South African Journal of Childhood Education

ISSN: (Online) 2223-7682, (Print) 2223-7674

Page 1 of 10 Original Research

An alternative term to make comprehensive sexuality

education more acceptable in childhood

Authors: Background: Ignorance, misconceptions and fear hinder the implementation of young
Raisa Cacciatore1
children’s age-appropriate sexuality education (SE) globally. Methods to promote the SE of
Susanne Ingman-Friberg1
Dan Apter2 young children are needed.
Nina Sajaniemi3
Riittakerttu Kaltiala4
Aim: We aimed to evaluate why parents and professionals resist the concept of childhood SE
and to test whether a child-centred term could reduce this resistance.
Affiliations:
1
Family Federation of Finland, Setting: We conducted nationwide studies in Finland plus focused studies in three groups.
Väestöliitto, Helsinki, Finland
Methods: In open online situation analysis and needs assessment studies among early
2
VL-Medi Clinical Research childhood education professionals (n = 507) and parents (n = 614) of 1–6-year-olds, negative,
Centre, Helsinki, Finland adulthood-associated connotations for the term ‘sexuality education’ were detected. We then
evaluated whether a less sex-connected term than SE would be feasible to promote SE of
3
Philosophical Faculty, young children. We combined ‘body’ and ‘emotion’, after our earlier study on children’s most
University of Eastern Finland,
common sexuality-related expressions, to form the new Finnish term Kehotunnekasvatus [body–
Joensuu, Finland
emotion education] and tested it among professionals of sexual health (n = 17) and early
4
Department of Adolescent education (n = 63) and primary health nurses (n = 29).
Psychiatry, Faculty of
Medicine and Health Results: Acceptance of the new term was excellent in all three groups; the new term
Technologies, Tampere was reported as ‘more positive, more neutral, downplaying thoughts of sex’. Most
University and Tampere respondents deemed it appropriate, necessary and usable in their work. Furthermore,
University Hospital, Tampere, the majority of those working daily with the parents of young children preferred the
Finland
new term to ‘sexuality education’.
Corresponding author:
Conclusion: After testing the functionality of a new Finnish term among Finnish professionals,
Raisa Cacciatore,
raisa.cacciatore@vaestoliitto.fi the authors suggest considering replacing the term ‘sexuality education’ with a more
child-centred and less sex-connected synonym when referring to SE for young children.
Dates:
Received: 25 Mar. 2020 Keywords: childhood sexuality education; adultism; child sexuality; heath promotion; early
Accepted: 28 June 2020 childhood education and care.
Published: 09 Sept. 2020

How to cite this article:

Cacciatore, R., Introduction
Ingman-Friberg, S., Apter, D.,
Sajaniemi, N. & Kaltiala, R.,
During the intense years of early development, sexual health and rights are widely overlooked
2020, ‘An alternative term (Brilleslijper-Kater & Baartman 2000; Davies & Robinson 2010; Morawska et al. 2015; Robinson &
to make comprehensive Davies 2016; Stone, Ingham & Gibbins 2013). Studies show that 1–6-year-old children are curious
sexuality education more
and learn about sexuality early from a vast array of sources, including unreliable ones. Socialisation
acceptable in childhood’,
South African Journal of in sexual issues not only takes place in the family, but also with kindergarten and preschool peers
Childhood Education 10(1), and staff, media and marketing and nearby older minors (Albury & McKee 2017; Collins et al.
a857. https://doi.org/​ 2017; Davies & Robinson 2010; Hornor 2004; Josephs 2015; Larsson & Svedin 2002). Despite this,
10.4102/sajce.v10i1.857
children’s right to receive reliable age-appropriate information, safety skills and positive attitudes
Copyright: regarding their sexuality is poorly implemented.
© 2020. The Authors.
Licensee: AOSIS. This work
Opposition to sexuality education (SE) provision in schools, even to adolescents, continues
is licensed under the
Creative Commons strong in half the countries of Europe (Ketting et al. 2018). No countries have mandatory
Attribution License. national SE programmes for early education, and professionals are mostly untrained in this.
Hence, children do not receive planned, equal and accurate responses to their needs related to
sexual development (Davies & Robinson 2010; Robinson 2013; Sandnabba et al. 2003).
Read online: International recommendations, however, support early introduced comprehensive SE, for
Scan this QR example, the United Nation’s Convention on the Rights of the Child 1989, the World Health
code with your
smart phone or Organisation (WHO) Regional Office for Europe and the Federal Centre for Health Education’s
mobile device (BZgA) Standards for Sexuality Education in Europe 2010, the World Association for Sexual
to read online.
Health’s (WAS) Declaration of Sexual Rights 2014 and the Federation of European Ombudspersons

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 Page 2 of 10 Original Research

for Children’s Position Statement 2017. The European Court childhood SE may be the negative response to the term
of Human Rights ruled in 2017 that children have the ‘sexuality education’. An individual’s ability to understand
right to early SE, even despite parental prohibition terminology well enough to make health-promoting
(European Court of Human Rights 2018). decisions is often inadequate. Interventions to improve
outcomes associated with health literacy are needed
In addition, childhood sexual development and common (Geboers et al. 2018). Therefore, alternative terminology
sexual behaviours are minimally researched. Children are for referring to very young children’s sexuality and SE,
treated as primitive forms of adults rather than from their nevertheless covering the relevant contents, may be a
own perspective (LeFrancois 2013). Studies of childhood helpful solution.
sexuality show that adult-like sex or reproduction was not
the focus of young children’s behaviours and questions Our aims were (1) to evaluate whether early childhood
(Brilleslijper-Kater & Baartman 2000; Cacciatore et al. 2018; education professionals and parents of 1–6-year-olds are
Sandnabba et al. 2003; Volbert 2000). In studying and critical of childhood SE because of connotations of the
approaching children’s sexuality, the child’s view should be concept SE with adulthood sexuality and (2) to test
central and respected (Flanagan 2011, 2014; Mckee et al. 2010; whether an alternative term for comprehensive childhood
UN 1989). Childhood is a period of becoming familiar with SE, Kehotunnekasvatus [Body–Emotion Education], could
one’s body and feelings, building necessary socio-emotional reduce resistance to young children’s SE.
skills, self-esteem and body image, learning norms and
relationships, and seeking pleasure and safe closeness. The Method
content of SE for young children should respond to this need
The stepwise study plan is presented in Figure 1.
(Cacciatore, Korteniemi-Poikela & Kaltiala 2019; United
Nations Educational, Scientific and Cultural Organization
UNESCO, 2009; United Nations Population Fund UNFPA Two online studies
2014; WHO Regional Office for Europe and BZgA 2010). In To gain an overview of the situation, obstacles and needs
our survey study among early childhood education and care regarding childhood SE in Finland, we first conducted two
(ECEC) professionals and parents of 1–6-year-olds, the most online surveys of ECEC professionals (study A) and parents
commonly observed sexuality-related verbal expressions of 1–6-year-olds (study B) (Figure 1). The surveys explored
among children were comments on the body, and the most adults’ experiences of, thoughts on and attitudes to sexuality
commonly observed sexuality-related behaviours were and SE among 1–6-year-old children.
openly displayed emotions such as infatuation for one other
(Cacciatore et al. 2020). Hence, young children’s SE should
Participant selection for the online studies
provide especially knowledge, skills and positive attitudes
about the body and showing emotions. • ECEC professionals. In May 2013, via e-mail, we asked (1)
the person who organises training days for ECEC
Many barriers have blocked the implementation of SE for professionals, (2) the person who organises the nationwide
young children, among them erroneous cultural beliefs, annual trade fair on ECEC and (3) municipal district
myths, fear and ignorance. In our clinical experience, managers of ECEC to forward a link to our Questionnaire
common objections include that children are not fertile A to professionals in the field (Cacciatore et al. 2020).
and therefore need not know about sexuality, that any
information destroys childhood innocence and that SE is
Parcipants of the naonwide situaon-analysis studies A and B
conducive to sexual abuse, promiscuity, sex or childbirth
at an early age. ‘Let them be kids!’ and ‘Sex and a child do A. Early educaon and care
professionals and preschool B. Parents of 1-6-year olds,
not fit in the same sentence!’ are adages, by which adults teachers of 1-6-years olds, n = 614 in 2014
want to protect their children against too-early information n = 507 in 2013

on sex, which is what they fear SE to be. In both parents

and professionals, this has caused ambivalence about Idenfying crical comments towards the concept SE from open quesons
childhood SE and provoked emotional argumentation,
reluctance and an urge to reject the topic (Davies & Robinson
Construcng the new term for childhood SE
2010; Flanagan 2011; Ketting et al. 2018). This has suppressed
sensible discussions around childhood SE (Goldman 2013;
Merghati-Khoei, Abolghasemi & Smith 2014). C. Parcipants tesng the new term

Early educaon and

Sexual health specialists Public health nurses
Misunderstandings about the content of age-matched SE care professionals and
at the Family Federaon from municipality of
preschool teachers from
may hinder its implementation. It is of utmost importance of Finland
municipality of Espoo
Rovaniemi
n = 17 in 2014 n = 29 in 2017
that all adults, regardless of background, education and n = 63 in 2015
literacy, gain knowledge of what young children’s SE
should be. Language creates reality. The simplicity of the SE, sexuality education.
concepts used is crucial. The first obstacle to understanding FIGURE 1: Flow chart.

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• Parents. In May 2014, we invited parents of 0–6-year-olds but we won’t call it SE’. ‘In my opinion, childhood sexuality
to respond to web-based Questionnaire B through is the wrong word and gives the wrong impression’. In the
the web pages of (1) the Family Federation of Finland, deductive or directed thematic content analysis, we read
(2) one baby magazine, (3) one family magazine and the material through again, searching for comments that
(4) one tabloid. criticised, misunderstood or challenged more the term
‘sexuality education’ than the education. A presentation of
For both studies, we set the response time at two weeks. In this criticism appears in the ‘Results’ section.
our covering text, we stated that participation was
voluntary, and all data would remain anonymous. We An alternative term for childhood sexuality
deemed responding to the web-based questionnaire to be education
informed consent. No responses were excluded because of Secondly, we examined the possibility of replacing the
inappropriate language. The University of Helsinki Ethical Finnish term for ‘sexuality education’ for this age group in
Review Board in the Humanities and Social and Behavioural order to distract attention from adult-like sexuality and
Sciences approved the parents’ study. We carried out the better reflect the content of childhood SE. We constructed a
studies following the principles of the Declaration of new term based on the most common topics of children’s
Helsinki. verbal expressions and behaviours related to SE themes in
day care (Cacciatore et al. 2020). Over 50% of professionals
Questionnaire design for online studies A and B and parents had stated that children in the groups they
Our web-based survey on adults’ reflections on sexuality taught or at home asked daily or weekly questions about
and SE among 1–6-year-old children was based on the different body parts and their functions (such as the navel,
comprehensive educational model in the Standards for ear, ‘willy’/genitals, buttocks) and hygiene (such as the
Sexuality Education in Europe (WHO 2010). The questionnaires appropriate way to clean the buttocks/genitals, teeth and
comprised multiple-choice questions on all topics of the hands). Over 50% of professionals and parents had stated
standards. The survey questionnaire for professionals (A) that children talked daily or weekly about liking, infatuation
presented 91 multiple-choice statements/questions and or love for other children or familiar adults (Cacciatore et al.
13 open-ended questions, and the survey questionnaire 2020). On the behavioural level, children were most
for parents (B) included 85 multiple-choice statements/ commonly observed to express their emotions easily and to
questions and 25 open-ended questions. In the open-ended show lots of feelings of infatuation, affection and liking
questions, the respondents were asked to report their towards each other, for example, by ‘kiss chase’ games. All
these related to the SE topics ‘The Body’ and ‘Emotions’ in
experiences of, thoughts on and attitudes to sexuality and
The Standards (WHO 2010). We, therefore, decided to call
SE among 1–6-year-old children (Appendix 1).
young children’s SE, Kehotunnekasvatus [body–emotion
education], to focus on their major expressions and interests.
The first data analysed for the present study were the
responses to the open-ended questions in the surveys for
professionals (A) and parents (B). Testing the new term
To test the new term’s acceptability and usefulness as an
Participants and attrition alternative to SE in the youngest age groups, we conducted
surveys among three different groups of professionals.
The professionals’ questionnaire (A) was opened 267 times
We formulated a written questionnaire (C) to assess the pros
without being completed and filled in 507 times, yielding
and cons of the new term.
a response rate of 65%, whereas the questionnaire for
parents was opened 1888 times without being completed
and filled in 614 times, giving a response rate of 25%. The Participants testing the new term
same person may, however, have opened the questionnaire Early childhood education and care professionals:
several times before answering. The distribution of both Respondents were professionals in ECEC in southern
groups represented the population of Finland across Finland. They worked daily in kindergartens and/or
demographic characteristics. preschools with 1–6-year-olds and their parents, usually
without training or guidance in SE. We distributed
Questionnaire C during a training day on aggression
Data analyses management skills. One of the researchers was present,
We analysed the open-ended questions in Questionnaires explained the study and collected the completed
A and B qualitatively, first inductively and then deductively. questionnaires. The response rate was 95% (n = 63).
Inductive and deductive reasoning approaches in the process
of qualitative data analysis are described by Elo and Kyngäs Public health nurses (nurses): Respondents worked in
(2008:107–115). In the inductive analysis, we conventionally Northern Finland and in their daily work met both young
read the material several times to understand the pros and children and their parents. The nurses had some training
cons of children’s SE. Surprisingly, the term ‘sexuality and instruction on counselling about childhood sexuality. We
education’ was one target of criticism: ‘We do educate, distributed Questionnaire C to these nurses before a training

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day on childhood SE. Two of the researchers were present, considered positive to the new term, and response alternatives
explained the study and collected the completed 4 and 5 negative. In addition, there was one open item: ‘You
questionnaires. The response rate was 90% (n = 29). may write your thoughts here’.

Sexual health specialists (specialists): The respondents

Data analysis
(n = 17) implemented SE in their work in the same
non-governmental organisation, the Family Federation of The proportions of those positive and negative to the new
Finland (Väestöliitto), where two of the researchers worked. concept on each question among the ECEC professionals,
The specialists worked as sexuality counsellors, therapists, nurses and specialists were compared by cross-tabulations
social workers and healthcare professionals. They promoted with Fisher’s exact test statistics. We did statistical
SE or counselled mainly adolescents and adults. They often analysis using IBM Statistical Package for Social Sciences
addressed sexuality in their work when people sought help statistics for Windows version 25 (IBM Corp., Armonk,
for their problems. Only five of the specialists were New York). Statistial significance was set at p < 0.05.
counselling or producing material on childhood sexuality.
We distributed Questionnaire C by internal mail. After one Finally, the comments expressed in the open-ended question
reminder, the response rate was 100%. will be described.

Participation was voluntary, and all data were anonymous. Ethical consideration
We deemed responding to the anonymous questionnaire
to be informed consent. No responses were excluded because The University of Helsinki Ethical Review Board in the
of inappropriate language. We conducted the studies Humanities and Social and Behavioural Sciences approved
following the principles of the Declaration of Helsinki. the parents’ study (B). The authors confirm that ethical
clearance was not needed/required for the studies A
and C.
Questionnaire C
In Questionnaire C, we introduced the new term as a possible Results
alternative to ‘sexuality education’ for 1–6-year-olds. The
new concept would stress providing age- and development-
Criticism of the terms ‘childhood sexuality’
appropriate SE following the instructions of The Standards
and ‘childhood sexuality education’
(WHO 2010). We also noted that what was central in this age
in Questionnaires A and B
group was becoming confident about one’s own body, In responses to Questionnaires A and B (Appendix 1),
learning to control emotions, learning safety skills and altogether 27 comments about the terms ‘childhood
acquiring the skills to negotiate about these. sexuality’ and ‘sexuality education’ were identified, and
they were all critical: 9 from professionals, 18 from parents
Questionnaire C consisted of seven questions with Likert scale (Table 1). Such critical comments were found in response
alternatives (Table 2): ‘Do you think that the new term to the following questions:
Kehotunnekasvatus [body–emotion education] as an alternative • Adults’ attitudes to, thoughts on and experiences of
for use in young children’s SE is appropriate, necessary, easy/ childhood sexuality
difficult to use, suitable for parents, suitable for professionals, What forms of expressing themselves and games that you
better/worse than SE, and you would/would not use it’. In all consider sexual have you observed among children? What
questions, responses ranged from 1 (positive to the new term; type of emotional responses does childhood sexuality raise in
‘easy to use’, ‘appropriate’, ‘I would use’, etc.) to 5 (negative to you? What kind of sexual behaviour do you think is
the new term; ‘difficult to use’, ‘inappropriate’, ‘I would not acceptable for a child, and what kind of behaviour requires
use’, etc.). In the analyses, response alternatives 1 and 2 were intervention? Please also justify your answer.

TABLE 1: Types of critical comments on the terms of childhood sexuality and childhood sexuality education among early education professionals responding in online
surveys (Questionnaires A and B, respectively) on childhood sexuality and childhood sexuality education.
Type of criticism n Example
1. No ‘sexual tone’ was observed in children’s actions 8 ‘Masturbation and “fingering” refer to sexual caressing of oneself, but for the child it is
not “sexual”. Good instructions and terms are needed for professionals to be able to
provide information in the right way, even to parents’. (ECEC professional’s comment)
2. Children’s actions are natural, not ‘sexual’ 7 ‘I don’t see the words young child and sexuality at all in the same context. There are
natural things about one’s own body and also other things are natural, and we talk
about them always, when they arise’. (Parent)
3. The word ‘sexuality’ has inappropriate connotations with adult-like sexuality 6 ‘It’s hard to think and talk about sexuality education, because “sexuality” as a word is
very adult-like and that, combined with children, gives rise to unpleasant connotations,
even though I know it means something completely different’. (Parent)
4. ‘Sexuality education’ is too complicated as a concept for children 5 ‘The concept sexuality education sounds unnecessarily official, but on the other hand
it conveys the importance of the subject’. (Parent)
5. Children already receive too much sexuality-related information 1 ‘We live in a world so full of sex that at first glance the whole idea of children’s
sexuality education is terrifying’. (ECEC)
ECEC, early childhood education and care.
Note: Education professionals (n = 507) and parents of 1–6-year-olds (n = 614) responding in online surveys.

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• Adults’ attitudes to, thoughts on and experiences of natural, not ‘sexual’; (3) the word ‘sexuality’ has inappropriate
childhood SE connotations with adult-like sexuality; (4) ‘SE’ is too
What are your thoughts on SE for young children? What are complicated as a concept for children; and (5) children
the difficult topics in SE? How do you implement childhood already receive too much sexuality-related information.
SE? How do you act in a situation where the child expresses Table 1 shows examples of the critical comments.
sexuality? Please give examples. Is there anything else you
would like to mention?
Acceptance of the new term
We categorised these comments in order of prevalence into The alternative term for childhood SE, Kehotunnekasvatus
five mutually exclusive groups: (1) no ‘sexual tone’ was [body–emotion education], was subsequently introduced to
observed in children’s actions; (2) children’s actions are three groups of professionals in Questionnaire C. Acceptance

TABLE 2: The opinions of early childhood education and care professionals, nurses and specialists towards the new term ‘body–emotion education’.
Question ECEC professionals Nurses Specialists p
n % n % n %
Appropriateness 0.089
1 (appropriate) 29 47.5 15 51.7 5 29.4
2 21 34.4 13 44.8 5 29.4
3 7 11.5 1 3.4 5 29.4
4 4 6.6 0 0.0 2 11.8
5 (inappropriate) 0 0.0 0 0.0 0 0.0
Necessity 0.429
1 (necessary) 25 41.0 16 55.2 4 23.5
2 18 29.5 7 24.1 6 35.3
3 13 21.3 4 13.8 4 23.5
4 3 4.9 2 6.9 1 5.9
5 (unneeded) 2 3.3 0 0.0 2 11.8
Ease of use 0.042*
1 (easy) 19 30.2 8 28.6 0 0.0
2 21 33.3 12 42.9 7 41.2
3 11 17.5 5 17.9 2 11.8
4 11 17.5 3 10.7 6 35.3
5 (difficult) 1 1.6 0 0.0 2 11.8
Suitability for parents 0.012**
1 (suitable) 27 44.3 15 51.7 5 29.4
2 17 27.9 12 41.4 3 17.6
3 10 16.4 2 6.9 7 41.2
4 7 11.5 0 0.0 2 11.8
5 (unsuitable) 0 0.0 0 0.0 0 0.0
Suitability for professionals 0.264
1 (suitable) 37 58.7 19 65.5 7 41.2
2 17 27.0 7 24.1 5 29.4
3 2 3.2 2 6.9 2 23.5
4 6 9.5 1 3.4 1 5.9
5 (unsuitable) 1 1.6 0 0.0 0 0.0
Better than ‘sexuality education’ 0.149
1 (better) 31 49.2 12 41.4 3 17.6
2 17 27.0 7 24.1 5 29.4
3 11 17.5 7 24.1 4 23.5
4 3 4.8 3 10.3 4 23.5
5 (worse) 1 1.6 0 0.0 1 5.9
Attitude to using 0.031***
1 (I would use) 39 61.9 18 62.1 6 35.3
2 15 23.8 5 17.2 3 17.6
3 4 6.3 6 20.7 3 17.6
4 2 3.2 0 0.0 3 17.6
5 (I would not use) 3 4.8 0 0.0 2 11.8
Note: Likert-scale response alternatives ranged from 1 to 5.
*, ECEC professionals vs specialists, p = 0.010; nurses vs specialists, p = 0.013.
**, Nurses vs specialists, p = 0.001.
***, ECEC professionals vs specialists, p = 0.036; nurses vs specialists, p = 0.039.

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of the new term was excellent, as shown in Table 2. The Some respondents also proposed alternative concepts in
majority of all respondents considered it appropriate Finnish.
(82%, 97%, 59%, respectively, among ECEC professionals/ ‘Should we call the topic ‘me and others?’ (Specialist)
nurses/specialists), necessary (70%, 79%, 59%) and usable in
their work (86%, 79%, 53%). Only two specialists (12%) and Two comments described a practical experience:
5% of ECEC professionals, but none of the nurses, reported
‘Although child SE is clear to me, and I view it as important,
that they could not use the term at all.
parents do not. For me, child SE supports a positive self-image
and underscores the importance of solid and safe intimacy.
A majority of ECEC professionals (63%) and nurses (71%),
In practice, discussing child sexuality with parents always
but fewer SE specialists (41%), considered the new term raises concerns. Parents are aware of and concerned about it
easy to use. Likewise, 76% of ECEC professionals and 65% because they want to protect their children from bad
of nurses in the field considered the new term even information. Some parents become anxious or angry. In the few
better than ‘sexuality education’, whereas of the specialists, moments dedicated to discussing it, more time is spent
47% considered it better. clarifying and explaining the concept of ‘SE’ and calming
parents’ negative emotional responses than discussing what to
Eighty-six per cent of ECEC professionals, 90% of nurses teach children.’ (Specialist)
and 71% of specialists considered the new term suitable for ‘The theme of ‘taboo’ hit close to home when I started my job at
professionals’ use. The suitability of the new term for use the clinic. We carry out a process: a selection of themes that
with parents caused more division of opinion: of the nurses, should be brought up at the visits. Once, a really nice 4-year-old
93% considered it suitable for parents to use; of the ECEC boy came with his dad. We talked really naturally. Then I asked,
professionals, 73%; but of the specialists, only 47%. ‘How does he express his sexuality?’ The dad froze on the spot.
However, no one found the new term totally unsuitable for He tensed up. He asked what I meant by that! I tried to explain.
use with parents. The rest of the visit was very stiff. I thought I shouldn’t have
used the word ‘sexuality’. That gave him a totally wrong
The differences between the groups were statistically impression! I haven’t actively brought up the subject since. Only
if a family brings it up first.’ (Nurse)
significant in concepts of ease, attitude toward use and
suitability for use with parents (Table 2).
Discussion
To the open-ended item in Questionnaire C, we received Sexuality education is vital for supporting children and
opinions from 12 specialists and 4 ECEC professionals and
young people in their sexual and general development. It
4 nurses.
enables them to increase their knowledge of sexual and
reproductive health and rights and to develop their decision-
Of these, some comments highlighted the benefits of the
making, communication and risk-reduction skills, as well as
new term:
positive and responsible attitudes to sexuality and
‘Body–emotion education’ as a concept may perhaps more relationships (WHO 2017). The objective of the present study
clearly reflect or describe the content. I think that using it will
was to explore criticism expressed towards childhood SE, to
make it easier to approach a subject which may otherwise
be difficult to address.’ (Nurse)
present an alternative concept for childhood SE and to test
this concept’s applicability among professionals working
‘Body–emotion education’ is more neutral and downplays
with children and in SE. This we did in order to reduce
thoughts of sex; it is more positive and may inspire parents to
think that this is important for their children … I could, as a
resistance and to accelerate the implementation of young
parent, use that. ‘Ordinary’ parents might need some time to children’s SE in Finland.
learn the term.’ (Specialist)
Our study suggested that one factor hindering childhood
Some comments favoured ‘SE’: SE was the negative adult-sexuality connotation of the
‘I think that a new term will confuse parents even more. term ‘sexuality education’. The term ‘sexuality’ was
I would explain these already familiar concepts more considered unsuitable when applied to 1–6-year-olds. To
thoroughly.’ (Specialist) overcome this, we formulated and tested a new child-
‘Is there a shortcut in this matter? I think not. You just have to centred term to replace the term ‘sexuality education’ for
open up SE and sexuality concepts.’ (Specialist) use with young children, however with the same content
and meaning as the age- and developmentally appropriate,
Some respondents shared pros and cons: comprehensive SE recommended in the WHO’s Standards
‘In the beginning, the new concept felt “stiff”, but I believe for Sexuality Education (2010) for young children. The new
that when it becomes more familiar, this may increase its term derived directly from observations of what sexuality-
“flexible use”. I agree that SE concept among young children related content emerges in young children’s everyday
needs a new concept. Wonderful that this matter is been verbal expressions and behaviour, underlined the age- and
addressed and a new term is being developed.’ (ECEC developmental appropriateness of the education as
professional) opposed to teaching adult-centred sexual topics to minors
‘Both are good words. SE needs more explaining.’ (Nurse) (Cacciatore et al. 2020).

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The healthcare and ECEC professionals indicated Nevertheless, children play sexual games and ask abundant
acceptance of the new term. The majority of all questions in day care (Cacciatore et al. 2020; Larsson & Svedin
respondents considered it necessary, appropriate, usable 2002; Sandnabba et al. 2003), where professionals need to
in their work and suitable for professionals. Moreover, the make spontaneous decisions about what are developmentally
majority of ECEC professionals and nurses working daily and culturally correct and health-promoting, age-appropriate
with parents considered the new term better than SE, easy answers to infants and with a wide diversity of children
and suitable for use with parents. The new term was (Davies, Glaser & Kossoff 2000; Leander et al. 2018). They
welcomed more positively by professionals in daily need tools and competencies to enhance parents’ and co-
contact with parents of young children than by specialists workers’ knowledge and acceptance of the subject and to
working daily with sexual issues. foster children’s rights and healthy development. Using
simple language is one means to promote health literacy
(Geboers et al. 2018).
Connotations of adulthood – A major obstacle
Our online studies indicated that one factor impeding the The sexual health specialists found the new term easy to use
implementation of childhood SE in Finland was the significantly less often and expressed less commonly
adulthood connotation of the term ‘sexuality’. Our finding positive attitudes towards using it. The specialists’ work
concurs with those of studies in Europe, New Zeland, was different from what the other professionals did among
Australia and the United States of America showing that for families with young children. They met people who were
many adults the words ‘children’ and ‘sexuality’ are prepared to discuss sexuality-related topics. Many
incompatible and have risky connotations (Brilleslijper- specialists preferred to use the term ‘sexuality education’
Kater & Baartman 2000; Flanagan 2014; Hornor 2004; and to make it more known, as Goldman also found to be
Robinson, Smith & Davies 2017). ‘Sexuality’ in the standard the case in Australia (2013). The specialists’ viewpoint may
language is associated with sex and reproduction (Flanagan be biased by a lack of experiences of obstacles in the field.
2014; Kurtuncu et al. 2015). Our findings are in line with
those presented by Leander, Larsen and Munk (2018), who Child-centred concepts
quoted a kindergarten director: ‘When children play doctor
Words create associations, images and emotions. Because of
games, they don’t think of it as something sexual. The the sensitive nature of childhood SE, professionals may need
thoughts of the adults/parents make it something bad’. words to explain child sexual development and behaviours
Adulthood-connected misunderstandings impede the to parents while avoiding harmful misunderstandings. The
promotion of SE in childhood and even negotiations about difference of childhood sexuality from that of adults becomes
it among parents and professionals (Flanagan 2011; Kaeser, more noticeable using age-specific concepts.
DiSalivo & Moglia 2000; Merghati-Khoei et al. 2014). For
this reason, the topic is frequently avoided and overridden Adult words lead to adult-like ideas of children’s
in everyday life. behaviour (Flanagan 2014). LeFrancois (2013) talked about
adultism as adult-centric policies and practices harming
Taboos associated with the word ‘sexuality’ even impede children’s lives. Adultism results in disadvantage and
SE for adolescents (Walker & Milton 2006), and using less oppressive social relations. In the case of sexual health,
sex-loaded terms such as ‘health education’, ‘relation adultism prevents children from receiving the education,
education’, ‘life-skills education’ or ‘youth education’ has information and protection they need and are entitled to
often been necessary in order to initiate SE (Ketting et al. (UN 1989). The ECEC professionals’ perturbation,
2018). Sexuality education for young children is even more confusion and distress regarding the term ‘sexuality’
taboo. The time intended for guiding parents to provide contributes to refusal to implement childhood SE
appropriate SE was often wasted in explaining the term (Merghati-Khoei et al. 2014). In a study in the United
and calming abrupt responses, emphasised some Kingdom, parents felt that they were interpreting some
respondents in our study. Parents were easily alarmed, behaviours and questions from their 3–7-year-old children
and fear and erroneous beliefs were common, as also using adult sexual scripts rather than considering the
claimed by Robinson et al. (2017). context from the child’s perspective (Stone et al. 2013).
Flanagan (2014) noted that parents, teachers and social
workers frequently named children’s actions from their
Professionals’ acceptance of the new term adult perspectives on sexuality, which led to adult
Early childhood education and care professionals and nurses constructions and judgements of childhood sexuality.
expressed a marked preference for the new term over
‘sexuality education’. Possibly they had experiences of One problem impeding the promotion of childhood SE has
obstacles to discussing childhood sexuality with parents and been the lack of terms free from adulthood connotations.
co-workers, who were unprepared and lacked training to Child-centred frames of sexuality, created with child-
understand and to negotiate about childhood sexuality centred words, may enable ECEC professionals, parents
and SE, under several misapprehensions and harbouring and policymakers to negotiate and plan childhood SE
prejudices. without serious negative prejudice.

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In some languages, words describing childhood sexuality are Limitations and strengths
different from those applied to adults or adolescents. This
A limitation of the online studies is that we do not know
makes it easier for parents to understand that childhood
how widely the links to Questionnaires A and B were
sexuality is different (Cacciatore et al. 2019). For example, the
distributed. We know how many times the link was
term ‘masturbation’ may be offensive to parents unfamiliar
opened, but we do not how many individuals received the
with the concept of sexuality in young children (Mallants &
link without opening it. Individuals uncomfortable with
Casteels 2008; Nechay et al. 2004). Using words such as ‘self-
sexuality issues may have avoided the study, resulting in
soothing’ have been shown to be more acceptable. In fact,
a bias towards respondents willing to communicate about
childhood masturbation is mostly aimed at calming (Mallants
sexuality.
& Casteels 2008; Sandnabba et al. 2003) as opposed to
becoming excited. Unnutus is a new Finnish term to refer
The results in testing the new term are preliminary as the
to childhood masturbation, introduced by the Family
respondent groups were small, and we tested a new Finnish
Federation of Finland 2000 (Cacciatore & Korteniemi-Poikela
term among Finnish professionals. The new term may not be
2000). It stems from the Finnish word for ‘sleep’. To refer to a
directly transferable to other languages.
child’s genitals, there are already traditional words in
everyday Finnish, pimppi [girls’ genitals] and pippeli [boys’
The new term, Kehotunnekasvatus, was built on extensive
genitals]. Similarly, in Swedish there are snippa and snopp, in
research among ECEC and parents.
Estonian tussu and noku. Children’s genitals look different
and function differently from those of adults; thus, it is
natural to use different words to refer to them. Similarly, a Conclusion
special term can make childhood SE easier for parents to Our study showed that simple, quick and creative methods
understand and accept. such as finding new and less adulthood-connected terms
can be introduced to overcome resistance towards childhood
Child-centred words are not euphemisms, but options and SE. Healthcare and education professionals welcomed the
synonyms for describing childhood sexuality. Child-specific new term, especially those working daily with parents of
terms highlight that children have their own kinds of bodies, young children.
experiences, intentions, perspectives and needs. Using
different words for children’s sexuality is not a repressed, Parents and teachers of young children need support and
evasive or euphemistic representation, but can help adults information to understand the content and importance of
to see the difference and to overcome their rejections, comprehensive age-appropriate SE for young children.
misunderstandings and objections. Nearby adults’ ability and capacity to provide SE is crucial
for children’s safety and well-being. Promoting health
The implementation of the new term in Finland literacy uses methods such as reformulating health
information to make it better understood.
The Family Federation of Finland has introduced the new
term, ‘body–emotion education’, on its Child and Sexuality
Policymakers, educational and health authorities, and
webpages, in materials, training sessions and in the media
specialists must make agreements to offer young children
since 2015. At the end of 2019, a Google search yielded over
accurate SE. New, developmentally appropriate terms can
30 000 hits.
facilitate these negotiations.
In October 2016, the new National Core Curriculum for Early
More studies are needed to identify the obstacles to
Childhood Education and Care was delivered, which for the
childhood SE in different countries. In terminology,
first time was an official and binding document based on the
idiomatic expressions may be needed for different
legislation (Finnish National Agency for Education 2018).
languages.
Each municipality was required to draw up local curricular
and qualification requirements based on the national
document, to outline how the objectives are to be achieved. Acknowledgements
In 2017, the Family Federation of Finland encouraged all Part of this study was presented at the EURAPAG 2017,
municipalities to implement SE in their local curricula, at the 14th European Congress of Paediatric and Adolescent
same time introducing the new term. As a result, at least Gynaecology. 7th–10th June 2017, Vilnius, Lithuania.
21 municipalities out of the 311 in Finland included SE as a Cacciatore, R., Ingman-Friberg, S., Apter, D. & Sajaniemi, N.,
part of their mandatory local curricula – 18 using the new ‘Can alternative words for describing childhood sexuality
term alone or together with SE. These municipalities cover education reduce common resistance?’
37% of Finnish 0–6-year-olds.

Two Finnish Members of Parliament tabled a written Competing interests

question to the Speaker of Parliament on body–emotion The authors declare that they have no financial or personal
education and the prevention of sexual harassment starting relationships that may have inappropriately influenced them
in early childhood education in December 2017. in writing this article.

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 Page 9 of 10 Original Research

Authors’ contributions Josephs, L., 2015, ‘How children learn about sex: A cross-species and cross-cultural
analysis’, Archives of Sexual Behavior 44(4), 1059–1069. https://doi.org/10.1007/
s10508-015-0498-0
The research was performed by R.C. and was supervised
Kaeser, F., DiSalvo, C. & Moglia, R., 2000, ‘Sexual behaviors of young children that
by S.I.-F., D.A., N.S. and R.K. All authors contributed to the occur in schools’, Journal of Sex Education and Therapy 25(4), 277–285. https://
doi.org/10.1080/01614576.2000.11074361
writing of this article.
Ketting, E., Brockschmidt, L., Renner, I., Luyckfasseel, L. & Ivanova, O., 2018, ‘Sexuality
education in Europe and Central Asia: Recent developments and current status’, in
R.A. Benavides-Torres, D.J. Onofre-Rodrigues, M.A. Marquez-Vega & R.C. Barbosa-
Funding information Martinez (eds.), Sex education, pp. 75–120, Nova Science Publishers, Hauppauge,
New York, NY.
This work was partially supported by the Finnish Cultural Kurtuncu, M., Akhan, L.U., Tanir, I.M. & Yildiz, H., 2015, ‘The sexual development and
Foundation (170158). education of preschool children: Knowledge and opinions from doctors and nurses’,
Sexuality and Disability 33(2), 207–221. https://doi.org/10.1007/s11195-015-9393-9
Larsson, I.B. & Svedin, C.G., 2002, ‘Teachers’ and parents’ reports on 3- to 6-year-old
children’s sexual behavior – A comparison’, Child Abuse and Neglect 26(3),
Data availability statement 247–266. https://doi.org/10.1016/S0145-2134(01)00323-4
Leander, E.M.B., Larsen, P.L. & Munk, K.P., 2018, ‘Children’s doctor games and nudity
Original data set available from the first author by request. at danish childcare institutions’, Archives of Sexual Behavior 47(4), 863–875.
https://doi.org/10.1007/s10508-017-1144-9
LeFrancois, B.A., 2013, ‘Adultism’, in T.S. Teo (ed.), Encyclopedia of critical psychology:
Disclaimer Springer reference, pp. 1–4, Springer-Verlag, Berlin.
Mallants, C. & Casteels, K., 2008, ‘Practical approach to childhood masturbation – A
The views and opinions expressed in this article are those of review’, European Journal of Pediatrics 167(10), 1111–1117. https://doi.
org/10.1007/s00431-008-0766-2
the authors and do not necessarily reflect the official policy or
McKee, A., Albury, K., Dunne, M., Grieshaber, S., Hartley, J., Lumby, C. et al., 2010,
position of any affiliated agency of the authors. ‘Healthy sexual development: A multidisciplinary framework for research’,
International Journal of Sexual Health 22(1), 14–19. https://doi.org/​
10.1080/19317610903393043
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Appendix starts on the next page →

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Appendix 1
TABLE 1-A1: All open-ended questions in studies A and B.
What are your thoughts on sexuality education for small children? (A, B)
What type of emotional responses does childhood sexuality raise in you? (A, B)
What forms of expressing themselves and games that you consider sexual have you observed among children? (A, B)
How do you implement childhood sexuality education in your work/in your role as the grown-up of the family? (A, B)
How do you act in a situation where the child expresses sexuality? Please give examples. (A, B)
Have you observed any behaviour of a child that may be due to some negative sexuality-related experience of the child? Please describe. (A, B)
What kind of sexual behaviour do you think is allowed for a child and what type of behaviour should be intervened with? Please also justify your answer. (A, B)
What other topics related to children’s sexuality did you miss in your training? (A)
On what other topics would you like to get additional material for childhood sexuality education? (A)
What do you think about if the gender of a child is concealed from the child and the environment before school age? Have you any experiences with this? (A)
According to your experiences, are children allowed to play gender-typical games as well as games typical for the opposite gender (e.g. the boys may play both pirate games and
princess games)? (A)
How is sexuality education provided in homes? Do parents have enough knowledge and skills to provide age-appropriate sexuality education? (A)
In your opinion, how is sexuality education provided in early childhood education and care? Do you think professionals have enough knowledge and skills to implement
age-appropriate sexuality education? (B)
What are the difficult topics in sexuality education? (B)
Have you received support and helpful information from a child welfare clinic about children’s sexuality education? Please give examples. (B)
How was sexuality education provided at your childhood home? Please give examples. (B)
If you wish, express what word you use for the boy’s and the girl’s genitals. (B)
Have you any knowledge or training on how to provide sexuality education for young children? Please indicate what. (B)
Is there anything else you would like to mention? (A, B)
A = early childhood education and care professionals (n = 507); B = parents of 1–6-year-olds (n = 614).

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