Self-gratification Habits among Children Under Five Years of Age: A Prospective Cohort Study

Introduction: Self-gratification or masturbation is a normal sexual behaviour; however, masturbation in childhood is less commonly addressed in literature. Aim: To describe the clinical profile of the children diagnosed with self-gratification condition. Materials and Methods: This prospective cohort study recruited all cases diagnosed to have the self-gratification condition presenting to the outpatient clinic in the Department of Paediatric Medicine, Burdwan Medical College, Burdwan, West Bengal, India during the period-January 2014 to December 2019. Diagnosis was made from history, home videotapes and sometimes by direct observation of the act during hospital stay. All relevant data pertaining to demographic characteristics, clinical presentation, investigations and treatment were collected in case sheets and were analysed by simple descriptive statistics. Results: Fifty-four patients were diagnosed to have the condition. Among them, 29 (53.70%) were girls and 25 (46.30%) were boys. The mean age at first symptoms was 20.98 +/- 9.31 months (range 3 months to 3 years 4 months). The average age at diagnosis was 26.16 +/- 11.35 months (varied from 4 months to 3 years 11 months). The mean frequency of events was 10.31 +/- 5.10 times per week, and the mean duration was 9.83 +/- 5.98 minutes. Events occurred mostly when children were left alone and bored (n=34, 62.97%). Usual presentations were: rocking in prone position (n=24, 44.44%), intermittent dystonic posturing of the crossed legs (n=23, 42.59%), direct genital manipulation (n=3, 5.56%) and others (n=4, 7.40%)). Two children had been previously misdiagnosed as having definite epilepsy. In 51 cases (94.44%) home videos were available which served as invaluable tools allowing confident diagnosis. Results of urine and stool examination were normal. MRI and EEG performed on two children with suspected epilepsy were reported normal, and antiepileptic drugs were stopped in both. Sixteen children (29.63%) were sent for behavioural therapy and all of them responded well in next one year. Conclusion: Gratification habits are not uncommon in children and should be considered in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Home video recording of these actions can be a very influential mean to help in diagnosis and to avoid needless investigations and treatments.