Pediatricians

Pediatricians are responsible for providing care to the most diverse developmental group among doctors, as they provide care to neonates, infants, children, and adolescents. As the first provider in a child’s life and most relied upon point of contact for parents, Pediatricians are at an advantage to provide comprehensive sexuality education to children across their entire childhood. In addition to treating clients for health-related issues, researchers have noted that pediatricians are often the first resource families utilize when seeking supports for mental health care.

With a focus on childhood wellness, the American Academy of Pediatrics and Bright Futures developed a set of comprehensive health guidelines for well child care, known as the periodicity schedule. Well child visits provide Pediatricians with recommendations for preventative care through a child’s life and are an opportunity to provide caregivers with the supports to check in on a child’s development. Spanning from birth to 21, there are a total of 32 visits which consist of specific recommendations.

Well child visits not only provide recommendations for physical development, but also encompass standards of care related to the social, emotional, and sexual health and development of children. Sexuality education topics have been integrated into the well child visits by the American Academy of Pediatrics that are founded on evidence-based education.

Clinical Guidances for Pediatricians

Breuner and Mattson (2016) with the support from the Committee on Adolescence and Committee on Psychosocial Aspects of Child and Family Health, created the following clinical guidance for pediatricians:

The pediatrician should encourage early parental discussion with children at home about sexuality, contraception, and Internet and social media use that is consistent with the child’s and family’s attitudes, values, beliefs, and circumstances.
Diverse family circumstances, such as families with same-sex parents or children who identify as lesbian, gay, bisexual, transgender, or questioning, create unique guidance needs regarding sexuality education.
Modeling ways to initiate talks about sexuality with children at pertinent opportunities, such as the birth of a sibling can encourage parents to answer children’s questions fully and accurately.
Parents and adolescents are encouraged to receive information from multiple sources, including health care providers and sexuality educators, about circumstances that are associated with earlier sexual activity. Adolescents are encouraged to feel empowered through discussing strategies that allow for practicing social skills, assertiveness, control, and rejection of unwanted sexual advances and cessation of sexual activity when the partner does not consent.
Discussions regarding healthy relationships and intimate partner violence can be effectively included in health care visits.
Pediatricians are encouraged to acknowledge that sexual activity may be pleasurable but also must be engaged in responsibly.
Specific components of sexuality education offered in schools, religious institutions, parent organizations, and other community agencies vary based on many factors. The pediatrician can serve as a resource to each.
School-based comprehensive sexuality education that emphasizes prevention of unintended pregnancy and STIs should be encouraged.
The discussion of methods of contraception and STI and HPV cancer prevention with male and female adolescents is encouraged before the onset of sexual intercourse (see the AAP statement “Contraception and Adolescents”). It is also important to discuss consistent use of safer sex precautions with sexually active teens. Bright Futures recommendations can be used.
Abstinence is the most effective strategy for preventing HIV infection and other STIs, as well as for prevention of pregnancy.
Preparation for college entry is an excellent opportunity for pediatricians to address issues such as the effects of alcohol, marijuana, and other drug consumption on decisions about safe, consensual sexual practices.
Children and adolescents with special issues and disabilities may benefit from additional counseling, referrals, and sharing of online resources.

The Pediatrician’s Role as a Comprehensive Sexuality Educator

There are several ways pediatricians can educate and support their clients’ sexual health. Framing every interaction with a client as an opportunity to provide CSE and utilizing a strengths-based approach provide a framework for positive sexual development. , Pediatricians can also promote health and healthy decision-making and assist youth in identifying ways to reduce their risks. It is important for pediatricians to be knowledgeable of the stages of sexual development and be prepared to provide medically accurate information about sexual and reproductive health while also emphasizing the importance of healthy relationships. It is crucial for pediatricians to be knowledgeable about the laws of minor consent, confidentiality, and the legal issues surrounding adolescent sexual activity and reproductive services. Furthermore, it is important for providers to be sensitive of the age, race, ethnicity, gender, sexual orientation, disability, family structure, and lifestyle choices of their patients.

Logistical consideration pediatricians can take to support their clients may include creating a welcoming environment, providing walk-in or same-day appointments, having office locations that are accessible by public transportation, and creating a referral network for providers.

As pediatricians integrate sexual health check-ins into their well-child visits, collaborate and support the client’s caregivers with information about sexual health, utilize resources from the American Association of Pediatrics and continue to develop their referral network, pediatricians can provide continuous comprehensive sexuality education to their clients throughout the course of a child’s life.

Hodgkinson, S., Godoy, L., Savio Beers, L., & Lewin, A. (2021) Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting. Pediatrics. Jan; 139(1):
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5192088/
American Association of Pediatrics (2022). Recommendations for Preventative Pediatric Health Care.
Breuner, C, Mattson, G., Adelman, W., Alderman, E., Garofalo, R., Marcell, A. V., & Committee on Adolescence and Committee on Psychosocial Aspects of Child and Family Health. (2016). Sexuality education for children and adolescents. Pediatrics, 138(2).

Mihaly, L., Lambright, T., Chang, A. (2021). Adolescent Health Working Group: Sexual and Reproductive Health Toolkit for Adolescent Providers. San Francisco, CA.. Retrieved from: https://ahwg.org/download/sexual-and-reproductive-health-toolkit-for-adolescent-providers/

Ibid (2021).
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