Pediatrics

Addressing Sexuality with Pediatrics:

It is important to understand the physical and psychosocial development occurring throughout childhood as children grow older, especially through puberty. Sexual maturation is a part of the lifecycle and something that all children will eventually go through and occurs in a rather predictable fashion.

Adolescence acts as the bridge between childhood and adulthood and is a time of stress and difficulty due to the amount of changes that a child goes through in this time.

    • Chronic disabilities magnify the intensity of this period of life and the maturation process, and gaining a healthy understanding of their sexuality is particularly difficult (Pritchard, Kordes, & Hoffman, 2012, p. 230).
    • Sexuality is complex in that it not only includes the physical, kissing, hugging, and intercourse, but also seeing oneself as attractive and feeling worthy of being liked, feeling confident around others and that there is something special and unique about oneself. Additionally, intimacy adds another layer of complexity. Intimacy includes bonding when one gives and receives affection and shares feelings, thoughts, and dreams for the present and the future. (Pritchard, Kordes, & Hoffman, 2012, p. 230)
      • Children with disabilities still experience these feelings and will want to participate in the same activities as their peers, including having boyfriends/girlfriends, getting married, being sexually intimate, and having a family.
      • Due to the complexity of sexuality, it is important to provide age-appropriate education and support in all areas of sexuality. This spans across puberty, pregnancy, contraception, and social interaction.
        • This will assist in appropriate behavior and a better understanding of sexuality for children with disabilities.

It is especially important not to ignore sexuality with this population, as it is a natural part of the lifespan and development. Children with disabilities experience the same feelings and inclinations towards sexuality as their peers, and need help in understanding sexuality and the experiences they are having during adolescence. If this topic is ignored it can lead to unwanted outcomes for the child's safety and health. Include the parents when you believe that this is becoming a necessary topic to address with your pediatric client. Talk with the parents first and present your thoughts on how the topic can be addressed and work with them to develop a plan that they are comfortable with and that will benefit the child.

Children with disabilities are at a high risk of being sexually abused compared to their peers, so incorporating what behaviors are appropriate between themselves and another person is a very important conversation to have. (Pritchard, Kordes, & Hoffman, 2012, p. 233)

Differences in the onset of puberty (Pritchard, Kordes, & Hoffman, 2012, p. 233)

  • Practitioners should research, based on their client's specific diagnosis, the expected age of onset for puberty. Specific diagnoses and ethnicity/race of the individual can determine earlier or later onset of puberty. Educating yourself on this could guide your process of thinking about when it would be appropriate to address topics of sexuality and maturation.

Barriers:

  • Cognition and the ability to understand sexuality as a concept and a construct. The conversation and education should be geared towards that child's level of understanding.
  • Varying physical abilities. While some children, such as those with cerebral palsy, will have higher levels o cognition but will struggle more with the physical component of sexuality. The conversation should be at an appropriate time, but should also be at a higher level of understanding and not diminished simply due to the diagnosis.
  • Psychosocial aspects of a child's life are impacted by disabilities, whether they be learning disabilities, intellectual disabilities, or physical disabilities, an should be incorporated into the conversation.
  • See Intellectual Disability and/or Autism for more specific information regarding these diagnoses.

Strategies

  • Parents should be provided with education on how to address sexuality and sexual health with their children (American Academy of Pediatrics, 2016). This information could either be provided by the occupational therapist or the therapist could refer to helpful resources.
  • Adolescents with disabilities were able to engage in romantic relationships more readily when provided with sexual health education related to their specific disability (Heller et al., 2016). As adolescents begin to transition into forming relationships and becoming sexually active, occupational therapists can have discussions with them about how their disability may impact sexual functioning.

References

American Academy of Pediatrics. (2016, July 18). APP clinical report: Pediatricians should provide sexuality education. Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Clinical-Report-Pediatricians-Should-Provide-Sexuality-Education.aspx

Heller, M. K., Gambino, S., Church, P., Lindsay, S., Kaufman, M., & McPherson, A. C. (2016). Sexuality and relationships in young people with spina bifida and their partners. Journal of Adolescent Health, 59, 182-188. Retrieved from https://doi.org/10.1016/j.jadohealth.2016.03.037

Pritchard, V., Kordes, T. L., & Hofmann, A. (2012). Spinal cord injury and sexuality. In C. Linkie & B. Hattjar (Eds.), Sexuality and occupational therapy: Strategies for persons with disabilities (pp.***). Bethesda, MA: American Occupational Therapy Association.