Gratification phenomena in children: a report of nineteen children and review of the literature

Abstract

Background: Gratification phenomena (GP) are self-stimulatory behavior and also called as infantile masturbation. This phenomenon is especially seen in early childhood. GP is often misdiagnosed as epilepsy, dystonia, urinary tract infection or infantile colic resulting in numerous investigations and treatment because of variable behaviors during this event.Methods: This study aimed to describe the features of GP, so that clinicians can better recognize this condition, to prevent unnecessary evaluations, and provide appropriate guidance to parents. This study is a prospective observational study, conducted in patients with GP between March 2019 and November 2020. GP was diagnosed on the basis of history, eyewitness account and video recording of the eventResults: During the study period, 19 children were diagnosed with GP. Out of 19, 17(89.4%) children were females. The mean age at onset was 17months (range 5-36months). The mean age at diagnosis was 20 months (range 8-47months). The mean frequency of events was 4/day (range 1-12/day). A typical GP was seen in 12 of 19 (63.15%) children. At the time of referral, 31% of children were diagnosed with epilepsy and 26% of children were diagnosed with infantile colic. During follow up period, GP was subsided within 4-12 months after the initial visit.Conclusions: A GP, otherwise called infantile masturbation, is an important consideration in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. A detailed history and video recording of events often prevents unnecessary investigations and treatments.

Gratification Disorder Associated With Perineal Irritation in Young Children: Management and Short-Term Outcome

“…Furthermore, 2 of the 3 cases were diagnosed and treated as UTI which was similar to another review reporting UTI diagnosis in 2 among 19 children with gratification phenomenon. 13 Additionally, it can be observed that UTI could have a dual role of both contributing factors and consequences in gratification behaviors in these 2 cases. The rationale behind this could be due to the learned behavior in response to the perineal irritation caused by UTI.…”

“…This is similar to the reports in some literatures showing that the masturbatory behaviors in children were more common in females. [12][13][14] Nonetheless, it can be presumed to be due to the studies being conducted in low magnitude and sociocultural factors of masturbation being considered as normal in males resulting in low referral rates of males. Furthermore, 2 of the 3 cases were diagnosed and treated as UTI which was similar to another review reporting UTI diagnosis in 2 among 19 children with gratification phenomenon.…”

“…This was similar to the reports of misdiagnosis of self-genital stimulatory behaviors as epilepsy in children in various case reports and reviews. 13,15,16 The findings such as no alteration of consciousness, termination with distraction, normal physical and neurological examination, and investigations can assist in the avoidance of mistaken diagnosis of gratification phenomena as epilepsy.…”

“…Majority of the case series and review also reported the age of onset to be between 3 months and 3 years. 10,12,13 This could be explained by their inquisitiveness regarding genitals and gratification along with immature understanding of social restrictions. This is similar to the reports in some literatures showing that the masturbatory behaviors in children were more common in females.…”

Gratification Disorder: A Case Report from the Himalayan Country–Nepal

“…10 Dilemmas in diagnosis and treatment are common even among clinicians, and it is observed that almost one-fourth of children are diagnosed and treated as epilepsy like that of our case. 11,12 Our index case was presented to a pediatrician and was a diagnostic dilemma for 3 months. She was started on an antiepileptic.…”