Approaches to sexuality in childhood from occupational therapy

Abstract

This article consists of a bibliographical review that aims to describe the different factors that influence the development of child sexuality to understand it from Occupational Therapy (OT). The problem raised addresses the invisibility of the natural and normative components of sexuality in early and second childhood and how OT approaches these factors in its intervention. To carry out this bibliographic search, various databases and journals of Occupational Therapy were used, in order to find texts that were related to the objective and proposed problem, which were filtered according to exclusion and inclusion criteria. From the results it is obtained that there is limited academic information regarding how the components of child sexuality are directly related to the areas of work of the OT. From the foregoing, it is concluded that the discipline is recently incorporating the approach to this issue and the urgent need to reconstruct the conceptualization of child sexuality is raised, from a base of children's rights, moving away from the hegemony of a heteronormative culture, and adult centric. The different factors that influence the development of child sexuality are considered, understanding it not only as an occupation but also as a fundamental part of occupational identity, whose components are bodily autonomy, socio-affective development, pleasure and enjoyment, gender and occupational choices, which would guide the occupational therapy approach.

Keywords:
Sexuality; Childhood; Occupational Therapy; Social Construction of Gender

Resumen

El presente artículo consta de una revisión bibliográfica que tiene por objetivo describir los distintos factores que influyen en el desarrollo de la sexualidad infantil para comprenderla desde la terapia ocupacional. La problemática planteada aborda la invisibilidad de los componentes naturales y normativos de la sexualidad en la primera y segunda infancia y cómo la terapia ocupacional se aproxima a estos factores en su intervención. Para llevar a cabo esta búsqueda bibliográfica, se utilizaron variadas bases de datos y revistas de terapia ocupacional, con el fin de encontrar textos que tuvieran relación con el objetivo y problemática propuesta, los cuales fueron filtrados de acuerdo a criterios de exclusión e inclusión. De los resultados se obtiene que existe escasa información académica respecto a cómo se relacionan directamente los componentes de la sexualidad infantil con las áreas de trabajo de la terapia ocupacional. Por lo anterior se concluye que la disciplina está recientemente en la incorporación del abordaje de esta temática y se plantea la necesidad urgente de reconstruir la conceptualización de la sexualidad infantil, desde una base de derechos de la niñez y alejándose de la hegemonía de una cultura heteronormada y adultocéntrica. Se consideran los distintos factores que influyen al desarrollo de la sexualidad infantil y entendiéndola no solo como ocupación sino como parte fundamental de la identidad ocupacional, que tiene como componentes la autonomía corporal, el desarrollo socio afectivo, el placer y el disfrute, el género y las elecciones ocupacionales, los cuales guiarían el abordaje de terapia ocupacional.

Palabras clave:
Sexualidad; Niñez; Terapia Ocupacional; Construcción Social del Género

Resumo

O presente artigo consiste em uma revisão bibliográfica que tem como objetivo descrever os diferentes fatores que influenciam o desenvolvimento da sexualidade infantil para compreendê-la a partir da terapia ocupacional. A problemática levantada aborda a invisibilidade dos componentes naturais e normativos da sexualidade na primeira e segunda infâncias e como o terapeuta ocupacional aborda esses fatores em sua intervenção. Para realizar esta busca bibliográfica, foram utilizadas diversas bases de dados e periódicos da área de terapia ocupacional, a fim de encontrar textos que estivessem relacionados ao objetivo e problemática propostos, os quais foram filtrados segundo critérios de exclusão e inclusão. Dos resultados obtém-se que há escassa informação acadêmica a respeito de como os componentes da sexualidade infantil estão diretamente relacionados às áreas de atuação do terapeuta ocupacional. Portanto, conclui-se que a disciplina está incorporando recentemente a abordagem dessa temática e se levanta a urgente necessidade de reconstruir a conceituação da sexualidade infantil, a partir de uma base de direitos da criança e afastando-se da hegemonia de uma cultura heteronormativa adultocêntrica. São considerados os diferentes fatores que influenciam o desenvolvimento da sexualidade infantil, entendendo-a não apenas como uma ocupação, mas também como parte fundamental da identidade ocupacional, cujos componentes são autonomia corporal, desenvolvimento socioafetivo, prazer e gozo, gênero e escolhas ocupacionais, os quais orientariam a abordagem da terapia ocupacional.

Palavras-chave:
Sexualidade; Infância; Terapia Ocupacional; Construção Social do Gênero

Introduction

In our society there is a widespread idea “[…] that sexuality manifests exclusively at puberty or at the beginning of adult life, because although it is recognized that human beings are born and live with one sex, they are generally assumed to be asexual during childhood […]” (Kader & Pacheco, 1994, as cited in Villalobos, 1999, p. 73), this could be explained based on ideas that have their origin in the fact that sexuality is reduced to intercourse and the genitals as the only erogenous zone.

It is Psychoanalysis, with Freud as its promoter, which has proposed that sexuality appears from birth and that, during the successive stages of childhood, different areas of the body provide special gratifications to the individual, since they are endowed with an energy that seeks pleasure, libido (Villalobos, 1999). However, it continues to reduce sexuality solely to eroticism, which reinforces in the social imagination that talking about sexuality in childhood is an aberrant and violating idea.

Occupational therapy views sexuality as an everyday occupation. In particular, the American Occupational Therapy Association (2020) integrates sexuality into the scope of basic activities of daily life, which are defined as “activities oriented toward caring for one's own body,” (American Occupational Therapy Association, 2020, p. 29) reaffirming the relevance of the body in this area of life, but presenting it as a rather individual experience and not from an interpersonal perspective in the relationship with social constructions and culture. Likewise, this Association establishes as a definition for sexual activity the ability to “[…] engage in the wide possibilities of sexual expression and experiences with oneself or with others (for example, hugging, kissing, foreplay, masturbation, oral sex, sexual intercourse)” (American Occupational Therapy Association, 2020, p. 29), limiting it, just as the psychological currents mentioned above have done, to pleasure and eroticism.

The truth is that sexuality goes beyond biology and reproduction, because it is also pleasure, feelings, communication and emotional exchange. As described by the Organización Mundial de la Salud (2019) and which adds that sexuality motivates us to seek affection, pleasure, tenderness and intimacy. Meanwhile, the holonic model of sexuality developed by Eusebio Rubio proposes the existence of four complete and interdependent components: eroticism, affectivity (or emotional bonding), gender and reproductivity (Baños Guerrero, 2019). Therefore, sexuality in childhood is a constitutive element of integral development, which is experienced primarily from emotional ties as a source of security and healthy coexistence. Childhood sexuality may be a more controversial topic than other aspects of child development, even a cultural taboo, and this is likely illustrated by the relatively small number of empirical findings available, making child sexual development a challenging topic for empirical research (Cacciatore et al., 2020).

This article presents the different components that influence the development of childhood sexuality. The importance of active participation, adequate support and the delivery of necessary tools and knowledge of the different contexts for the full development of sexuality in childhood is analyzed and, from a critical perspective, the influence of the present hegemonic systems is considered in today's society. All of the above in order to reflect on the possible approach of Occupational Therapy in the development of childhood sexuality.

Methodology

This work takes the form of an exploratory study, therefore, to collect data, a bibliographic review was carried out, which consists of a selective, in-depth and detailed study that covers intrinsic information on specific topics, in order to analyze the bibliography and give it some perspective (Guirao, 2015). The selection of texts was carried out between October 3 and November 2, 2022. During this period of time, the following databases were consulted: Scopus, Dialnet, Scielo and Web of Science. The search was carried out in English, Portuguese and Spanish, with the combination of the following search engines Sexualidad (Sexuality), Infancia (Childhood), Sexualidad Infantil (Child Sexuality), Terapia Ocupacional (Occupational Therapy), Desarrollo Emocional (Emotional development), Desarrollo Socio Emocional (Social Emotional development), Afectividad (Affectivity), Género (Gender). In addition, concepts derived from and related to these search engines were used, such as: Childhood, Children, Emotions, Body and Affect.

After the review in the databases mentioned above, it was complemented with the search, under these same criteria, in different Occupational Therapy journals, which were: Chilean Journal of Occupational Therapy, Galicia Occupational Therapy Journal (TOG), Human Occupation Journal (Colombia), Argentine Journal of Occupational Therapy, Cadernos Brasileiros de Terapia Ocupacional, British Journal of occupational therapy and Canadian Journal of occupational therapy.

For the selection of articles that will be part of this search, the following inclusion criteria were used: articles written in English, Portuguese and Spanish, with free access and that have been published between 2017 and 2022. In turn, we used the following exclusion criteria: texts referring to sexuality in boys and girls with disabilities or illnesses, articles focused exclusively on adolescence or adulthood, in institutionalized childhood contexts, and on bodily expressions (such as dance, theater or cinema).

Firstly, the search was carried out with the aforementioned criteria, and for the selection, titles, keywords and summaries of each article were read to determine whether they were relevant to the research question and whether they addressed the topic of interest. If this was met, each text was read in full, which would lead to finally deciding, based on a group discussion, whether the article was discarded or kept in the database of this bibliographic review. In total, 982 texts were found when entering the keywords, of which 24 were selected for full reading. Once the 24 texts were read, 8 were discarded because they did not fully meet the inclusion criteria described.

After carrying out this first review, and with the aim of complementing and addressing specific topics in depth, 5 texts found within the same databases mentioned above were compiled, using different keywords.

Both parts of the review provide a final total of 21 articles to be used in the development of this article.

Results Analysis

Conceptualizations about sexuality as an occupation in childhood

Sexuality within each person's life is an activity that entails assuming and playing roles within various contexts and environments, being something inherent to human life since it constitutes a biological, psychological, emotional, cultural and social identity over time (Pinilla, 2020). In relation to childhood, it is recognized as an active period in the process of shaping sexuality throughout life development (Uribe & Chirino, 2019) since each person, from a very early age, has the ability to integrate the development and exercise of sexuality in its maturation and growth process (Baños Guerrero, 2019). From the above, the question arises: can we consider sexuality as an element of the occupation?

In the early stages of life, knowledge of the body and sensations allows us to build a way of relating and bonding with the environment in which we develop (Baños Guerrero, 2019). The person, their roles, activities and development environments are terms that Occupational Therapy has appropriated for its reasoning, therefore, they are necessarily evaluated in search of a balance of vital occupations; sexual activity is an everyday activity and is related to the holistic vision of the human being that the profession uses as a focus of intervention (Pinilla, 2020).

Based on this, it can be understood that, from the profession, sexuality should be an area of interest not only as an object of intervention, but also as an important component of each person's identity (Pinilla, 2020). The concept of identity brought to the occupation can refer to how each individual makes decisions, develops, performs and achieves satisfaction through choosing occupations within different contexts and throughout the stages of life (Vautero & Silva, 2022).

Therefore, occupational identity understands the relationship between what people do and how this affects their perception of themselves; added to this, occupation can encompass what people do, so that life extends through time and space through meaningful occupations (Ocasio et al., 2022).

The definition given to the concept of “sexuality” may be related to the meaning that each person gives to it, considering personal, age, contextual and cultural factors, however, being defined as an occupation is part of everyday reality of people and their development of occupations (Pinilla, 2020). Consequently, it is then proposed that in childhood sexuality is more related to occupational identity and how it develops throughout life.

Sexuality from adult centric, biological and moral hegemony

After reviewing the selected articles, it is evident that there are three hegemonic systems that dominate the sexual development of childhood. In the first instance, we find the biological domain, where the psychoanalyst Sigmund Freud proposes that sexuality appears and develops from birth and during each successive stage of childhood; when talking about childhood sexuality, the existence of early genital arousals or needs is recognized, as well as the intervention of other erogenous zones that seek pleasure (Villalobos, 1999). In addition to this, we find that the notions of gender and sexuality are based on a binarism, for example, in relation to culture/nature, sex/gender, man/woman, etc., this binarism has normatively shaped the processes of subjectivation (González, 2018). This biological bias derived from a reproduction of gender binarism has hegemonized the teaching of school sexual education, which has caused the invisibilization of sexuality in childhood (Montenegro & Ezquerra, 2022).

Along the same lines, and as a second system of dominance, we face the moral dilemma, where sexuality is a taboo within heteronormative society, which has a direct impact on sexual education and its various areas of occupation, which could lead to occupational injustices (Marchant Castillo, 2019). This is based on the deprivation of access to knowledge and experiences that enable comprehensive, healthy and autonomous development.

To finish with the hegemonic systems, we find the adult centric view regarding sexuality in childhood, where talking about this is a challenge and a risk. According to Baños Guerrero (2019, p. 4), “Adults assume that girls and boys are asexual, distant beings to pleasure and self-discovery”, it should be noted that the idea persists that childhood and adolescence are locked in the subjective hypothesis of being naive beings, that when they have formal contact with sexuality through education they can lose that characteristic of purity (Brenes, 2020). It could be concluded then that childhood sexuality from the adult centric perspective is seen as an “experimentation” or as a “game” and not as part of a development process.

Role of the family in sexual development

The appreciations that families have vary greatly when talking about the expressions of childhood sexuality; these differences directly affect the behavior of children (Uribe & Chirino, 2019).

Adequate support in the field of parenting helps children learn to make decisions, regulate emotions, resolve conflicts assertively and be sensitive to the needs of other people. Caregivers play a key role in the development of these skills, since they serve as a model for childhood, because the emotional interactions that arise between them promote social emotional development and influence the maturation of the parts of the brain responsible for emotional awareness and regulation (Quintero et al., 2022).

In surveys on sexuality carried out on caregivers of girls and boys, it was identified that they lacked confidence in their ability to talk and answer questions about topics related to sexual development in childhood, and that their conversations focused largely on the biological aspects of sexuality, where personal relationships were left aside (Bennett et al., 2018). Similarly, they relied on questions as an opening to dialogue, however this often led to closed or incomplete answers.

During this study, it was found that caregivers who had had positive role models during their childhood found it easier to communicate openly about sexuality (Bennett et al., 2018). It leads to the conclusion that the family plays a relevant role in the construction of a communication model based on good treatment and respect, where it is educated based on the full and healthy development of each component of sexuality in the period of childhood.

Role of educational establishments

Childhood sexuality is present in the everyday life at schools. At this stage, those in charge of teaching girls and boys should be prepared to answer clearly and objectively the variety of questions they may have, which could be linked to their bodies or the bodies of others, gender relations and many other topics related to sexuality. However, this is not always the case, since there is a certain invisibility in the educational context of childhood and little work with these educational people, considering the importance given to the academic field in school daily life and the great lack of knowledge on these topics, which denotes the absence of training in their teaching and higher education courses (Blankenheim et al., 2022).

Those in charge of early childhood education feel limited, in part by the vigilance of some parents, when they consider talking and educating about sexuality or gender diversity, since these topics are considered inappropriate for these environments and outside from the field of child development (Davies et al., 2021). In relation to this, various studies have commented on the awareness about the stages of childhood development in the preschool stage with respect to their own sexuality, since being open to questions is an important factor for providing sexual education. There is a difference between providing facts and imposing beliefs; those in charge of early childhood education seek to provide an honest answer, educate, and not undermine a family's belief system (Davies et al., 2021). Therefore, the role of educational institutions is based on education in areas of childhood sexuality, both from each school to its officials, and from the latter to children, understanding the impact that talking about these issues has on sexual development in childhood.

Discussion

After carrying out the bibliographic review, it was found that there is minimal and almost no research done in the last five years on the development of childhood sexuality, as well as little scientific knowledge about it and the development of its components. Most of the existing articles problematize or provide a perspective of risk prevention around sexuality, limiting it to the sexual act or topics related to teenage pregnancy, sexually transmitted infections and sexual abuse.

Child development is essential in human life, it is the first link and the most important, since it is there where the first repertoires are acquired and the development of different essential areas occurs (Mansilla, 2000 as cited in Santos et al. 2019). In this stage, the limit in which the windows of opportunities for development operate is established (Katz, 2005 as cited in Rodríguez-Garcés & Muñoz-Soto, 2017), which facilitate adaptation to the environment, the exercise of autonomy, learning and independence in everyday activities. The function of occupational therapy in the pediatric area lies in becoming a facilitating and channeling vehicle for the child and their family, allowing them to find the necessary strategies in the acquisition of certain skills expected for their age (Blásquez et al., 2015). Therefore, it is a subject that has the theoretical-practical foundations necessary to address the area of sexuality as another dimension of development, addressing it at both a promotional, preventive and treatment level. The latter is relevant since boys and girls without a medical diagnosis and apparently 'typical' can go to OT, as well as others with brain injuries, genetic syndromes, specific diseases and other causes that affect development (Pérez, 2016).

Based on the review carried out, the need to reconstruct the conceptualization of childhood sexuality from a rights and gender approach is presented, where the development of its components is promoted in a healthy and natural way in the daily life of girls and boys, also recognizing that it is an obligatory factor for the construction of each person's occupational identity, since “[…] sexuality also includes thoughts, subjectivation and ideas that are expressed through occupation. Therefore, their relationship is inherent” (Morrison & Poblete, 2023, p. 396).

Based on the review we can project that for occupational therapy there are four components of addressing sexuality in childhood a) bodily autonomy b) socio-affective development c) pleasure and self-discovery d) gender and occupational choices, Therefore, OT interventions should contribute to development and learning in early childhood (Pérez, 2016) by contemplating these components.

When childhood coincides with sexuality, it is constructed under the parameters of adults (Brenes, 2020). This occurs because currently the hegemony of an adult centric, binary and heteronormative culture under which society is built, deprives children of the leading role in the exploration, discovery and development of their own sexuality, defining the way in which they should look, think and act, influencing the role they can fulfill socially (Contreras Contreras & Flores Aguilar, 2022). In the family context, daily life at home is a mosaic composed of complex scenarios, routines, interpersonal relationships, activities and tensions (Nina, 2006), where occupational therapy would be well positioned to help people with parenting problems (Germaine et al., 2021) related to the development of sexuality.

Meanwhile, in the school system, there are regulatory advances around Comprehensive Sexual Education (CSE), however, there are still strong challenges for its implementation (Ronconi et al., 2023) so taking advantage of the spaces for girls’ and boys’ daily interaction among themselves would facilitate learning and social transformations around the topic.

Conclusion

We propose that childhood sexuality from Occupational Therapy must be understood in a comprehensive manner, where it is recognized that it not only corresponds to an occupation (such as the sexual act), but is also part of the construction of the person's occupational identity. We know that there are different factors that influence its development; therefore, it is from here that Occupational Therapy could address and intervene from a critical perspective, with different models and reference frameworks, considering the contexts in which the person develops and the systems of domination that perpetuate reductionist ideas of sexuality.

In this context, each person, professional, family and educational institution can be configured as an agent of relevant change to stop the reproduction of these binary, infantilizing, patriarchal and hypersexualized behaviors, where Occupational Therapy in particular is not exempt from generating transforming processes by facilitating an intervention.

Finally, the dimension of sexuality in childhood is an emerging topic for occupational therapy, which is why it is essential to project future research that allows us to delve deeper into the components of sexuality in childhood and the approach strategies used by the profession.

• How to cite: Poblete Almendras, M. J., Hernández Morales, C., Alcaide Riveros, C., Álvarez Vera, E., & Campos Jeria, C. (2024). Approaches to sexuality in childhood from occupational therapy. Cadernos Brasileiros de Terapia Ocupacional, 32, e3614. https://doi.org/10.1590/2526-8910.ctoAR277436141

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Edited by

Section editor

Prof. Dr. Daniela Edelvis Testa

Publication Dates

• Publication in this collection
  18 Mar 2024
• Date of issue
  2024

History

• Received
  15 July 2023
• Reviewed
  04 Aug 2023
• Accepted
  08 Jan 2024