
has been learned from peers. Children will continue to be
curious about others’ nudity and may take advantage of
opportunities to see others naked or undressed, but will
desire increased modesty for themselves (i.e., requesting
privacy while changing clothes). Parents will need to con-
tinue to monitor their child’s understanding of sexual mat-
ters and will want to find opportunities to introduce sexual-
ity education on emerging topics of interest to children in
this age range. Caregivers will want to begin to discuss with
13
TABLE 4
Early Elementary School Children (6–9 years)
Normal Behaviors Concerning Behaviors/Signs Educational Implications
• Asks about genitals, breasts, inter-
course, babies
• May seek out books or websites on
sexual matters
• Uses “dirty” words for sexual behavior;
tells sexual or obscene jokes
• Limited understanding of adult sexual
behavior
• Plays “sex games” with same-aged
children involving touching and looking
(e.g., truth or dare)
• Compares genitals with siblings and
peers (close in age)
• Self-stimulation of genitals; shows oth-
ers his/her genitals in private location
• Plays house, simulating mother/father
roles
• May put something in own
genitals/rectum
• Takes advantage of opportunity to look
at others’ genitals, buttocks, breasts
• Single or infrequent occurrences of
peeping/exposing
• Affectionate behavior with peers (e.g.,
kissing, flirting)
• Cuddle and romp with familiar
adults/children
• Becomes aware of different forms of
sexual orientation
• Child’s sense of gender constancy
(they will always be male or female) is
complete
• Tease, call names, make sexual com-
ments to or about opposite-sex peers
• Child has advanced sexual knowledge,
gestures, language, and activities
• Continuously uses sexual or obscene
language even after told not to and
parents/relatives do not use these
words
• Coerces/forces/bribes much younger
children to play “sex games”
• Is preoccupied with sexual play, espe-
cially with much younger or older chil-
dren
• Engages in or attempts advanced sex-
ual activities (oral sex, digital penetra-
tion, intercourse)
• Forces child to take clothes off and
touches/inserts something in child’s
genitals
• Demands to see/touch others’ genitals,
breasts, or buttocks
• Excessive touching/rubbing of genitals
in public; shows genitals in public
• Preoccupation with masturbation
• Masturbation which includes vaginal or
anal penetration
• Imitating intercourse
• French (tongue) kissing
• Uses coercion/force to insert some-
thing into vagina/rectum of self, others,
dolls, or animals. Causes harm to
own/others’ genitals/rectum.
• Sneaks peeks at others while naked
even after reprimanded
• Wants to watch nudity on television
• Repeated or chronic peeping/exposing
• Exposes others’ genitals (e.g., pulling
down pants or exposing breasts)
• Simulating intercourse with dolls,
peers, animals (i.e., humping)
• Harasses/uses discriminatory
labels/terms
• Provide more detailed information
about sexual issues (e.g., anatomy and
reproduction), even if a child does not
ask for it.
• Emphasize that sexual activities
(including oral sex, fondling, inter-
course) are for adults only, not children.
• Set rules in your home for what words
are acceptable and unacceptable to
say, especially in public. Explain that
others may be offended by hearing
these words. Check your child’s knowl-
edge about what an unacceptable
word means. Sometimes they stop
using obscenities when they know
what they mean.
• If a child uses obscenities when angry
or frustrated, teach more appropriate
ways of expressing emotions.
• Explain that ouching or playing with
private parts can feel nice, but it’s
something people only do in private.
• Explain concepts of heterosexuality,
homosexuality, and bisexuality.
• Treat classmates (same- and opposite-
sex) with respect. Adults should inter-
vene when children engage in sexually
disrespectful behaviors, stressing that
these behaviors or words may hurt or
upset others and are not allowed.
• Continue teaching about privacy. Set
family rules about respecting each oth-
ers’ rights to privacy, and that chil-
dren’s private parts are private.

their children several more mature themes, such as repro-
duction, sexually transmitted diseases, sexual orientation,
sexual respect, along with the impending changes that
accompany puberty . Counselors may play an important role
in helping parents communicate this information to their
children, as many parents may feel unprepared or embar-
rassed. Counselors can recommend “best practices” for
diverse family structures (see SIECUS, 2002, for a review
of innovative approaches to increase parent–child commu-
nication about sexuality).
PREADOLESCENCE AND EARLY ADOLESCENCE
(9–12 YEARS)
Nine- to 12-year-old children are in the early stages of
adolescence. This phase of life includes the first two sub-
stages of sexual development identified by Sharpe (2003)—
Substage I: Preadolescence (occurring before 10 years of
age) and Substage II: Early Adolescence (between 10 and 13
years). Preadolescence is the time of adrenarche, when the
adrenal glands mature and manufacture the androgen hor-
mone dehydroepiandrosterone (DHEA), occurring around
ages 6 through 8 years in girls and about one year later in
boys (Dorn & Biro, 2011). As DHEA begins to increase,
sexual interests awaken, often manifested in teasing and
roughhousing (Sharpe, 2003). Early Adolescence is the time
when gonadarche occurs with reactivation of gonadotropin-
releasing hormone and secretion of estradiol and testos-
terone, leading to development of the primary sex organs
(testes, ovaries) and a variety of physical changes in boys
and girls called secondary sex characteristics (e. g., breast
and genital development). Toward the end of this substage,
youth go through a predictable process of biological devel-
opment called puberty. Puberty refers to a stage of biologi-
cal maturation where a boy or girl becomes capable of
reproduction and develops an adult-like body.
The average age for puberty to begin for girls is between
10 and 11 years and for boys between 11 and 12 (Haffner,
2004), although normal pubertal changes may begin as early
as age 8 for girls and 9 for boys. Early pubertal timing in
girls is associated with psychosocial problems throughout
adolescence (i.e., substance use, early sexual behavior;
Mendle, Torkheimer, & Emery, 2007), and early maturers
are also at risk for depression and having many sexual part-
ners in young adulthood (Copeland et al., 2010). In contrast,
early-developing boys seem to have few problems and are
more likely to be popular, good in sports, and school lead-
ers. Late-maturing boys actually have more problems than
those who mature early.
For both boys and girls, the biological and physical
changes of puberty lead to a flood of emotions, most notice-
ably a new interest in romantic relationships and sex.
Around age 10, both sexes begin to have sexual thoughts
and feelings and attractions to others (Herdt & McClintock,
2000). Sexual attraction coincides with rising androgen lev-
els due to the maturation of the adrenal glands. Now chil-
dren begin to purposefully masturbate for sexual pleasure,
usually in private. Boys are more likely than girls to mas-
turbate, either alone or with other boys (Hyde & Jaffe,
2000). Unlike the more casual genital touching or rubbing
typical of earlier stages, preteens masturbate to experience
arousal, orgasm, or ejaculation. Research shows that as
many as three quarters of boys and about half of girls under
the age of 15 masturbate (Haffner, 2004). There are also cul-
tural differences: Masturbation is more common among
White adolescents than among African American teens
(King, 2009). A study of adults’ childhood recollections
found that over half of both men and women had mastur-
bated to orgasm by age 12 (Ryan, 2000a). Women who said
they started masturbating before puberty (defined as before
menarche) had more positive attitudes about sex, more pos-
itive sexual experiences, and better sexual self-esteem than
women who did not report early-onset masturbation (Ban-
croft, Herbenick, & Reynolds, 2003; Smith, Rosenthal, &
Reichler, 1996).
During this stage of development, children become more
modest and may want increased privacy. It is not uncommon
to see a sign posted on a child’s door that says, “KEEP
OUT!”. Modesty prevails at this age, and children are shy
about undressing, even in the presence of their same-sex
parent. They may also be embarrassed about undressing in
front of peers, because of a concern about being too devel-
oped or underdeveloped compared to their friends. For
example, a boy who is concerned about the size of his penis
or a girl who is embarrassed about her breast size may be
reluctant to change in the locker room at school. With regard
to their relationship with their parents, teens often become
less physically demonstrative and may be embarrassed by
physical affection from parents. As they age, children want
more emotional freedom and space from parents. This emo-
tional and physical distancing is believed to have biological
roots in that children are preparing, ultimately, for a time
when they will no longer be living with their parents.
As tweens become aware of themselves as sexual beings
and of their peers as potential partners, many start connect-
ing romantically. Some start “going together” or “hanging
with” a boyfriend or girlfriend sometime in middle school.
In a national survey of youth ages 12–14, 39% of 12-year-
olds reported being in a romantic relationship (Bruckner &
Bearman, 2003). Their concrete thinking may mean they
like someone one day but hate them the next. Romantic
crushes tend to be of short duration and rather innocent in
terms of sexual behavior (e.g., holding hands during school
movie, sitting next to each other on school bus, saying “hi”
14 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

to them in hallway). These (typically) short-lived relation-
ships often involve experimenting with sexual behaviors
like holding hands, hugging, and kissing, whereas touching
each other’s genitals under the clothes (often called “pet-
ting”) is less likely (i.e., reported by 10% of 12 year old girls
and 13% of boys) (Bruckner & Bearman, 2003). Fewer
tweens report having intercourse; only 7% of teens report
having sex by age 13 (Eaton et al., 2008). Not all tweens are
interested in dating (about 20% of youth said they did not
have romantic attractions in Russell & Self, 2002), and not
all preteenagers are interested in people of the opposite gen-
der. In fact, it is common for preadolescents and adolescents
to be attracted to people of the same sex; to develop crushes
on a teacher, counselor, or coach of the same sex; and to
have sexual experiences with a same-sex friend (Haffner,
2004). Most of these same-sex experiences are short lived
and not predictive of a homosexual orientation. However,
sexual orientation usually emerges during the mid- to late-
teenage years, with most gays and lesbians having their first
same-sex sexual experiences by the time they are 20.
Romantic relationships can provide many benefits for
teens. Having a boyfriend or girlfriend makes teens more
popular with their peers. Romantic partners provide accep-
tance, companionships, and emotional comfort to weather
the storm of adolescence. Dating also helps teens explore
their sexual identity and prepares them for adult romantic
relationships. Thus, through romantic relationships teens
gain intimacy, social status, and pleasure (Ott, Milstein,
Ofner, & Halpern-Felsher, 2006).
The pubertal and social transitions of early adolescence
may explain the increased likelihood of tweens perpetrating
sexual harassment, also referred to a sexual bullying (SB;
Fredland, 2008). SB includes touching, grabbing, pinching
in a sexual way; brushing up against someone in a sexual
way on purpose; giving someone sexual pictures, messages,
or notes; name calling such as slut, gay, or “lesbo”; writing
sexual messages/graffiti in school restrooms; spreading sex-
ual rumors; and forcing someone to do something sexual
such as kissing or oral sex. A substantial number of youth,
both boys and girls, are involved in SB with same-gender
and cross-gender peers. McMaster, Connolly, Pepler, and
Craig (2002) found that cross-gender sexual harassment at
school increased in youths from grades 6 –8, and boys were
significantly more likely to report sexually harassing behav-
iors than were girls. Early maturing girls and gay and les-
bian youths are common targets (Perry & Pauletti, 2011).
Although peer-to-peer sexual harassment is frequent as
children enter adolescence, McMaster et al. noted that it is
“by no means a necessary or healthy aspect of adolescence”
(p. 104) and called for interventions to prevent its develop-
ment. As suggested by Fredland (2008), identifying inap-
propriate sexual behavior such as SB and intervening early
may prevent deviant behavioral patterns (like dating vio-
lence) from developing.
SB not only occurs at school but is also perpetrated using
electronic technology (e.g., through e-mail, in a chat room,
instant messaging, on a web site, or through digital mes-
sages or images sent to a cell phone; Kowalski & Limber,
2007). Males and females participate about equally in cyber-
bullying (Hinduja & Patchin, 2008). Sexting (e.g., a girl
sends a nude picture of herself to a boy) and its conse-
quences (e.g., the boy circulates the picture among his
friends, the girl is humiliated, and in tragic cases commits
suicide) are also growing problems (Wurtele, 2011). Sexual
bullying, whether online or offline, represents an emerging
public health problem (David-Ferdon & Hertz, 2007).
As curiosity about sexual behavior increases, some chil-
dren begin seeking out sexual content in media (television,
movies, games, music, magazines, internet). Longitudinal
studies have found that young adolescents’ exposure to sex-
ual content in the media is related to subsequent sexual
behavior, including earlier intercourse and greater risk for
pregnancy and sexually transmitted disease (see reviews by
Brown & Bobkowski, 2011, and Stasburger, Jordan, & Don-
nerstein, 2010). The newer media (e.g., the internet, cell
phones) are also important sexual socialization agents.
About 20% of children between ages 10 and 17 who have a
computer at home use the internet to get health or medical
information (Brodie et al., 2000). Adolescents use the inter-
net to ask questions about sexual topics, exchange informa-
tion with peers about sexuality, and explore their emerging
sexuality (Subrahmanyam, Greenfield, & Tynes, 2004;
Suzuki & Calzo, 2004). Unfortunately, the internet can be a
dangerous sex educator. Wolak, Mitchell and Finkelhor
(2007) found that 66% of children between 10 and 17 who
used the internet were exposed to pornography in the past
year. In a sample of middle-school youth, exposure to sexu-
ally explicit content predicted perpetration of sexual harass-
ment (for males), more permissive sexual norms, having
oral sex, and engaging in sexual intercourse while in high
school (Brown & L’Engle, 2009). Given the importance of
technology for children this age, it is not too alarming that
they are using it to gain information about sexual material.
However, parents should be concerned about the potential
for internet sex addiction (Kuss & Griffiths, 2011) or when
tweens view child pornography.
As sexual feelings and interests increase during this time,
some youth (both boys and girls) try to satisfy their sexual
curiosity by experimenting with younger children. Clini-
cians and researchers have become increasingly aware of
young children (under the age of 12) who demonstrate sex-
ual behavior problems (SBPs) (Araji, 1997; Chaffin et al.,
2008; Elkovitch et al., 2009). Sexual behaviors in children
are considered problematic when they are either potentially
15

harmful to themselves or others or are developmentally
inappropriate or atypical. Furthermore, SBPs involve behav-
iors that “(a) occur at a frequency greater than would be
developmentally expected; (b) interfere with children’s
development; (c) occur with coercion, intimidation, or
force; (d) are associated with emotional distress; (e) occur
between children of divergent ages or developmental abili-
ties; or (f) repeatedly recur in secrecy after intervention by
caregivers” (Chaffin, Letourneau, & Silovsky, 2002, p.
208). These youth have been referred to in the literature as
“juvenile sex offenders,” “children with sexual behavior
problems,” “sexually aggressive children,” “children who
molest,” or even “mini-perps” (Chaffin & Bonner, 1998).
Victims can include their siblings and cousins along with
children in their care (e.g., while baby-sitting). In contrast to
sexually abusive adults, intentions and motivations for their
SBPs may or may not be related to sexual gratification or
sexual stimulation. Instead, their sexual behaviors may be
related to curiosity or anxiety, may be imitative or attention-
seeking, a reaction to their own victimization or living in a
sexually dysfunctional environment, or a way to meet inti-
macy needs and feel emotionally safer (Chaffin et al., 2008;
Elkovitch et al., 2009; Johnson, 2009).
Implications for Sexuality Education/
Developmental Guidance
During this stage, it is important that parents and care-
takers increase their communication on sexual topics with
youth. Most importantly, children will need help under-
standing puberty and the myriad of changes both boys and
girls will experience. Children this age often want to know
the answers to a variety of questions, including: What’s a
boner? What’s sex? What’s masturbation? What’s a period?
What’s a wet dream? What should I do when I get a hard on
during class? What does ‘gay’ mean? Parents need to pre-
pare their sons and daughters for all the physical changes
associated with pubescence, most importantly menarche
(beginning menses) and erections during the day and at
night (i.e., nocturnal emissions or “wet dreams”). With girls
maturing earlier compared to decades ago (Dorn & Biro,
2011; Slyper, 2006), it becomes important to have these dis-
cussions early, between ages 8 and 10 or younger, especially
for early-maturing girls. Discussions with children should
emphasize that processes such as menstruation and noctur-
nal emissions are normal biological processes of develop-
ment. Despite the embarrassment some parents may expe-
rience, they are still reported as the preferred source for
information about sexuality by adolescents (Somers & Sur-
mann, 2004). However, parents do not seem to be provid-
ing this much-needed education. More than half of adoles-
cents report that they learned about pregnancy and birth
control from television and movies, and more than half of
adolescent girls state that they learned about sex from mag-
azines (Brown & Witherspoon, 2002). Many boys said
although they knew about ejaculation, no one spoke to them
about it ahead of time, or told them what physical changes
would happen during puberty (Omar, McElderry, &
Zakharia, 2003). Tweens who are prepared are more likely
to react more positively to pubertal changes.
Parents also need to convey that growth and maturation
rates differ from person to person and that different parts of
their bodies will grow at different rates. Puberty affects chil-
dren at different ages, and children may be comparing them-
selves to others and wondering when they will “catch up.”
They can be reassured that everyone will eventually
change—and “get there.” Parents can also help their tweens
develop a healthy genital image by stating that everybody
develops at a different rate and that their bodies are unique
and beautiful (Berman, 2009).
Books and videos can be very helpful for both boys and
girls. Parents can read them together or have books available
for their children to read alone. It is also important that both
genders be informed about the changes of puberty experi-
enced by both boys and girls. As suggested by Haffner
(2004), knowing what the other sex is experiencing may cut
down on inappropriate teasing or insensitive comments.
Appendix A includes resources for this age group. Since
research on adolescence has shown that parents (primarily
mothers) talk more to daughters than to sons about sexuality
(Martin & Luke, 2010), both mothers and fathers may need
assistance from counselors in how to handle such discus-
sions with their children.
As tweens begin expressing sexual interest, adults can
help them with this developmental challenge. This age is a
prime time for caregivers to insert family values and reli-
gious or moral beliefs into discussions about intimate rela-
tionships, dating, and sexual activities. As children develop
relationships with peers that are based on attraction, parents
can use these “first love” experiences to share their values
about healthy intimate relationships and also to continue
emphasizing body ownership and respectful relationships.
Tweens and teenagers with a healthy concept of body own-
ership are more likely to take responsibility for keeping
themselves safe in many situations, for protecting their sex-
ual and reproductive health, and for avoiding sexual behav-
iors that are harmful to themselves or others (Wurtele &
Berkower, 2010).
A child who asks for permission to date presents the per-
fect opportunity for parents to talk about dating rights and
responsibilities. This is an ideal time to promote healthy
relationships and prevent patterns of dating violence that
can last a lifetime (Wurtele, 2011). Setting limits on a child’s
dating is very important, especially for young girls, as early
dating is more likely to lead to involvement in high-risk
16 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

behaviors: drinking, doing drugs, having intercourse, and
getting pregnant. Parents should be cautious about allowing
their middle-school children to date, especially if their chil-
dren are dating someone much older. Parents need to care-
fully monitor their young teens’ dating and romantic activi-
ties and communicate more with their young teens about
sex, love, and relationships. Topics of importance for tweens
include making decisions in the context of relationships
(“Do I really want to do these sexual things with this boy
now?”), recognizing risky social situations and potential
dangers of dating (i.e., sexual pressure, date rape, dating
violence), and treating partners—whether sexual or roman-
tic—with respect. Given that sexual harassment increases
during the early adolescent years and is evidenced at school
(in “hostile hallways”; AAUW, 1993), parents, teachers, and
counselors can help adolescents establish appropriate ways
17
TABLE 5
Early Adolescence (9–12 years)
Normal Behaviors Concerning Behaviors/Signs Educational Implications
• Shows sexual interest in peers of simi-
lar age (feelings of sexual attraction)
• Begins dating(hanging out, going with)
usually in groups
• Start of sexual attraction/interest in
peers
• Puberty begins or continues; body
changes can result in anxiety and con-
fusion; need reassurance that changes
are normal
• May have fantasies about ideal partner;
likely to be a celebrity
• Some youth begin to engage in kissing
and fondling with peers or other affec-
tionate behavior with peers (e.g., flirt-
ing)
• Asks questions about sex
• Displays more advanced knowledge
about sexuality (draws sexual parts,
uses sexual words, talks about sexual
acts, looks at nude photos)
• Seeks out sexual information from
media and internet (wants to see pho-
tos of naked or partially naked people)
• Listens to music, watches movies with
sexual themes
• Desires more privacy, may want bed-
room door locked
• Awareness of own and others’ sexual
orientation
• Shows secondary sex characteristics
(signs of puberty)
• Menstruation and nocturnal emissions
• Masturbates (in private) for pleasure
and orgasm
• Most early sexual experiences are with
the opposite sex but may engage in
same-sex activity (does not indicate
homosexuality)
• Engages in adult-type sexual activities
with younger children
• Forcing a younger child to have oral,
vaginal, or anal sex
• Preoccupied with sex and relationships
• Frequents sexually explicit websites
• Shows pornography to younger chil-
dren
• Difficulty adjusting to sexual orientation
• Masturbation interferes with academic
or social life
• Simulating intercourse with dolls,
peers, animals (i.e., humping)
• Manually stimulates or has oral or geni-
tal contact with animals
• Child exhibits sexual bullying, whether
in real life or online
• Child touches adults in a manner more
like adult–adult sexual contact, offers
him- or herself as a sexual object,
solicits sexual touch from adults
• Child sexualizes nonsexual things or
sees people as sexual objects
• Uses coercion, force, bribery, manipu-
lation, or threats to engage another
child in sexual behavior
• Exposes genitals and/or masturbates
in public
• Provide broad-based sexual health
education.
• Provide information about sexual
issues (e.g., reproduction, pregnancy),
even if a child does not ask for it.
• Discuss dating (relationship) rights and
responsibilities.
• Review body-safety rules when inter-
acting with younger children.
• Respect child’s desire for privacy
• Help tweens develop decision-making,
communication, and assertiveness
skills.
• Help tweens recognize and respond to
peer pressure.
• Discuss family values about dating and
love and the role of sexuality in rela-
tionships.
• Keep conversation going.
• Develop media literacy skills to under-
stand, interpret, evaluate sexual mes-
sages and imagery.
• Discuss appropriate and inappropriate
uses of electronic devices before pur-
chasing new technologies.
• Emphasize safe connections and
boundaries whether in person or
online.
• Discuss internet safety and teach kids
to be respectful of others online and
not to engage in “sex talk” online or
electronically bully others.
• Talk about how to recognize and avoid
risky social situations.
• Provide information about basic physi-
cal changes of puberty.
• Provide tweens with age-appropriate
sexuality books.
• Discuss family values about pornogra-
phy (e.g., the way women and children
are viewed as sexual objects, only to
be used for sexual satisfaction; the
association of sex with violence).

of interacting with cross-gender peers and promote norms
for nonharassing ways of relating to each other.
Given children’s increasing use of electronic communi-
cations, parents need to set developmentally appropriate
guidelines for use of the new technologies (computers, web-
cams, digital cameras, mobile phones); discuss appropriate
and inappropriate uses of these devices; and make sure teens
know that cyberbullying is harmful and, in some cases like
sexting, illegal (Wurtele, 2011). Using examples of teens
involved in such cases and the consequences of their behav-
iors can serve as a good starting point for such discussions.
Parents and educators will want to discuss the safe use of the
internet with boys and girls (since girls outnumber boys in
electronic bullying; Kowalski & Limber, 2007) and how to
obtain reliable sexual information from the internet (see
Wurtele & Kenny, 2010b and Appendix A for resources).
Caregivers and educators will also want to help children
decode the powerful messages about sex in the media
(including television, advertisements, videos, videogames,
internet, music, movies). This can be accomplished by par-
ents spending time with children as they view movies, listen
to music, or browse the internet and by media literacy
classes offered in schools (David-Ferdon & Hertz, 2007).
School administrators and counselors should work to edu-
cate students, teachers, and staff about electronic bullying
and sexual bullying and ensure that school policies related
to bullying and harassment include electronic and face-to-
face forms of sexual bullying (Kowalski & Limber, 2007).
Given that some children engage in sexual behaviors
with other children while supervising them (whether a fam-
ily member or someone else’s child), caregivers are encour-
aged to establish ground rules for tweens wishing to baby-
sit. Parents can review body-safety rules tweens must follow
to keep themselves, as well as the children they supervise,
safe. Caregivers can emphasize that sexual contact with
children is abuse, not play; that it is a crime and harms chil-
dren; and that children can never consent to sexual relations
(Wurtele, 2011).
Discussing self-stimulation is another way of normaliz-
ing these budding sexual feelings. Berman (2009) recom-
mends that around age 12, parents say to their tween, “As
you start to get older, your hormones might cause you to
have some sexual feelings. That’s completely normal and
it’s happening for everyone else in your grade, too” (p. 50).
She recommends that parents then talk to their children
about how self-stimulation is a healthy way to experience
sexual pleasure without engaging in any emotionally or
physically harmful behaviors. It is also important to empha-
size that all sexual thoughts, feelings, emotions, and fan-
tasies are normal during this age, but tweens need to learn to
control their sexual behaviors and not act on their sexual
arousal when inappropriate.
Summary
Nine- to 12-year-olds are going through the most rapid
period of physical, social, and emotional development since
toddlerhood. Preadolescence and early adolescence are
marked by considerable biological changes and great vari-
ability in sexual exploration and experience. However, the
swell in sexual thoughts, feelings, and behaviors is fairly
universal. Toward the latter part of this stage, many children
will begin to form romantic attachments to others, engage in
masturbation for pleasure, move toward emotional indepen-
dence from their parents, and desire more privacy. As they
spend increasingly more time outside of the home with
friends and are influenced by peers and the media, caretak-
ers will need to amplify their efforts at sexuality education
and include such topics as adjusting to pubertal changes,
handling peer pressure, sexual orientation, and sexual deci-
sion-making in romantic relationships. Although some par-
ents may feel uncomfortable with such topics, research has
shown that parent–child closeness and communication at
this stage are highly important in helping children success-
fully navigate puberty.
CONCLUSION
The purpose of this paper was to provide a framework for
parents, teachers, and counselors to understand children’s
sexuality development. As seen in this review, the notion
that young children are asexual is incorrect. Humans are
sexual beings from early infancy, and childhood is a time
when children explore and discover their own sexuality,
both alone and through interacting with others. As we have
seen, sexual behaviors in children are quite common, occur-
ring in 42–73% of children by the time they reach the age of
13 (Kellogg, 2010). Our review has drawn attention to the
notion that sexuality is a developmental phenomenon, and
like other developmental domains (e.g., cognitive, physical,
psychosocial) is affected by the child’s ecology. By empha-
sizing childhood sexuality as expected and normative, we
add to the recent push for consideration of positive sexual-
ity development and less focus on the pervasive “problema-
tizing of sexuality in terms of risk” (Tolman & McClelland,
2011, p. 250) typical of childhood and adolescent sexuality
research during the 20th century (Moran, 2000). We also
emphasize that parents and professionals working with chil-
dren have numerous opportunities to provide sexual abuse
prevention education within the context of nurturing chil-
dren’s sexuality development. Through these efforts, chil-
dren can get a head start toward becoming sexually healthy
and respectful adolescents and adults as well as becoming
less vulnerable to being sexually exploited and exploiting
others.
18 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

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APPENDIX A:
SEXUALITY EDUCATION RESOURCES
Young children:
Blank, J. (1993). A kid’s first book about sex. San Francisco, CA:
Down There Press.
Brooks, R., & Perl, S. (1983). So that’s how I was born. New York:
Simon & Schuster Books for Young Readers.
Brown, L. K, & Brown, M. (2000). What’s the big secret? Talking
about sex with girls and boys. New York: Little, Brown.
Cole, J. (1994). How you were born. New York: Harper Collins.
Curtis, J. L. (1996). Tell me again about the night I was born. New
York: Harper Collins.
Eyre, L., & Eyre, R. (1999).
How to talk to your child about sex: It’s
best to start early, but it’s never too late—A step-by-step guide for
parents.
New York: Golden Guides from St. Martin’s Press.
Freitas, C. (2010).
The birds and the bees with ease
. Healthy Chats
LLC. (also available in Spanish)
Girard, L. W. (1992). You were born on your very first birthday. Niles,
IL: Whitman.
Gordon, S., & Gordon, J. (1992). Did the sun shine before you were
born? Amherst, NY: Prometheus Books.
Harris, R. (2004). It’s so amazing!: A book about eggs, sperm, birth,
babies, and families. Somerville, MA: Candlewick Press.
Harris, R. (2006). It’s not the stork: A book about girls, boys, babies,
bodies, families and friends. Somerville, MA: Candlewick Press.
Mayle, P. (2000). Where did I come from? The facts of life without any
nonsense and with illustrations. New York: Kensington.
Meredith, S. (1999). Where do babies come from? London: Usborne.
Nilsson, L., & Swanberg, K. L. (1996). How was I born?: A child’s
journey through the miracle of birth. New York: The Bantam Dell.
Richardson, J., & Schuster, A. (2003).
Everything you never wanted
your kids to know about sex, but were afraid they’d ask: The
secrets to surviving your child’s sexual development from birth to
the teens.
New York: Crown.
Saltz, G. (2005).
Amazing you! Getting smart about your private parts.
New York: Dutton Children’s Books.
Schoen, M. (2008). Bellybuttons are navels. No location: BookSurge.
Stinson, K. (2006). The bare-naked book. Vancouver, BC, Canada:
Annick Press.
Ziefert, H. (1990). Getting ready for new baby. New York: Harper &
Row.
Pre-Teens:
American Medical Association (2006). Boy’s guide to becoming a
teen. San Francisco: Jossey-Bass.
American Medical Association (2006). Girl’s guide to becoming a
teen. San Francisco: Jossey-Bass.
Annunziata, J., & Nemiroff, M. (2003). Sex & Babies: First facts.
Washington, DC: Imagination Press.
Bailey, J. (2004). Sex, puberty and all that stuff: A guide to growing up.
London: Franklin Watts.
Bell, R. (1998). Changing bodies, changing lives: A book for teens on
sex and relationships. New York: TimesBooks.
Blackstone, M. & Guest, E. H. (2000). Girl Stuff: A Survival Guide to
Growing Up. San Diego: Gulliver Books.
Bradley, M. J. (2004). Yes, your parents are crazy! A teen survival
guide. Gig Harbor, WA: Harbor Press.
Cole, J. (1988). Asking about sex and growing up: A question and
answer book for boys and girls. New York: HarperCollins.
Columbia University’s Health Education Program. (1998). The “Go
Ask Alice” book of answers: A guide to good physical, sexual, and
emotional health. New York: Holt Paperbacks.
Dunham, K. (2007). The boy’s body book: Everything you need to
know for growing up YOU. Kennebunkport, ME: Applesauce
Press.
Dunham, K. (2008). The girl’s body book: Everything you need to
know for growing up YOU. Kennebunkport, ME: Applesauce
Press.
Gitchel, S., & Foster, L. (2005). Let’s talk about S-E-X. Minnetonka,
MN: Book Peddlers.
Gravelle, K. (1998). What’s going on down there? Answers to ques-
tions boys find hard to ask. New York: Walker.
Gravelle, K. & Gravelle, J. (1996).
The period book.
New York:
Walker.
Gurian, M. (1999).
From boys to men: All about adolescence and you.
New York: Price Stern Sloan.
Harris, R. (2009).
It’s perfectly normal: Changing bodies, growing up,
sex, and sexual health.
Somerville, MA: Candlewick Press.
Jukes, M. (2002).
The guy’s book: An owner’s manual.
New York:
Crown.
Loulan, J. & Worthen, B. (2001).
Period.
Minnetonka, MN: Book
Peddlers.
Madaras, L., & Madaras, A. (2007).
The “What’s happening to my
body?” book for boys
. New York: Newmarket Press.
Madaras, L., & Madaras, A. (2007).
The “What’s happening to my
body?” book for girls.
New York: Newmarket Press.
Mayle, P. (2000). What’s happening to me? An illustrated guide to
puberty. New York: Kensington.
Saltz, G. (2007). Changing you: A guide to body changes and sexual-
ity. New York: Dutton Juvenile.
Schaefer, V. (1998). The care & keeping of you: The body book for
girls. Middleton, WI: Pleasant Company.
Yeager, S. (2002). What’s with my body? The girls’ book of answers to
growing up, looking good, and feeling great. New York: Prima
Lifestyles.
Books for Parents:
Bell, A. R., & Zeigler-Wildflower, L. (1983). Talking with your
teenager. A book for parents. New York: Random House Press.
Bernstein, A. C. (1994). Flight of the stork: What children think (and
when) about sex and family building. Indianapolis, IN: Perspec-
tives Press.
Berman, L. (2009). Talking to your kids about sex: Turning “the talk”
into a conversation for life. New York: Dorling Kindersley Limited.
Bradley, M. J. (2003). Yes, your teen is crazy! Loving your kid without
losing your mind. Gig Harbor, WA: Harbor Press.
Calderone, M.S. (1983). Talking with your children about sex: Ques-
tions and answers for children from birth to puberty. New York:
Ballantine.
22 COUNSELING AND HUMAN DEVELOPMENT MAY 2011

Calderone, M., & Johnson, E. (1981). Family book about sexuality.
New York: Harper and Row.
Cavanagh, T.J. (1999). Understanding children’s sexual behaviors:
What’s natural and healthy. Oakland, CA: New Harbinger.
Family Health Council, Inc. (2000). Family Connections: A guidebook
for parents and children. Pittsburgh, PA: Author.
Flowers, J.V. (1982). Raising your child to be a sexually healthy adult.
Englewood Cliffs, NJ: Prentice-Hall.
Goldman, R. (1988). Show me yours: Understanding children’s sexu-
ality. New York: Penguin Books.
Haffner, D. W. (2002). Beyond the big talk: Every parent’s guide to
raising sexually healthy teens from middle school to high school
and beyond. New York: Newmarket Press.
Haffner, D. W. (2008). From diapers to dating: A parent’s guide to
raising sexually healthy children—from infancy to middle school.
New York: Newmarket Press.
Hickling, M. (2005). The new speaking of sex: What your children need
to know and when they need to know it. Kelowna, BC, Canada:
Wood Lake.
Howard, M. (1988). How to help your teenager postpone sexual
involvement. New York: Continuum.
Leight, L. (1988). Raising sexually healthy children: A loving guide for
parents, teachers, and caregivers. New York: Rawson Associates.
Lewis, H. R. (1983). Sex education begins at home: How to raise sex-
ually healthy children. E. Norwalk, CT: Appleton-Century-Crofts.
Maxwell, S. (2008). The talk: What your kids need to hear from you
about sex. A breakthrough guide to raising healthy kids in an over-
sexualized, online, in-your-face world. New York: Penguin.
Palmer, P. (1989). Teen esteem. Toronto: Impact.
Pipher, M. (1994). Reviving Ophelia: Saving the selves of adolescent
girls. New York: Riverhead Books.
Riera, M. (2003). Staying connected to your teenager: How to keep
them talking to you and how to hear what they’re really saying.
Cambridge, MA: Perseus.
Roffman, D. M. (2001). Sex and sensibility: The thinking parent’s
guide to talking sense about sex. New York: Perseus.
Roffman, D. M. (2002). But how’d I get in there in the first place?
Talking to your young child about sex. New York: Perseus.
Schwartz, P. & Cappello, D. (2000). Ten talks parents must have with
their children about sex and character. New York: Hyperion Press.
Sutton, R. (1997). Hearing us out: Voices from the gay and lesbian
community. Toronto: Little Brown.
Wilson, P. M. (1991). When sex is the subject: Attitudes and answers
for young children. Lawrenceville, GA: Network.
Wolf, A. E. (2002). Get out of my life, but first could you drive me and
Cheryl to the mall? A parent’s guide to the new teenager. New
York: Farrar, Straus and Giroux.
Wurtele, S. K., & Berkower, F. (2010). Off limits: A parent’s guide to
keeping kids safe from sexual abuse. Brandon, VT: Safer Society
Press.
WEBSITES for Young People
Birds and Bees—www.birdsandbees.org
The Body—www.thebody.com
Go Ask Alice! —www.goaskalice.columbia.edu
I Wanna Know—www.iwannaknow.org
My Sistahs—www.mysistahs.org
Sex, Etc. —www.sxetc.org
Sex Talk—www.sextalk.org
Teenwire—www.teenwire.com
Youth Resource—www.youthresource.com
WEBSITES for Parents
www.advocatesforyouth.org (Advocates for Youth has a Parents Sex
Education Center)
www.cfoc.org (Campaign For Our Children website has information
for both parents and teens)
www.drspock.com (Dr. Spock’s Web site)
www.familiesaretalking.org www.lafamiliahabla.org (The Sexuality
Information and Education Council of the United States has devel-
oped this Web site for parents on sexuality education in the home.)
www.plannedparenthood.org (Planned Parenthood Federation of
America’s Web site includes resources for parents.)
www.talkingwithkids.org (The Kaiser Family Foundation sponsors
this site.)
www.aap.org (American Academy of Pediatrics)
www.siecus.org (Sexuality Information & Education Council of the
U.S. This Web site offers a section for parents and caregivers.)
http://thriveonline.oxygen.com/sex/experts/sex_ed_mom/index.html
(Sex Ed Mom. This Web site is “a parent’s guide to the birds and
the bees.”)
www.goaskalice.columbia.edu (Go Ask Alice! This Web site is main-
tained by Columbia University’s Health Education Program. It
uses a question-and-answer format to provide information.)
Videos about Childhood Sexuality
Committee for Children’s What do I say now? DVD www.cfchil-
dren.org.
Committee for Children’s Yes You Can Say No. DVD www.cfchil-
dren.org.
Communication about sexual health begins at birth. These parents and
young people tell how they discuss sexual health. Experts offer
insight and skills to help families start and continue these conver-
sations. Includes discussion guides. Recommended for parents and
other caregivers.
Program #1 For parents of young children. Addresses setting
limits, labeling body parts, how babies are made, self-touch,
appropriate/inappropriate touch and more.
Program #2 For parents of preadolescents and adolescents.
Addresses sharing values, keeping communication open,
postponing sexual intercourse, avoiding absolutes, building
strong relationships and more. Each program is 20 minutes.
The Growing Up Series, National Film Board of Canada, Ottawa,
Canada, 1989. A series of three videos designed for parents to
watch with their pre-adolescent children. It serves as an introduc-
tion to sexuality education. http://www.tsbvi.edu/Education/sexu-
ality-education-parent.htm.
Raising Healthy Kids™: Families Talk about Sexual Health–DVD
www.advocatesforyouth.org, order at www.wordscanwork.com.
Where Do Babies Come From? Starring Ruth Hummel. Concordia
Publishing House.
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24 COUNSELING AND HUMAN DEVELOPMENT MAY 2011