Talking With Your Young Child About Sex

General Information

Studies have shown that medication is effective in treating the symptoms of ADHD alone or in combination with behavioral interventions. There are several types of medications, and they are grouped into 2 major categories: stimulants and non-stimulant medications. Most children are initially treated with stimulants, although there are reasons why your doctor may choose to treat your child with a non-stimulant. Deciding which medication is right for your child may take time. Your doctor may try several different doses or switch to different medications to find the best choice. Discuss any family history of heart disease, high blood pressure, or substance use with your doctor.

Stimulant medications usually work within 15 to 90 minutes, depending on dose and formulation. Stimulant medications come in short-acting preparations that need to be given 2 or 3 times per day and long-acting preparations that are given only once a day. Although the medications are similar, each child may experience different benefits and side effects with different medications.

Stimulant medications should be given at the same time of the day, and you should never give 2 doses at the same time to make up for a missed dose. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Follow-up

Currently, there is no way to know which medication will be best for any particular child. To make sure that your child is receiving the dosage that gives the best effect with the least amount of side effects, your doctor will need to start at a low dose and increase the dose until a good effect or fewer side effects are seen. To judge whether the medication is helping, your doctor will obtain completed rating scales of your child's symptoms from you and your child's teachers when your child is at baseline (without medication) and is taking different medication doses. If there is no beneficial effect at the maximum recommended dose, your doctor will usually try another stimulant medication. Approximately 80% to 90% of children will respond to one of the stimulants.

Side Effects

There are several side effects that can be associated with stimulant medications. These include stomachache, headache, decreased appetite, sleep problems, and increased symptoms as the medication wears off (known as rebound). Preschool children may also experience emotional outbursts, repetitive behaviors or thoughts, or irritability. Usually these effects are mild and often decrease after the first 1 to 2 weeks. Your doctor will adjust medications or discuss other strategies at follow-up visits if these side effects continue. It is helpful to observe the time of day when side effects occur. Serious side effects are rare, but you should contact your doctor's office if your child experiences dizziness, fainting, severe irritability, tics, or serious behavioral changes.

Setting a Follow-up Plan

Your child will need to be seen frequently during the initial treatment phase. After a satisfactory dose has been found, your child will be scheduled for a follow-up visit at regular intervals, usually every 2 to 3 months.

At follow-up visits, your doctor will review rating scales from you and your child's teachers and will check weight, blood pressure, and emotional status and review any medication side effects.

Parent's follow-up responsibilities include

Discuss your child's treatment program with appropriate school personnel.
Bring copies of completed parent and teacher follow-up rating scales to all follow-up visits.
Schools may be willing to fax completed follow-up rating scales to your doctor's office.
Inform the doctor before the next scheduled visit if your child is experiencing serious medication side effects.
Ask your child how he or she feels on the medication.
Schedule follow-up visits.

Your doctor will set up an anticipated follow-up schedule with you at the time medication is started. They are more frequent, typically weekly at the beginning since there is the need to increase dose until the most effective dose is achieved. There should be a visit within 14 to 30 days after any change in medication and dosage. Once that stabilization occurs, the frequency of routine follow-up stretches out.

Remember: If you have any questions or if you see side effects that cause concern, do not wait for the next scheduled visit. Call and speak with the doctor, and the doctor will arrange an appropriate immediate or interval follow-up.

The recommendations in this resource do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Original resource included as part of Caring for Children With ADHD: A Practical Resource Toolkit for Clinicians , 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

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Some parents may not be comfortable talking with their children about sex and sexuality. However, if children aren’t getting the facts about sex and sexuality from their parents, they could be getting incorrect information from their friends or the media. Media rarely show responsible sexual behavior or offer correct information about abstinence, sexual intercourse, birth control, or the risks of pregnancy and sexually transmitted infections (STIs).

Here is information from the American Academy of Pediatrics to help parents talk with their children about sex and sexuality.

Parents Are the Best Teachers

Talking about sex and sexuality gives you a chance to share your values and beliefs with your children. Your children need to know there is always a reliable, honest source they can turn to for answers—you. You can teach your children about relationships, love, commitment, and respect. When your children feel loved and respected by you, they are more likely to turn to you for answers and advice.

Teachable Moments

You can find teachable moments in everyday events. For example, talk about body parts and what’s “private” during bath time. A pregnancy or birth in the family is a good time to discuss how babies are conceived and born. Watching TV with your children may also be a good time to discuss an on-screen relationship.

Use these teachable moments when they happen. Start by asking what your children already know. Let them guide the talk and ask questions. Let them know you're comfortable answering, so they feel comfortable asking.

General Talking Tips

When your children begin to ask questions, keep the following tips in mind:

Talk openly, and let your children know they can ask you about anything.
Try not to laugh, even if the question is cute. Your children might feel ashamed if you laugh.
Try not to appear overly embarrassed or serious about the matter.
Answer in simple, age-appropriate terms. Answer the question, but don't go on to add unnecessary details.
Use proper names for all body parts.
See if your children want or need to know more. Follow up your answers by asking, “Does that answer your question?”
Listen to your children’s responses and reactions.
Be prepared to repeat yourself.

If you are uneasy talking about sex or answering certain questions, be honest about that too. You may want to ask a relative, a close family friend, or your children’s doctor to help explain things.

Talking With Preschool and School-aged Children

The questions your children ask and your answers will depend on each child’s age and ability to understand. Here are common questions and issues for different age groups.

Preschool children

“How did I get in your tummy?”

“Where was I before I got in your tummy?”

“How did I get out?”

“Where do babies come from?”

“How come girls don’t have a penis?”

18 months to 3 years of age— Children in this age group begin to learn about their own body. It is important to teach your children the proper names for body parts. Making up names for body parts may give the idea that there is something bad about the proper name. Also, teach your children which parts are private (parts covered by a bathing suit).

4 to 5 years of age— Children in this age group may begin to show an interest in basic sexuality. It’s normal for children to touch their own genitals (private parts) or to be curious about what other people’s genitals look like. Children may also engage in sexual play, like pulling their pants down or pulling other children’s pants down to reveal their genitals. However, children need to learn that

It’s not appropriate to show their genitals in public.
It’s not appropriate to touch anyone else’s genitals.
No other person, including even close friends and relatives, may touch their genitals. The exceptions are doctors and nurses during physical exams with the parent’s permission and parents when they are trying to find the cause of any pain in the genital area.

By the time children are school aged, they should know the following:

Proper names and functions of body parts (including the womb or uterus where a baby grows—not “mom’s tummy”)
Physical differences between people with male and female body parts

School-aged children

“Who can have a baby?”

“Why do some people get erections?”

“What is a period?”

“How do people have sexual intercourse?”

“Why do some kids have 2 mommies or 2 daddies?”

5 to 7 years of age— Children in this age group may become interested in what takes place sexually between adults. Their questions will become more complex as they try to understand the connection between sexuality and making babies. They may come up with their own explanations about how the body works or where babies come from. They may also turn to their friends for answers. Lessons and values they learn about healthy sexual relations at this age will stay with them as adults.

8 to 9 years of age— Children in this age group may become interested in learning more about relationships. For example, they may become interested in how their parents met and fell in love. As questions about romance, love, and marriage arise, they may ask questions about different types of relationships, including homosexual relationships. Use this time to discuss your family’s thoughts about relationships . At this age, children will be going through many changes that will prepare them for puberty. Teaching your children to be sexually responsible is one of the most important lessons.

As children approach puberty, they should know about

The body parts related to sex and their functions
How babies are conceived and born
Puberty and how the body will change
Menstruation (All children can benefit from this information.)
Sexual intercourse
Birth control
STIs, how they are spread, and how to protect themselves
Masturbation
Homosexuality
Family and personal guidelines
Gender identity

About Masturbation

Up to the age of 5 or 6 years, masturbation is quite common. Around age 6, children become more socially aware and may feel embarrassed about touching themselves in public. Make sure your children understand that masturbation is a private activity, not a public one. Masturbation in private may continue and is normal.

There are times when frequent masturbation can point to a problem. It could be a sign that a child is under a lot of stress. In rare cases, it could even be a sign of sexual abuse. If masturbation becomes a problem, talk with your children’s doctor.

Visit HealthyChildren.org for more information.

Disclaimer

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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