Kelsey Magnuson (Host): Hi everyone, and welcome to HealthWorks Here. I'm Kelsey Magnuson, community Benefits Manager at Emerson Health, And we are back for part two with Dr. Deborah Simon, a pediatrician, and Kristina Howell, a Licensed Independent Social Worker from Acton Medical Associates. This conversation is going to build on part one where we talked about how to have open and ongoing conversations with kids about body parts, puberty, and the basics of sex.

In this episode, we're continuing the conversation to focus more on intimacy and pornography. Welcome Dr. Simon and Kristina.

Deborah Simon, MD: Thanks for having us.

Kristina Howell: Thank you so much, Kelsey.

Host: In part one, we really laid the foundation of why early and often conversations are better with kids. It creates comfort and trust for kids to be able to ask questions and seek parental guidance first before going to the internet or their friends. As kids get older and to middle school and early high school, they'll start having crushes and interest in romantic relationships. How can parents approach this topic with their kids?

Deborah Simon, MD: Yeah. Thanks Kelsey. Like you said in part one of the series, we spoke a lot about the positive impact of starting early with open conversations between parents and their children. Now we're moving further and we have to accept that now it is a normal phase of child development that tweens and teens are starting to explore romantic and sexual feelings. So now we need to address that. Through these discussions, parents can have a huge impact on the decisions their teens make with regard to the romantic relationships, while at the same time weaving in their own parental values. Parents need to proactively talk to their children about these hard topics because the children now are being exposed daily to unreliable sources like their friends, the internet, social media, TV, song lyrics, and now even AI. The children are hearing so much misinformation through these sources and this misinformation has shown to increase the risk of poor decision-making and then subsequently risky behaviors in the areas of sexual activity and substance use.

Kristina Howell: So how can parents approach this topic with kids? Be thoughtful. Be intentional. It's important, it's influential to your kids about sexuality and sex. But it's important to note that sexuality and sex aren't really the same thing and adolescents need to learn about both in order to launch into a healthy adulthood.

 So sexuality is more so defined as a broad range of issues that include a healthy regard for our own bodies and respect for other's control over their own body. Healthy sexuality is interwoven with human relationships. On the other hand, sex is physical acts that when experienced thoughtfully, at the right time, with the right person, can be a wonderful part of the human experience.

 So not only is it important to make sure that our kids learn the correct facts about sexuality, but also how to make healthy and safer decisions about sex. Research has showed that parents who talk openly about sexuality to their kids have way more influence over their child's sexual behaviors as they grow than if they don't attempt to have these conversations.

 You might be fortunate enough for your tween or teen to come to you with questions, but if not, look for opportunities to talk about these sensitive subjects. You can utilize things like TV shows, movies, websites, books, as a springboard for educating your teen about sexuality. The storylines in that kind of media are about other people, which may make it more palatable and more accessible for your teenager to be comfortable talking to you about it.

So topics that you could easily find in those types of media are like where babies come from, romantic attraction, LGBTQ questioning and issues, dating, breakups, pregnancy, sexuality, all of the above could be utilized through books and media as a support in your conversation with your kids.

Host: I love how you gave so many different examples of ways that we can approach the conversation and use as a springboard, that's a perfect word for utilizing what is around us culturally and encouraging time spent with each other as well, to be able to understand what kids are watching and reading and consuming across the board in all situations. We've talked a lot about age-appropriate conversations, and I know I've gotten the question in the past. I've wondered myself, if I start talking about this with my kids, will it make them more interested or make them want to start experimenting with different sexual acts? So what are some age-appropriate ways to discuss sexual development and intimacy, and how can we reduce fear around introducing the topic?

Deborah Simon, MD: Well, age appropriateness is really important. So individualizing your conversation to the emotional stage of your child is the key. It may come to a surprise to many parents that children between the age of 10 and 13 already know about sex. This is the reality, so we need to start addressing these topics early on. Kelsey, recently, I had a parent of an 8-year-old boy ask me what to do because her son told her that he wants to have sex with a particular girl. I know. Take a deep breath. You can be shocked, but don't shut down if that happens to you. This is your chance to explore what your child means and do some teaching. The parent, at that point could ask her child, what do you mean by that? See if they really mean the sexual act. Most likely he meant she's pretty, and that the comment had nothing to do with sex. The parent could ask questions to illustrate the importance of a strong relationship. Focus on what she is like, what does she like to do?

What are her friends like? Find out where he's at. This opens up the conversation on having relationships, focusing on the quality of the person, which is the most important aspect in a relationship. If the boy had meant a sexual act when talking about the girl, then addressing that is of course warranted.

If he says he wanted to kiss her, the parent could talk about mutual respect, consent, and boundaries. If he was describing a true sexual idea, the parent could talk about it being adult behavior. The parent could say something like, adults do this when they have a relationship, care for each other and are in love. They can also say sex is a way to have children and open the door to talking about pregnancy; so that the child learns that sex is adult behavior.

Host: Yeah, thank you so much for giving those various examples and for helping us understand really how early kids are thinking about and starting to talk about sex. Whether they actually mean it because they maybe just heard the word, or if they are farther along in their maturity journey and ready to fully talk about it. And for parents to jump on that opportunity and continue to ask questions, which is so helpful. Kristina, how do parents balance openness with their kids while maintaining their own values and beliefs?

Kristina Howell: Great question. Overall, knowledge of sexual activity and the way things work does not equal permission to teenagers. It equals preparedness. Studies have shown that talking about romantic and sexual relationships do not lead to earlier sexual activity. And as a matter of fact, it's been shown to lead to less risky decision-making; that includes a later onset of first sexual experience, less risk of date rape and sexting, and a lower incidence of sexually transmitted diseases and teen pregnancy.

Knowledge equals preparedness and not permission. Overall, there's three main don'ts and three main do's that I pulled together for our podcast today on how to talk to your kids while maintaining your values and beliefs. So for the don'ts; don't assume that your kid knows it all or is heard it all. When we assume they know too much, we deny them the basic knowledge that serves as the foundation of healthy sexuality. Don't assume that just because a question is asked that they're doing it. Plenty of teens may ask questions about sex, sexuality, contraception, and more, simply because they're curious and it's important that they get the accurate information about those topics.

Don't assume that your kids understand everything you've told them or that we understand everything they're trying to communicate to us. Ask your teen to repeat back what you said to them. If something seems unclear, it's okay to say I may not know the answer to that question, but let me get back to you on that. And either utilize the resources we already talked about, your pediatrician or other trusted adults to discuss how you may feel more comfortable talking to your kids.

The do's are, begin talking with your children early. Keep the conversation going. Listen to what your tweens and teens have to say about sexuality. Listening to our teens is the key to getting them to talk to us. And the more they confide in us, the more we as parents will be able to guide them towards developmentally appropriate solutions regarding sex. And overall, do encourage them to talk. If they have a question, ask what they already know or have heard.

 Be nonjudgmental, be factual. Take notes of their reactions. And again, if you're unprepared to answer a question, it is okay to tell your child, I don't know, and find out the answer later and get back to them.

Host: Thank you for those great tips and breaking it down into the do's and don'ts of the conversation. I think that's really helpful for us all to have in approaching this topic. So now switching gears a little bit, I want to go into understanding the potential impacts of pornography on kids' expectations and understanding of sex.

Deborah Simon, MD: Yes, unfortunately, pornography exposure at younger ages is a reality that we have to face. The exposure to children is very concerning because it normalizes the unrealistic sexual behaviors as well as body images that are not realistic and should not be strived for. And the exposure also can portray aggressive and violent acts, which we do not want to normalize.

Studies have shown that exposure at a young age increases the risk of earlier initiation of sexual activity, and more permissive sexual behaviors in children and tweens. Studies have shown that exposure to aggressive sex can normalize the aggressive sexual behaviors and even sexual harassment. And also early pornography has also been found to increase the likelihood of engaging in high-risk sexual behaviors such as unprotected sex, multiple partners, substance use during sex. So the fact is that pornography distorts children and adolescents' understanding of healthy relationships and sexuality.

 On the flip side, open communication by parents along with parental monitoring of media exposure are associated with delayed sexual initiation and safer sex practices. So the parental monitoring really becomes a key component of protecting our children.

Host: So it's really helpful to understand kind of the background of kids' pornography use and what impact it can have. And many parents, it's hard to admit that kids are seeing it or, have seen it. So what do parents do if they find out their kids have accidentally seen it or if they catch their kids viewing it and how to have that open conversation?

Kristina Howell: That's a great question. If they discover pornography, don't respond in crisis mode. Sit down, have a calm, private, safe conversation. Do not blame, shame or scold, rather approach the conversation with a curiosity and a willingness to hear your child's thoughts.

This would be a perfect opportunity to discuss that sexual activity is wonderful when it is in a loving, stable, and trusting relationship with two consensual people. Parents can ask if their kids are in a relationship or wish to be in a relationship, which further opens the door to more discussions.

 Proactively try to use those tried and true resources, as a means to introduce consent and mutual respect to your teenager for any physical interaction, not just sexual interactions with other's. That includes holding hands, kissing, intercourse, et cetera. And if they know what an appropriate understanding of healthy relationships and boundaries look like before they're exposed to pornography, they're less susceptible to the influences of that pornography, and the inaccurate portrayals of relationships, sex and sexuality that it often demonstrates.

One of those resources that can be really useful with your teenager is the FRIES model of consent by Planned Parenthood. FRIES outlines the ways that people can agree for the actions that they're going to do to be consensual and without consent, it's dating abuse, assault, or rape. So going over the FRIES model F in the FRIES stands for freely given. Any physical activity should never be forced or coerced in any way, so no one feels pressured to do anything they don't feel comfortable doing. You teach your kids the R. R means reversible or revocable. Anyone can change their mind to know at any time, for any kind of activity and the partner must respect that no without question. The I in FRIES stands for informed. All parties should be aware of any risks involved. So teach your kids that knowing STD status, birth control status, and agreement upon what is being consented to between them and their partners is important. And enthusiastic. E for enthusiastic. If it's not, teach your kids that if you don't feel like it's an enthusiastic yes, it's a no.

For instance, a hesitant maybe is not the same as an enthusiastic yes and should be considered a no by both you and anyone you may be involved with. And finally, the S in FRIES stands for specific. Essentially it gives consent for one activity. It does not give it consent for increased activity or recurring physical or sexual content.

So using the FRIES model of consent with your kids, it's just one of the many ways to talk about healthy relationships, boundaries, and consent.

Host: Thank you for such a great method that we can break down and always remember the FRIES and what it stands for. I'm so glad that we were able to bring this group back together to have this important conversation and continue to build on it. I want to give each of you just one more opportunity for final tips and tricks for parents having these conversations.

Dr. Simon, we'll start with you.

Deborah Simon, MD: My final recommendation for parents is use any and every opportunity to have a short, non-judgmental conversation. Making general inquiries about your children's friends, instead of asking them directly about themselves, may be a little less threatening and more likely to open up the conversation.

 It can show that you're a cool parent to talk to and a safe parent to talk to. Then hopefully you can morph the conversation to focus more on your child's views and thoughts about themselves and their activities or relationships. And one more thing. While it doesn't always seem like it, teens actually want their parents to talk with them about relationships and sex.

Think about what you would've liked your parents to do with you. Wouldn't you have wanted your parents to be cool to talk to? Nonjudgmental? Wouldn't it have been nice to feel your parents were people you could ask private hard questions to? Rather than navigating these waters secretly and wondering where to turn? Be the parent that you would've wanted, you can do it.

And I would bet that when your adolescents are older, they will thank you.

Host: Awesome. That's great advice. Kristina, what about you? What are your final closing thoughts on this?

Kristina Howell: My final closing thoughts are, use the resources available to you. Consider going to the websites for Planned Parenthood Federation of America safe teens. they provide up-to-date clear, medically accurate information, helps understand adolescent sexual health. A lot of the websites also offer articles and other suggestions on how to further these conversations with your kids in creative ways.

So overall, I would like to hit home that teens say that their parents and not their friends actually influence their decisions about sex more than anyone else, but that's only if their parents talk to them. So as tough as it may seem at times, having these open and honest conversations about sexuality allows us to shape our teens into adults who will be better prepared for healthy and meaningful relationships.

Host: So great, and thank you both for your time in preparing for this conversation and for being here today. I know that parents will find it so valuable and I'm so glad that we were able to do this, with part one and now part two to really fully round out this conversation. Thank you all for listening to Emerson Health's HealthWorks Here podcast. Make sure to catch the next episode by subscribing to 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.