Every parent pauses when they hear the big matzoh ball question, “Where do babies come from?” I am about to delivery our fourth baby and so all things “baby” have been part the regular conversation at our house. Naturally, how you answer each of these questions is entirely related to the age and maturity of the child asking the question.
- Be short and direct. Avoid the big long explanation at first. Don’t be afraid to fish for what your child is looking for answer-wise. The child may be content with a short answer and enable you to avoid telling a child more than he/she is developmentally ready to hear/know. My two- year old is perfectly content to hear, “…from mommy’s tummy” or “Heaven.” My six-year old (who is inquisitive beyond her years), isn’t content with these sorts of answers and wants the details. I told her that women were born with all the eggs they were ever going to have. I simply told her that when they join with the daddy, that a baby forms. She didn’t ask THE follow up question of “how,” so I opted not to tell her (she’s still young). She thinks it is super cool that she has little eggs that could be her own babies one day. My ten-year old knows how that baby got in there.
- Be honest. Avoid answers like “the stork” or “baby factories.” Kids need to know that they can rely on you to tell the truth.
- Build on knowledge your child already has. You may answer a question by starting with something like, “As you know, boys have a penis and girls have a vagina…”
- Don’t laugh or squirm. I know this is easier said than done. Your child will use your reaction to gauge their own reaction. If you are very simple and matter of fact about how it works, you will be surprised at how accepting of the knowledge your child will be. Don’t be surprised if it is days later when you get follow up questions (after your child has had time to digest it).
- Reiterate the private/sensitive nature of the topic, especially if your child is young. If you have just told your young child (6-10 years old) the whole story of how the baby got there and is formed, make sure and tell your child about the sensitive nature of these topics. I usually say something like, “Now, I have told you the truth. You know more than most of your friends about this. Many of your friends’ parents haven’t had a chance to tell them yet. Let’s give them a chance to talk about it first, especially since it involves private body parts. So DON’T talk to your friends about it. Do you have any questions?” This little reminder can save you a lot of heartache later when you get called into the principal’s office because your second grader is telling everyone where babies come from, or you’re fielding angry phone calls from other parents.
Kids often learn best when you introduce a new topic by relating it to something they know. For this reason, as I talk about body parts, pregnancy, periods, sex, and where babies come from with my patients and own children, I will use a phrase they can remember. First, introduce the correct anatomical part (e.g., literally tell your child that girls have a vagina and boys have a penis). Then relate it to something the child will remember.
- Vagina—“the baby shoot.” As we have talked about the baby coming at our house, my kids know that the baby will either come out the baby shoot, aka, vagina or be cut out (C-Section) if there is a problem and she has to come out quicker.
- Uterus—“the baby sack.” I am always very careful to clarify that the baby is in her own sack. Mommy’s stomach is where the food goes. Mom’s bladder is where the pee is. The baby has her own special sack to grow in. Inside that sack, there is a bag like a balloon or water bed filled with water. We’ve discussed that when the bag pops (and the water comes out) the baby will be done growing and ready to come out.
- The cord—“the tube that connects the baby to mommy.” Simply explain that it is through the cord that the baby gets food and what she needs from mommy. It is fun to point out to the kids that their belly button is what is left to remind them of that connection to their mom.
You know your child best and are best equipped to understand his/her unique perceptions, developmental readiness, and likely responses. While these conversations can be uncomfortable and intimidating, it is better coming from you than a misinformed peer. As I see it, I’d rather have my kids hear about these sorts of sensitive topics from me, where I know the information is factually correct and I can add in little plugs for my own personal values at the same time (e.g., in addition to telling my child where babies come from, I’ll tell them when I think a good time in life to have a baby is).
No parent wants to think about the possibility of their teen being sexually active. But the truth is, it’s happening. Kids everywhere are having sex. I practice in a very conservative part of the nation. People are very religious and promote sex after marriage. The problem is that the parental beliefs aren’t always shared by the teens and so the topic isn’t being addressed.
In my practice, I usually have the parents step out of the room at the end of an adolescent well child/physical exam. It gives the teen a chance to ask questions that they may not feel comfortable asking about in front of the parents, and it gives me a chance to ask the uncomfortable questions. In my experience, the teen is much more likely to be honest about topics like sex, drugs, and alcohol if the parents aren’t in the room. And honest they are. Parents would be blown away at the number of positive answers I get to these questions.
What does the doctor ask?
What exactly and how to ask is the art part of medicine. It’s a style point difference and undoubtedly everyone does it a little differently. In someone that is very young and naïve, I may ask if they have ever heard of sex. In other situations, I may ask if the friends are sexually active. Teens are often engaged in the same activities as their friends, and it can be an easy gateway into conversations about their own activity.
Once a teen is determined to be sexually active, my job is to determine what needs to be done. I’m asking the hard questions. I ask: how often, how many sexual partners, and protected or not? It gives me a chance to educate and intervene (e.g., test for infections, etc.).
My teen is sexually active, now what?
- Educate, educate, educate. Teens need to know the physical and emotional consequences of sexual activity. Talk about more than just pregnancy prevention. Is the teen being pressured? Does the teen know how to properly use a condom? Does the teen know the signs of a sexually transmitted infection? Does the teen know the different kinds of infections out there (i.e., some are treatable and others are not). Teens often don’t realize that the sex can (indirectly) kill you (if you contract diseases like HIV).
- Bring your teen in for STI (sexually transmitted infection) testing. Many teens are not in tune enough with their bodies to recognize symptoms of sexually transmitted diseases. In all the positive results I’ve got over the years, I can only think of a handful who came in specifically for testing due to some specific symptom.
- Birth control. Generally speaking, parents don’t want their teens to be parents. Acknowledge the sexual activity and help prevent unwanted consequences.
What birth control options are there?
Many teens are surprised to find out that there are many more options beyond “the pill.” Talk with your doctor to tailor the treatment to fit your teen.
- “Abstinence.” The only 100% effective method is no sex at all. However, for the sake of the article, let’s assume sexual activity and read below.
- “The pill.” Oral contraceptive pills are taken once daily and typically have varying levels of estrogen and progesterone hormones. The effectiveness is dependent on your daughter’s ability to remember taking the pill every day.
- “The patch.” The patch is a transdermal slow release of hormone (a.k.a., a sticker laced with hormone). It is put on the skin and the hormone is absorbed through the skin. It’s a good option for those who have trouble remembering something every day (not good for those with sensitive skin).
- “The ring.” This is a hormone laced flexible plastic ring that is inserted in the vagina and sits around the base of the cervix. It lasts for a month (also a good option for those who can’t remember daily pills). However, the girl has to be really comfortable with her own body to stick her finger up her vagina to insert and take out the ring.
- “The shot.” The shot is referencing Depo-Provera which is a progesterone shot given once every 3 months. There is often break through bleeding initially (spotting), but then results in months without periods.
- “Implantable” options. These reference IUDs (intrauterine devices) and implantable rods (tubes filled with slowly released hormones that implant under the skin).
- “Barrier methods.” These refer to options like condoms (which should be used regardless for STI protection and is the only method mentioned that the guy uses), cervical sponges, and diaphragms. The problem with all of these methods is that they require a few minutes of stop and demonstrate self control while implementing use. Teens don’t reliably do that.
- “Rhythm method” (a.k.a., get pregnant method) requires a predictable cycle and only having sex during certain times. In my humble opinion, a terrible “option” in general. I mention it only for completions sake.
I’m pretty conservative. I’d rather my kids wait until they were older to have sex. I get it. However, if they are going to do it, I’d much rather they didn’t contract HIV, herpes, chlamydia, etc. I want to be a grandparent one day, but not before the time is right.