3.4 Harmful sexual behaviour

Contents

• Responding to harmful sexual behaviour(Jump to)
• CSA medical examinations(Jump to)
• Definitions(Jump to)
• Signs and indicators(Jump to)
• Further information(Jump to)

Responding to harmful sexual behaviour

Concerns about the behaviour and safety of the children should be referred to Children social care, in line with the Referrals Procedure.

Responses to children and young people’s HSB should reflect the level of risk and need they present, and should be at the least intrusive level required to effectively address the behaviours presented.

An evidence-informed framework for children and young people displaying harmful sexual behaviours provides a coordinated, systematic and evidence-based approach to recognising and responding to the risks and needs of children displaying harmful sexual behaviour. It sets out a continum of responses.

CSA medical examinations

Medical  assessments for children are child-friendly and child-led. Children with harmful sexual behaviours are at increased risk of having been sexually abused themselves and of having experienced other forms of maltreatment. Medical assessments should be considered for children who have been found to harm other children. They are provided to address health needs, reassure children and their families, answer health questions, address wider medical safeguarding needs and sometimes to provide forensic information. 

Referrals for a specialist medical can be made only via police or children’s services. Paediatricians are happy to attend strategy discussions and advise professionals as needed.

Please see the links below for contact details and pathways, referral forms and patient leaflets:

Download the guide to medical examinations in suspected child sexual abuse (CSA). 

Download the HIPS pathway for pregnancy in children under the age of 13

Download the HIPS child protection medical request form

CSA medical leaflet for children and carers

Definitions

NSPCC Harmful Sexual Behaviour Framework: “Sexual behaviours expressed by children and young people under the age of 18 years old that are developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person or adult.”

It is also useful to distinguish between problematic and abusive sexual behaviours:

• Problematic sexual behaviours: Problematic behaviours don’t include overt victimisation of others but are developmentally disruptive and can cause distress, rejection or increase victimisation of the child displaying the behaviour. Sexual behaviour problems are defined as behaviours involving sexual body parts that are developmentally inappropriate or potentially harmful to the child or others. They range from problematic self-stimulation and nonintrusive behaviours, to sexual interactions with other children that include more explicit behaviours than sex play, and aggressive sexual behaviours.
• Abusive sexual behaviours: Abusive behaviours involve an element of coercion or manipulation and a power imbalance that means the victim cannot give informed consent, and where the behaviour has potential to cause physical or emotional harm. Power imbalance may be due to age, intellectual ability, race or physical strength. Abusive sexual behaviour may or may not have resulted in a criminal conviction or prosecution. Such behaviours are more commonly associated with young people over the age of criminal responsibility or those in puberty.

Technology assisted harmful sexual behaviour is sexualised behaviour which children or young people engage in using the internet or technology such as mobile phones. It encompasses a range of behaviours including viewing pornography (including extreme pornography or viewing indecent images of children) and sexting (Hollis and Belton, 2017).

Signs and indicators

Children and young people demonstrate a range of sexual behaviours as they grow up, and this is not always harmful. Sexualised behaviour is often seen as a continuum with five stages:

• appropriate – the type of sexual behaviour that is considered 'appropriate' for a particular child depends on their age and level of development
• inappropriate – this may be displayed in isolated incidents, but is generally consensual and acceptable within a peer group
• problematic – this may be socially unexpected, developmentally unusual, and impulsive, but have no element of victimisation
• abusive – this often involves manipulation, coercion, or lack of consent
• violent – this is very intrusive and may have an element of sadism (Hackett, 2010).

A child's behaviour can change depending on the circumstances they are in, and sexual behaviour can move in either direction along the continuum. So it's important not to label all of a child's behaviour as belonging to one category.

The  Brook Traffic Light tool categorises behaviours as green, amber or red, so that professionals across different agencies can work to the same standardised criteria when making decisions and can protect children and young people with a unified approach.

Further information

• An evidence-informed framework for children and young people displaying harmful sexual behaviours 
• Sexually Harmful Behaviour - NSPCC research briefing
• Child's Play? Preventing Abuse Among Children and Young People (Stop It Now publication)
• Harmful sexual behaviour among children and young people (NICE 2016)
• Safety planning in education: A guide for professionals supporting children following incidents of harmful sexual behaviour (csacentre.org.uk)
• HIPS CSA toolkit