Kelsey Magnuson (Host): Hi everyone, and welcome to HealthWorks Here. I'm Kelsey Magnuson, Community Benefits Manager at Emerson Health, and today I have with me two special guests; Dr. Deborah Simon, a pediatrician for almost 30 years at Acton Medical Associates in Acton. She has been the school physician for Concord Carlisle Public School System for almost as long.

Dr. Simon has the privilege of observing and supporting families as children transition from newborns to toddlers and childhood, pre-teen and teenage years, and then into early adulthood. And secondly, we have Kristina Howell, a licensed independent clinical social worker who recently joined Acton Medical.

She's been working with children, adolescents, and their families for the past 15 plus years. Her experience has been in outpatient clinics, day treatment programs, group homes, community-based crisis teams, and emergency department psychiatric crisis teams. At Acton Medical, Christina provides integrated behavioral health services to primary care and pediatric patients and their families.

 Welcome Dr. Simon and Kristina.

Deborah Simon, MD: Thank you so much. I'm so happy to be here.

Kristina Howell: Thank you, Kelsey.

Host: Today we are going to be discussing how to talk to kids about sex and breaking down the myths around the "big talk" and why ongoing open conversations are healthier and better for everyone. And we're going to talk about when to start the conversations, tips for discussions specifically within that middle school range.

The goal is that what we talk about today can also be translated to other difficult topics. To get us started, Dr. Simon, what are the benefits of open communication between parents and children in general?

Deborah Simon, MD: Establishing this open communication Kelsey, is so important. These topics are difficult and uncomfortable for children and their parents. Having these open conversations from the early ages, builds trust and security for the children and the parents or guardians. It allows the parents to teach their own values to their children before the teens become more autonomous and more independent and lean on their peers for information. And these behaviors may not align with their family values. It's normalizing the words and topics that are discussed so that as the children become older and into teenage years, they're not uncomfortable using these words or talking about these topics.

And it has been shown in studies that these families who have these open conversations and are more comfortable talking about these topics. Those teens have lower rates of pregnancy, lower risk of sexually transmitted diseases, substance use, lower incidence of anxiety and depression. So really my point is there's no one and done talk. There's no one big talk. It has to really start from early childhood and continue throughout the adolescent and early adult years.

Host: Thank you. That is really helpful to understand that it doesn't need to be this one big thing, but really can be ongoing conversations.

We know that parents bring all sorts of experiences into their parenting journey, from what they experienced to what they observed. When discussing these sensitive topics. I want you to provide some encouragement and guidance. Kristina, what are the biggest barriers parents face when starting these conversations?

Kristina Howell: Yes. Thank you, Kelsey. Some of the things that come up in these conversations is the parents' own feelings and how they manage their feelings first before having these conversations with their kiddos. One important thing would be to acknowledge your anxiety. It's normal to feel nervous. It's normal to feel awkward, especially if these conversations weren't had with your own parents.

And recognizing these feelings are related to your personal history, not to your child. So reflect on your upbringing, your personal trauma. And cultural or religious beliefs that make these topics more difficult, your own baggage. We are always on a journey in pursuit of truth and should be in learning mode as we navigate the challenges of our current age as we sort through our own sexual stories.

And another problem that comes up and barriers that parents face is that they don't want to see their child as sexual. Most of us are not conscious of this reason for avoiding these sexual conversations, but that doesn't mean it isn't real. There's a natural barrier for most parents in thinking of their children as sexual creatures.

And so we make up names for child's genitals instead of using anatomically correct terms, not to spare our children, but because we can't bring our ourselves to think of our children as sexual. So some of the ways that we can rectify this is to approach the conversation thoughtfully. Before you have the conversation and as children grow, it's appropriate to have respect for each other's bodies and how we talk to one another in our own homes. As well as how children relate to one another in schools. But that is not the same as avoiding honest conversations about sexual things. The last piece is that oftentimes we think we need to know everything.

You don't need to know everything. It's okay not to know. And one thing I would stress to remember is that if and when you do say the wrong thing, humility in general is one of the most powerful traits that we can model for our children.

Host: Thank you so much for all of that background and setting the foundation of how we can approach the conversation. And as you both have mentioned, age appropriate information.

So let's get into what is age appropriate and how do we start the conversations earlier with body parts and moving on as they get older? So Dr. Simon, can you provide just kind of an overview of how we approach this topic at different ages?

Deborah Simon, MD: Yes, Kelsey, it's so important to think about the age of your child and speak appropriately to them on their level, and sometimes that means trying to feel out your child as far as what level they're at. I really believe that parents should start during the toddler years, like age one to three by starting to use the anatomical words.

Don't be afraid to call the girls private part the vagina and the boys the penis, rather than using a cute word or teaching them a cute word for their private parts. This is really important in creating normalcy in using these words that adults often feel very uncomfortable using. If adults show they're uncomfortable, then the children will learn that these words are taboo. During the four to 6-year-old range, your child may ask, where does a baby come from? Answering with anatomic and physiologic accuracy really continues the journey of having these straightforward, very honest conversations that hopefully then will lead to conversations during the preteen and teenage years.

It's okay for parents to say the baby grows in the uterus, rather than being uncomfortable and just saying the stomach or the belly. If the child asks further questions about birth, it's okay to say that the baby comes from the birth canal, which is called the vagina. As the child gets older, like six to eight years of age, for example, they may ask, how is a baby made?

Stating that the man has a sperm and a woman has an egg, and then when they come together, they can make a baby; that starts off your sex education in a very simple way. See it's all factual. Let the child lead the way. The amount of detail really depends on the child. Parents can give simple answers to the very simple questions asked, and they can keep going until the child seems satisfies or just gets distracted. Children will vary in how much information they want or need and let them lead the way.

Host: That's so helpful, as a parent of young ones and very curious kids ask lots of questions. It is important to kind of focus on those anatomical words and normalize those. And to kind of going back to what Kristina was saying earlier, trying to lower our own discomfort of those because we have not typically gone out in public saying the anatomical words. So now that they know about their body parts, what are kind of the next steps as kids get a little bit older?

Deborah Simon, MD: So as the kids get a little bit older, like elementary school age, they may start and it's normal to start exploring their own bodies. You may find that the children are touching their own private parts. This is a great time to teach them that their private parts are private and only theirs to touch. No one else should ask to touch them, look at them, or touch their privates.

Also, you can use this opportunity to teach your child that if this ever were to happen or that they ever feel unsafe, they should tell their parent or an adult who would be there to help them. When parents are proactive in having this discussion about this very uncomfortable topic, it opens the door for any child who feels violated to feel it's safe and tell someone.

Host: Yes. That is so helpful and important to start those conversations of what parts of your bodies can be touched and what cannot and who to go to when you need that help or when you have questions or when things don't feel right. And the more that parents are having these conversations, the more open kids can be to bring up concerns or questions to them.

Deborah Simon, MD: Exactly. Now, the older elementary school age and the early middle school age may ask their parents about words that they hear, that they don't know what they mean. Or you may hear your child using a slang word or that someone got in trouble at school for sexting, for instance. This is a perfect opportunity for parents. Seize the moment and ask them what that word means for them or what the scenario means to them. Rather than getting upset with your child for using this slang word, you can use it as a teaching opportunity to get a feel for where your child's at. What do they know about that word? What does it mean for them? So this is the chance for parents to teach their children about the topic. Ask them if they ever considered it, or even in a less threatening way, ask if their friends ever are involved in these activities. Again, always discuss this in a non-judgmental way. Learn from your child. The goal is to keep your child comfortable when talking to you about these topics.

I'd also like to add that discussion about puberty can be brought up as a very natural discussion. Oh, you always want to discuss it privately, but if you notice that your child needs deodorant, you can ask them if they noticed, rather than telling them you need deodorant. Ask them if they notice that their armpits are starting to smell in the morning or after a sport. Another way of doing it is bringing up things that you notice about other children in their grade, like their height differences or breast development in another girl or a boy with facial hair or change of his voice and make the conversation less directed at your child, which would be a gentler way to open up the conversation about pubertal changes.

Then really taking the opportunity to reading a puberty book with your preteen. It's quality time together and can make answering questions easier. And if you as the parent, you're not sure of an answer, it's okay. It's okay to say, I'm not really sure, but let me get back to you on that. Or, that's a great question to ask your pediatrician. We can make an appointment for that. You can always have backup from your pediatrician.

Host: Awesome. Thank you so much for that broad overview and really giving us the ability to go through the whole journey from young kids and talking about body parts all the way through puberty and the slang words and how all of that continues to create the open conversations. And further, I want to kind of switch to Kristina and talk about some of the practical tips of how to have these conversations, like what settings are best to have these, or what everyday opportunities can parents seize to have these conversations and weave it in naturally so it's not again, breaking down the big talk and having it over time.

Kristina Howell: Absolutely. So settings that work well for kids are where is your child comfortable? Where is their happy place and where is their safe space? If your home is their safe space, talk about it at home. If their bedroom is more safe for them, talk about it there with them. If, you're in the car with your kids or not directly facing them per se, you can have the conversation without it feeling as directed or as about your specific child and more just about how it's normal for everyone to go through these things and to have these things. Everyday opportunities can also include while you're cooking dinner, while you're waiting for the bus, there's an infinite number of places where you can weave this into your conversations with your kids.

And, I think that seizing those opportunities when they pop up, answering your child's questions when they have them without embarrassment and listening to them in a non-judgmental way is really important, so that they don't shut down or feel embarrassed.

Deborah Simon, MD: Yeah, Kristina, my mom used to use the opportunity of driving me to the mall to have these discussions. I think that was really smart of her.

Host: I love that. I think that's a good example and a great way to create a less intimidating aspect of the conversation.

Deborah Simon, MD: Exactly. I's not eye to eye.

Host: Yeah. That's awesome. So thank you for all that you have shared. I want to give both of you the opportunity to give final encouragement to parents who might feel nervous about this. So Kristina, we'll start with you.

Kristina Howell: I think that as previously mentioned, don't wait to have the big talk. Think of it as a series of ongoing discussions, not a single talk. Everyday things like a scene in a movie can be a teachable moment and I think be honest about your own discomfort. Admitting, I feel uncomfortable talking about this, but it's important, can break the ice and really model healthy emotional communication with your child.

Secondly, keep it age and developmentally appropriate as we stated, and then provide reassurance. Be clear that your kids can ask you anything without judgment. And this helps them to prevent from seeking mis information elsewhere, whether that's from their peers or from social media. Having these conversations with your children, open the door in the future for ongoing discussions. With pre-teens, you can discuss puberty changes, body image, peer influence. And it's also something that will develop into conversations of how to respect your partners, what consent means, and birth control basics.

I think that pediatricians, social workers can be allies in this conversation and help out in terms of if you get stuck. And a little tip is it's never too late to talk to your child about difficult topics. We've been saying that starting at an early age is beneficial. It is. And you are their parent, and you can create a safe environment at any age for them.

Host: Thank you. Dr. Simon, what about you? What's your final encouragement to parents on this?

Deborah Simon, MD: Well, I agree with Kristina that the small talks along the way, starting early in toddlerhood with the correct words and moving into preteen and teenage years really allows for easier open conversations when they're adolescents. And who knows? Your teen may even come to you for advice, and that would be the ultimate satisfaction.

And, you know, you have provided a safe and secure place for your teenager to come and ask questions. You are the safe place for your children to go for their questions, and you have a huge influence on your child's emotional and behavioral maturity. So seize every moment possible to have the non-judgmental, factual, and sometimes emotional conversation with your children.

This is what parenting's about. You get to guide them with your own beliefs before they solely depend on their friends and start to make their own decisions. Enjoy the responsibility. That's what I would say to the parents. Just enjoy that responsibility. It'sa precious one.

Host: Yeah. Thank you guys so much for this, and I think both of those closing statements really show how, talking about body parts and puberty and sex can translate into many other difficult topics. Things like relationships, gender identity, sexuality, bullying, and violence. Breaking those down into, again, age appropriate content and creating space for open and honest conversation with your kid and being able to connect with them on all of these different topics and why it's so important to Dr. Simon as you just said, be that safe space for them and be a trusted resource that they can come to instead of seeking out other ways for it. So again, thank you so much for being here.

Deborah Simon, MD: Thank you so much for having us.

Kristina Howell: Thank you.

Host: Thanks for listening to Emerson's HealthWorks Here podcast. Make sure to catch the next episode by subscribing to the HealthWorks Here podcast on Apple Podcast, Google Podcast, Spotify, or wherever podcasts can be heard. And visit Emerson Health.org/podcast. To learn more or schedule an appointment with Dr. Simon or Kristina, visit actonmedical.com or call 978-635-8700.