How to Have Difficult Health Conversations With Your Kids

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We asked Dr. Brightman when and how to have these conversations so they make an impact.

When it comes to health, puberty, and the birds and the bees, kids pick up information everywhere. Whether they learn from their bunkmate at summer camp, a particularly dramatic episode of Grey’s Anatomy, or a factually inaccurate TikTok post, kids are constantly having to make determinations about what’s “normal” when it comes to their own bodies. That’s why, for parents, it’s crucial that your kids feel they have an open line of communication when it comes to questions surrounding their health. 

Our partners at Hologic have done some incredible research on women’s health around the world, and some of their findings prove we have quite a ways to go when it comes to making sure women have the resources and knowledge to lead long healthy lives. While this might seem like an insurmountable task, the first step in addressing this global issue is to make sure our own families are set up for success. Our resident women’s health expert, Dr. Rebecca Brightman, has already offered us some great information about how parents can encourage daughters to advocate for their own health. Now she’s back to talk about how and when to broach crucial conversations with your kids on topics like puberty, emotional health, and family health history.

KCM: At what point is it appropriate to talk to your kids about your family health history?

Dr. B: It’s so important to share family history — it’s one of the leading determinants of health. But these conversations can be really stressful for kids. Unless there’s some really extenuating circumstance, I don’t see any reason to tell a kid about a family history of cancer before they’re 18. I think it would create great anxiety. That said, kids are very perceptive. Maybe they have a classmate whose parent is sick, and they may ask questions. In that case, I think it’s important to tell kids that you’re going for screenings and you’re taking care of your health. I tell my patients to think about their bodies like a car: Taking it in for service every once in a while is just part of the deal. That’s how you should think about screenings, and it’s an easy way to explain it to kids, too. 

If you’re dealing with a cancer scare, that’s not something I suggest telling your kids until you absolutely have to. There’s no need to cause them undue anxiety. If you’re on top of your own wellness screenings, that will set a great example that they’re just a normal and necessary part of life. Only 12 percent of women worldwide reported being tested for cancer in the last 12 months. For those of us who have easy and available access to screenings, keeping on top of them is one of the best ways to show our kids the value and importance of preventative care.

Young adults — 18 to early 20s — will hopefully be able to appreciate and understand what a family history of cancer means, and how to use that information to keep themselves healthy. Depending on your family history and potentially on genetic testing results, you might have hereditary mutations that predispose you to have cancers at an early age. If that’s the case, and your child needs to have their first mammogram or colonoscopy when he or she is 25, then I’d have that conversation as your child approaches that age. 

At what age should you start to talk to your kids about puberty, and how do you broach that conversation?

For the puberty conversation, the most important thing for kids to know as they approach adolescence is that everyone is different. Changes are going to happen to their bodies, and maybe not at the same time as their friends, and that’s OK. Some girls can get their periods as early as nine or 10, so if you see your daughter is developing — usually it starts with breast buds and pubic hair — it’s time to initiate that conversation. Your pediatrician likely will too. Usually, menstruation is one of the last things to happen in pubertal development. I would suggest keeping it positive and factual — girls bleed once a month, and an unfertilized egg is released. This is a cool thing that happens to almost every biological female, and it’s totally normal. It starts for different girls at different ages and that’s normal too, but it can also tell women a lot about their overall health. 

As such, we need to educate girls that a period is an important vital sign to pay attention to. Missing a period can be an indicator of a health concern, like heightened stress, issues with nutrition, or a greater condition. Further, heavy periods or abnormal uterine bleeding can be indicative of a broader health issue, like polyps or uterine fibroids. Teaching girls to monitor their periods for irregularities will empower them to stay on top of their health and seek care sooner if needed. 

How do you know when it’s time for “the sex talk”?

I don’t think this concept of the uncomfortable “sex talk” you see on TV is realistic — this isn’t going to be a “one and done” conversation. When my kids were little, I got them age-appropriate, factually accurate books — there was one called It’s So Amazing: a Book about Eggs, Sperm, Birth, Babies, and Families. We went to a nature museum, where we watched a video about how animals procreate. Then when they were a little bit older, we had a book about the Tanner stages of development for girls and boys so they could see that the changes happening to their bodies were normal. 

Then when your child is a little bit older — say, in high school — and you want to talk to them about safe sex, you’ve already laid the groundwork for them to know about the science behind sex. One of my biggest pieces of advice is to never assume your child’s sexual orientation. Make it clear that no matter what gender he or she is attracted to, practicing safe sex is paramount. Even if pregnancy isn’t a risk, genital-to-genital contact puts you at risk for STIs. There should be no shame around getting tested for STIs at any age — it’s just a normal part of care for anyone who is sexually active. (STIs are incredibly common — a recent study found that one in five people in the U.S had an STI on any given day, and young people aged 15-24 account for 50 percent of all incident STIs, including chlamydia and gonorrhea.)

If you come from a culture or community that doesn’t speak openly about sex or health, how do you approach these conversations with your children? 

Thank goodness sex ed is part of most school curriculums. But there are certain cultures where it isn’t seen as appropriate to speak about sex, and unfortunately, that can lead to misinformation. For many parents, it can be hard to separate your own personal or cultural history from what’s right for your child. In those situations, I would make sure your kid has a great pediatrician he or she can speak with. Your child should be getting annual checkups, so they’ll hopefully have developed a relationship with their doctor. Even if you accompany your kid to the doctor, typically at some point the doctor is going to ask you to leave the room, and at that point, your child can ask clarifying questions and get accurate information. 

It’s also important to note that it’s not always a reluctance on the part of the parent that keeps them from having these conversations, but a lack of access to information and resources. On a national and global scale, we need to get better at figuring out how to provide care for underserved populations. [To learn more about the disparity in healthcare, check out Hologic’s project health equality.] 

There’s an emotional-health crisis that’s rampant, particularly among women — in fact, women’s emotional health is at its worst in 15 years. Can you explain the signs that your daughter might be struggling, and how to broach this subject in a way that won’t make them shut down?

These are really unprecedented times, and I think people are a lot more open to speaking about mental health than they’ve ever been. If your child isn’t talking to you, the first thing I would do is look for signs of changing behavior — not sleeping, sleeping way more than usual, changes in eating habits, weight loss or gain, lethargy, social withdrawal. Eating disorders are still a huge issue, particularly among girls. So if your daughter is losing weight, obsessing over food, or starts wearing baggy clothes, it’s important to intervene.

Any kind of underlying mental illness or anxiety has likely snowballed because of the pandemic.  I think kids really need routine, and unfortunately for most kids, that has gone out the door for the past two years. Some teens are having a lot of trouble trying to reintegrate themselves back into a normal social life. That can be very anxiety-provoking. As a parent, the best thing you can do is to make sure your child knows these feelings are normal, and listen to them.