Anyone had child ripping/self-harming private parts?

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My son is 3.5 years old and is not yet diagnosed as anything (he's not been assessed), though we have recent concerns if he could be somewhere on the autistic spectrum (towards high functioning or aspergers end).

I have failed to find any parents anywhere else (either in real life or on the internet) who seem to share the experience we have in this regard, so I'm desperate to know if anyone else with an ASD child has gone through this sort of behaviour at all!

My son started with severe eczema at around 18 months, requiring special mitten sleepsuits to keep him from dripping with blood by morning. He's always had to be watched very closely because of his excessive scratching, and seeming to not care about the pain, blood, or damage he does. Due to the eczema and scratching habits, he's always worn quite secure clothing to keep his hands out of places - so tights with poppered vests (onesies) on top under his ordinary clothes during the day were necessary from about age 18m till nearly 3 years of age, when the eczema finally stopped plaguing his feet and legs so much. But he's continued to need the poppered vests over his nappy to keep his hands out. Not that he's ever done any kind of smearing like is common with austistic children (thankfully he's too afraid of the germs/mess, I think! ) but he's always been terrible about ripping at his private parts, particularly his scrotum and just under his penis. This started around 18 months and bath time was just horrible - we'd have to put socks on his hands to minimise the damage he'd do, otherwise it would be coming out of the bath with blood everywhere from his bits! We never told him he couldn't touch his privates, just tried to encourage him to be gentle and not scratch and rip at them - but that's been rather unsucessful for the past 2 years!

Bath time has improved over time, as he's gained more self-control, though there are times when he seems to feel his lack of control and will actually ask to wear a pair of underpants in the bath just to help him not scratch himself! But in general, we frequently (often multiple times a day) find that he's got his hand down his trousers and there is blood everywhere! And then he's left sore with all these open wounds, and everytime he has a wet nappy, he'll be upset because of the pain of the urine on the open sores.

And added to all this, HOW am I to ever get him potty trained?! The main way we prevent him from harming himself is by the vest over his nappy and trousers on top - and keeping an eye on him! But as soon as he's in less clothing, the problems are greatly multiplied! Shorts are a big no-no, as that's so much easier access to his privates. And just sitting on the toilet usually means in blood being drawn!

Has *anyone* been here before, or have any ideas? He is quite good about using the toilet when I take him (knows what to do, etc) - but trying to work out potty training with lots of secure clothes on top - and the fact that he can't be left at ALL on his own in the nude, means I feel daunted by the task and wonder if I can ever get anywhere!

So any tips, greatly appreciated! He's been telling me these past few days "Why are you putting me in nappies? I don't want to wear nappies!" - but it's not easy to think of potty training with so much clothes on top! And added to all of this, he drinks a LOT! We've always found that if he drinks too little, that makes him rip himself a lot more (so maybe there could be physical problem there??) so he's always got a tall juice cup with him all day long and drinks at least 2 x 14oz cups a day. Which of course makes getting to the potty with lots of clothes on even harder!

Sorry for the ramble - just hoping someone out there has knowledge or experience of this behavoiour!

Grace x

Oh My!

I think it is quite typical for little boys to explore their nether regions - often and vigorously. And if they aren't available very often I can see why he's doing it. However, it sounds like the eczema and the bleeding are the problem. It also sounds like he has an extremely high pain tolerance, so he isn't getting the signal to stop when it bleeds.

I think this will probably be solved once he "gets" that causing bleeding down there is a bad idea. Have you tried allowing the exploration (while you are present) until he gets rough and then immediately covering up? I think that over time and with maturity, if he wants to be out of nappies, he will start controlling the degree of touch.

Of course that is my total non expert theory! I do have two boys (well past that age) one is NT and the other AS and yes, they spent plenty of time figuring that area out.

I would imagine that an OT may have some thoughts about the pain tolerance which may be halpful.

My son does have dry skin and scratches a lot, but not to the extent you describe and not in that area.

Have you ever had him tested for diabetes? Something about what you said rang a bell with me and I've just googled "diabetes and itching". It seems that itchiness is commonly associated with diabetes, and people who are diabetic often drink a lot. I had a friend from work whose son was always thirsty and after becoming very unwell was found to be diabetic.

The only other thing I can think of is that at one time he did have an itch down there, perhaps with the exzema, he scratched it and liked the sensation so continues doing it. Self-harming behaviours are not uncommon with autism, and my son has been banging his head since he was a baby, so much so that he has a bald patch.

This is going to make potty-training pretty much impossible, so you really do need some way of dealing with this. I'm sorry I can't offer anything more helpful.

Have you explored all possible medical causes and treatments for this? I can't imagine how uncomfortable that level of itchiness would be. The poor little guy.

My sons also had/have eczema, not that severely though. They get eczema on the bottom of their feet that does not look like the eczema they get on the other parts of their bodies (at first the docs thought it was athlete's foot). Is it possible that he has eczema on his scrotum, that is just not as apparent because of the differently textured skin?

That is just terrible!! Anyway the excessive scratching in the privates could be related to his skin condition? That would be the logical assumption, so you probably already ruled that out.

When my son was around 4 and 5 he went through a time when he would excessively scratch his privates and get all worked up over them feeling itchy and scratchy. I could not figure it out, but it became a big problem. He did not scratch until he bled, as you are describing, but he scratched pretty bad.

Here's what I figured out for my son - he always wore very very tight underwear (sensory related) and refused to change them (sensory/need for sameness). I think the sweat due to the tight clothing caused some kind of fungal or bacterial infection that I could not visibly see - it was always red from itching but I didn't see any physical sign of infection. I started putting hydrocortizone on the area. I explained to him what it was an he should tell me any time he feels itchy and I will put it on. I put it on every night before bed (after bath if he took one) and any other time he said he was itchy or started itching. IDK if the hydro actually treated anything of if it was psychosomatic (sp?), but it worked.

It sounds like Jock itch:

http://en.wikipedia.org/wiki/Jock_itch

For those of you who are not male, allow me to explain. It burns, and itches, and is very uncomfortable. It is usually caused by tight, and sweaty clothes which create an ideal environment for the bacteria to grow. As you say, you have him buttoned up all the time, so I somehow doubt he is getting the proper ventilation.

So, yea, I would try some anti-fungal cream, and also let him wear some more breezy clothes to bed.

I had a long and detailed post.. and the @% website ate it. Again.
So heres the basics:
I deal with pretty much the same thing (I don't wreck my bits, but I do wreck my legs)
- have him tested for gluten allergies: see if this is the origin of the excema.
- find out why he's so interested in overhydrating.
- humidity is the enemy. buy a dehumidifyer.
- diaper him in CLEAN cheesecloth at all times. new socks 3 times a day.
- bag balm, coco butter are good creams.
- avoid denim, wear all cotton if you can.
- use alcohol cleansers (bowl of rubbing alcohol) & a sponge to 'burn' away the itch sensations.

It's a long fight, but if I were more dedicated to these steps, I'd probably cure myself.
As it is, I usually get 90% of the way there and then have one moment of mindlessness and ruin all of it. I know it sounds like I lack self control, etc etc.. and I do realize what I'm doing is detrimental.. but another part of my mind just says 'I need relief'. Usually the part that isn't quite awake yet.
------

http://www.bagbalm.ca/bagbalm.ca/

My daughter had an area by her privates that itched a lot. She would scratch and irritate it (not to the extent you are witnessing, though). The main part of it was around two inches long in the fold of skin where your leg meets your body. It would fan out from there and travel to her butt cheeks and sometimes over her pubic area. We tried different over the counter creams and lotions and some prescription creams but she would still scratch. Some times the creams would help a little, other times they did nothing. The doctor didn't really know what it was. Finally they decided to try Cutivate ointment (which is a corticosteroid that works by reducing inflammation). Within a few days I could barely see the rash anymore! We applied it twice a day for a week, and then once a day for a week. It cleared up and we haven't seen it again (going on 5 months now). If you haven't tried Cutivate ointment yet, ask your doctor about it.

The doctors initially thought it was some form of jock itch, like Tracker mentioned, but no antifungal creams would clear it up. They thought it was perhaps eczema, but weren't sure. We never ended up getting a diagnosis beyond that it appeared to be some kind of an inflammatory skin condition. I second what OddFiction said about humidity being the enemy. Every summer when it gets hot and humid I see an increase in her rashes.

Hopefully you find a solution to this because I know how horrible it is for the both of you.

You may want to get him checked out for allergies. I have a similar problem with both eczema and hives. I believe both problems are related. Hives are caused by elevated histamines. I can sometimes itch all over though no hives seem to be visibly present, but it feels like they are there anyway.

Antihistamines help me.

Oatmeal baths can help too. Pharmacies usually carry mixes you can add to the bath.

The itching can be so bad sometimes it wouldn't surprise me at all for a young child to scratch so hard it causes damage.

Oh this reminds me of my childhood, I had terrible eczema, I would scratch myself raw when I slept, my parents had me tested at 5 years and it was found that I had several food and environmental allergies, milk, wheat, animal dander, molds.

Many thanks for all the kind replies! However, perhaps I'm still finding that no one else shares the same experience!

Anyway, I thought I should clarify a few things I may have not made clear, which were mentioned in various replies:

* First, I am fully aware that boys find it necessary to explore these areas and can do so with force! But I'm pretty sure that the specific problem I'm trying to work out the cause of isn't normal exploring etc! I also have a son who is currently 18 months old and he likes to get his hands down below whenever he gets the chance - saying "tickle tickle" and thinks it's great fun! And if his fingernails aren't short enough, he'll do a bit of damage, because yes, he's quite forceful! But you can tell he's just exploring what is there, having fun, etc. But with his older brother (who my original post was about), it's always been a case of direct and immediate ripping with fingernails - most of the time nothing gentle or un-harmful comes first, he just draws blood as soon as his hand touches that area. It seems as if he wants to remove his scrotum! Occasionally in the bath, or sitting on the toilet he'll grab his penis and mess with it, look at it, etc - in a non-hurtful way. But the ongoing issue with actual harm happening is not related to this. He WILL tell me that it itches there - I think he pretty much always admits that it's an itch. But, the skin has always looked perfect there - he's *never* had problems with diaper/nappy rash, never had eczema there, or dry skin. The skin always looks wonderfully soft and happy - until his fingernails meet it (despite me keeping his nails as short as possible)!

* I have wondered if there was any connection between the large amount of apple juice he drinks and possibly strong urine that makes him miserable down below. But if it was an allergy or reaction to the apple juice, then I haven't worked out why the itch is always worse when he goes WITHOUT drinking very much. A number of times when I find him digging in his nappy during the day, I realise he's not had a drink recently - give him his cup, and once he's drunk something and passed urine, the itch seems to go away! But the fact that it's mainly his scrotum he tears at - not sure how that fits in with the need to urinate! ALSO, the need to have a bowel movement quite often makes him tense and itchy in his privates. So maybe it's a general tension in that region of his body which he translates into an itch??

* As for heat/humidity, that isn't really an issue here, as we're in Northern Europe - where we hardly have to bother with hot weather!

* Re clothing and tight fitting clothes - he has been wearing 100% cotton clothes since he was around 18 months. Once we worked out he had eczema, I started reading the labels on all his clothes and making sure he was only in cotton because of his skin. And as for the tightness of poppered vests (onesies) over his nappy, a couple of months ago I actually made a pattern for some larger poppered vests (since you can't buy his size in ordinary shops) and I made them very roomy, so nothing is pressing against his body. The poppered crotch area actually hangs a couple of inches *below* his nappy (not exactly elegant) but basically is acting as a tail to tuck into his trousers! So it's not tight against his private regions at all, but very loose. It's just necessary to have something as a bit of a barrier to slow his hands getting inside his nappy! And partially necessary because he frequently is found to have dug himself out of his nappy and is on display outside the house attacking his bits in public view! And of course, this is with the vest and all being worn anyway - but it at least deters him a bit more - or so i think!

* as for allergies, he's not been tested for anything. Our local doctors all seem to be of the opinion that allergy testing isn't very useful for young children and will just come back telling us he's allergic to everything. Even the dermatology department which we've eventually gotten to meet with because of his eczema doesn't seem to think it would be much help (at least with regard to the original eczema issues), and has told us they feel his quite an atopic child and reacts to a lot of enviromental issues. Though we could push to have him tested - but I fear he'd find it very frightening!

* oatmeal baths, yes - he's been having Aveeno Bath Oil in his baths for about a couple of years now. We've tried other bath emollients (due to the eczema) and have stuck with Aveeno in the end. We tried straight oats at times, but found the Aveeno oil satisfactory enough and less mess.

* Antihistamines that we've tried for eczema in the past actually had an opposite effect - made his itching hyper-active! So I've been scared to try them in general, having not had any success with the couple of ones we tried.

* The most helpful "cause" I've come across in my research has been studies talking about yeast overgrowth (which some people say can cause/be connected with autism. But apparently too much yeast in ones body (candida etc) can be connected with itchy genitals! So it's something I've thought about - if it could be a yeasty itch. He has certainly had a large amount of steroid creams applied for his eczema over the past 2 years (tho a tiny amount compared to what some children use!) and steroids can affect the healthy gut flora and yeast balance of people, it seems. But when the "itch" started, he'd never had any antibiotics in his life and no steroids yet either.

So, maybe it's all still a mystery! Perhaps I should pursue medical help - but I think it's hard to get doctors to understand what the actual problem is. I think people are likely to think I'm just an over-concerned mother who doesn't know what boys get up to! But I'm still convinced it's different behaviour!

The two things that come to mind are a yeast infection (internally) and a food allergy. Please insist on testing for at least both of these things. Your son is suffering, and you don't want him to continue to suffer because doctors won't test him.

I tottaly understand about the low pain tolerence but ripping oneself to shreads. I personaly can practicaly cut my fingers off and not notice until the room looks like the set of CSI. Yet. something light or brushy makes me feel like I am being tortured. I litteraly cringe when I see the opening sequence of Little House on the Pararie becuase how those weeds and flowers would feel rubbing across my skin. I often wonder if I have an alergery to poison Ivy and mosquito bites becuase of how bad they itch. Itching is one of the sensations I cannot take. I also itched constantaly as a child and if my parents made it so I couldn't stop it I think I would have gone insane. As an adult, I litteraly take a knife and cut mosquito bites open to make them stop itching. Have you looked into holistic itch relief? Hollistic products have helped me the most.

I think it is most likely he's got a sub-dermal (under the skin) infection. Likely that itches. The lack of pain response seems to be common with ASD, so ignore that and worry about the cause.. which he himself has identified as "itch".

Take his word for it.

Consider what has been said above regarding diabetes and systemic (blood borne) fungus.
It may be subcutaneous or systemic, since you see no permanent outside indications. It may be bacterial or fungal in nature, but somewhere along the line, an open wound has let something into his genetals. Specifically into the skin - or possibly the interior - of his scrotum or his blood supply.

I assume it's any kind of juice that distracts him from it? How about food? The body often experiences less 'random sensation' at the extremities when it is busy ingesting and digesting. Tell us if food or milk distracts him as much as apple juice does. Next time you see the doctor, use the words "subdermal" and "subcutaneous" - maybe it will trigger them to some interest or inspiration. Throw in your idea about blood borne candida. It's actually a good possibility.

It sounds like you have gotten lots of advice here, I don't have anything to add except that I don't think you are overreacting. I have a 5 yr old boy with PDD-NOS, and although he has explored his private parts, he has never itched and ripped at his genitals. I think there is definitely an underlying reason for your son's itching.

Hope you can figure this out soon, it sounds like your son is in a lot of pain.

im suprised i havent seen anyone mention the possibility of skin picking. its more compulsion based than due to itching, often you dont even notice you are doing it, and drawing blood and causing scabs is common with picking. i have several areas of skin that i cant seem to leave alone and maintain scabs on. quite frankly, the textured wrinkly skin of a scrotum just begs to be picked at! glad i dont have one =)

and uhhhh, there is this guy i know who shall remain nameless, just in case he pokes his nose in here, who does have an issue with scratching his scrotum so frequently that he has discoloration in the skin. he just says it itches. his move is more of a pinching the sack between two fingers and rubbing his fingers back and forth to "scratch" rather than using fingernails. perhaps if you son is scratching from an itch, getting him to alter his method would at least prevent the bleeding and breaking of the skin while still relieving the itching sensation.

another possibility is of course yeast infection. if he does drink a lot of sugary juices, those can simply be feeding yeast in his system.

other possibilities, urinary tract infection, bacterial prostate infection. it sounds like it warrants a trip to the doctor for some cultures and testing, especially if its been going on that severely for so long.

btw, my oldest wore mittens too as an infant, or else he would scratch himself till he bled. he sometimes still did if he managed to get the mittens off, and often woke up with chunks gouged out of his cheeks or ears. he had eczema too, inside his ears!