No matter how sophisticated parental controls for internet access are, research shows the average age children are now exposed to pornography is 13, with some children being exposed by age 7. Digging deeper, 60% of 11- to 13-year-olds are exposed to adult content by accident. And 93% of males and 64% of females under 18 have purposefully accessed pornography. All of these statistics correlate with ever greater smartphone use in young people. With this in mind, the truism of “teach your children about sex or the internet will” has never rung more true.
“With so much online content being thrown at our children daily that could have adult themes, ” says Asma J. Chattha, M.B.B.S., pediatrician at Mayo Clinic Children’s Center, “it is all the more important to have these conversations with our children earlier than we thought.”
What does this look like in practice?
At Mayo Clinic’s Children’s Center, Dr. Chattha and colleagues begin laying the foundation of age-appropriate sexual health education by introducing the topic of consent. This occurs at age 5 during well child exams.
“Pediatricians really walk the walk when it comes to consent,” Dr. Chattha says. “When we first do a hands-on examination of a young child, we’ll say, Hey, do we have your permission to do this? And the child will say yes or no. And if they say no, we sit down with them and talk to them about why we are doing what we’re doing. If, after this, a child still says no, I do not examine them. Consent is extremely important and body basics as taught in school — my body, my space, my consent — should be established long before puberty, which can begin anywhere from 8 to 14. A child should be aware of their consent to being touched or handled — or their space being invaded — from age 5.”
Dr. Chattha recommends the following books to parents to help guide family discussions on consent at home:
- Good Pictures, Bad Pictures: Porn Proofing Today’s Young Kids by Kristen A. Jenson and Gail A. Poyner
- Don’t Hug Doug (He Doesn’t Like It) by Carrie Finison
- Personal Space Camp by Julia Cook
- No Means No! by Jayneen Sanders
Themes concerning sexual and reproductive health are then introduced later at the well child exam at age 7.
“We bring up topics regarding puberty and start talking with children about these in the presence of the parent,” Dr. Chattha explains. “Our goal is for this to fuel discussion between child and parents. It is ideal if parents have already had conversations about this at home by this exam, for example couching it within discussions of their child’s growing height or how their body is constantly changing.”
For this era of sexual health education at home, the following books are recommended:
- What Makes a Baby? By Cory Silverberg
- It’s NOT the Stork!: A Book About Girls, Boys, Babies, Bodies, Family & Friends by Robie H.Harris
- From Diapers to Dating: A Parent’s Guide To Raising Sexually Healthy Children — From Infancy to Middle School by Debra W. Haffner
The puberty clock
Despite this new early age roll-out of information, sexual health education has traditionally been timed to coincide with puberty and left parents improvising with little sense of how to go about it.
“Parents fear the conversation will be awkward, embarrassing, not knowing the right words to choose,” says Dr. Chattha, a parent herself. “Our discomfort is the biggest barrier to getting this knowledge to children. That’s why I’m a huge believer in equipping parents with educational material — what to talk about and when. Waiting until puberty is the easiest way to have the sexual health conversation. But with today’s challenges, if you wait until, say, menstruation to have this discussion with your daughter, in most cases, this is too late because then the internet, school and peers will collectively have introduced information in a sequence that may not match your family values.”
While pediatricians today believe sexual health education should start at home — that is, before schools offer mandatory sexual health education (SHE) — some families do not want their child receiving early sexual health prompts.
“Usually this happens when a child is not having any signs of puberty,” Dr. Chattha reflects. “And the parents will say, We‘re not quite there yet, and they know their child best, so we take their cue.”
If puberty has begun, though, parents often want Dr. Chattha to initiate the conversation for them. “After a well check exam, I’ll say to the child, Hey, what do you know about these changes that are happening to your body? And start from there. You can gauge a lot about where the child is at from a mental, emotional and maturity standpoint and you can also gauge what the parent’s opinion is.”
Why do parents delay the sexual health talk?
There are many reasons why parents procrastinate over this conversation including:
- Religious, familial, social or cultural traditions
- Badly handled sex education by a parent’s own parents
- A discomfort with imagining one’s child as a future sexual being
- Embarrassment over what the child may ask the parent about their own sex lives
- A parent carrying trauma from having been sexually abused as a child or the victim of a sexual assault
Another common concern is that early sexual health education will promote precocious risky sexual activity, a myth Dr. Chattha is quick to dispel.
“There’s a lot of research on early sexual health education, delayed education and no education,” Dr. Chattha says. “Children who are well equipped with information at an early age showed no higher rate of sexual promiscuity compared to those who had this knowledge later or were completely oblivious. We often think talking about it will encourage it. However, talking about it and laying information out in a factual, scientific manner — and explaining the consequences — may deter a teenager from getting into a risky situation that may lead to a sexually transmitted infection (STI) or unwanted pregnancy. Taking the ‘no education’ approach, a child could become sexually active, unknowingly contract an STI — and this may affect their fertility later on. That’s a big consequence.”
The value in collecting sexual history
As a standard part of adolescent health care, Mayo Clinic starts collecting sexual history at age 12 in girls — and at age 13 in boys, as boys usually experience pubertal changes later than girls. To initiate this, Dr. Chattha will ask parents for permission to hold a short confidential meeting with their child one on one, while the parents wait nearby.
“I have never had a single parent refuse for me to talk with their child on their own,” Dr. Chattha says. “When I sit down with the teenager, I tell them that everything we talk about is between you and me, including the notes I write. To date, every teenager has wanted to talk to me. We cover sexual activity, sexuality, gender, whether they have any gender dysphoria and consensual versus nonconsensual actions and sometimes I don’t think a child is sexually active but in the interview, I find out they are. All of this information is so important to know.”
Sometimes a confidential interview reveals sexual activity that may have been unprotected and subsequent tests reveal pregnancy. “Having been in this situation one too many times,” Dr. Chattha says, “I take the approach of having the whole family meet with me at the same time if possible and I break the news and say: Here’s the problem, we all know we have very strong feelings about this but right now, medically there are things that we need to address for the child’s safety.” This involves Chattha facilitating a confidential interview with the child to make sure the pregnancy has not arisen from any nonconsensual sexual activity or if there are other concerns a patient wants Chattha to know about the circumstances of the conception or issues concerning the father of the baby.
Let instinct lead
In the end, this necessary expediting of sexual health education has a clear and simple pathway. “For all families today,” Chattha concludes, her own children included, “the discussion on body basics and consent should start at 5. The discussion on pubertal changes can start between 7 to 9 years of age, tailored to their emotional maturity and also signs that they might be early bloomers. And from there, you keep building knowledge until it meets experience.”
It’s often hard to see your six- or seven-year-old-child cycling and laughing out in the street on a summer afternoon as a future sexual being, but if you blink, a decade will have passed and when that future arrives sooner than you expect, you will want your child to be as prepared to navigate sex as driving in a rainstorm, fending off a bully, running their own finances, sitting important exams or dealing with a toaster on fire.
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