Gratification, masturbation or paroxysmal hyperkinetic motor syndrome of infancy?

views on infant sexuality encompassed " pleasurable activities far removed from any concerns with reproduction, " 13 activities such as sucking, cuddling, hugging etc. Martinson suggested that infantile sexuality be viewed under a " general conceptual rubric, such as the pleasure-pain principle. " 12 Although penile erections and vaginal secretions in response to stimulation have been interpreted as sexual arousal in infants, 8,11 these are generally considered reflexive. 16 " Masturbatory " activities in fetuses, 17-19 are also open to other interpretations. The social " sexual behaviors " of immature primates cannot be extrapolated to the " self-stimulatory " behavior of the human infant, as Bakwin did. 8 Therefore, infant sexuality must be considered from the infant's " perspective, " not the adult's. 12,14,20 A community-based study of 2-12 year olds, strongly linked sexual behavior in children to that in the family; 21 children in this age group may imitate adult behavior but it is unlikely that those < two years have sufficient cognition to do so. In a commentary on Bakwin's paper, 8 Elkind wrote that while " evidence for self-stimulatory behavior on the part of infants and children is abundant and clear-cut, " interpretation of such behavior from the adult " sense " is questionable. 22 Sexual behaviors, including masturbation, involve " a complex of feelings, attitudes and fantasies; " a " complex " that " must wait upon the onset of the child's physical, cognitive, and emotional maturity. " 22 Hence, the concepts of adult sexuality (and the desire-excitement-orgasm cycle) do not apply to infants, 12,14,20 and the pleasure (soothing) that infants and young children (certainly those < four years) experience from self-stimulation of the thighs and genitals cannot be considered to be either erotic or masturbatory. However, a pleasurable act may become a habit. 1,8 Authors of some clinical reports, Jan et al included, have acknowledged that the " gratification disorder " may have a different basis from the masturbatory behavior seen later in life. 1,3,23 Understandably, many parents also have reservations about accepting " masturbation " as an explanation for the episodes. 1,3,4,6 The apparently entrenched views on masturbation and orgasm in fetuses and infants, 8,11 need critical re-appraisal. " Self-stimulatory behavior " and " gratification disorder " seem more appropriate and acceptable than " infantile masturbation, " but these terms also reflect opinion, and do not evoke an image of the motor behaviors that …