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Research
August/September 2022 Vol 3 No 4 British Journal of Ch ild Health 183
© 2022 MA Healthcare Ltd
Increased sexual activity among younger children
is a global concern (MacBlain et al, 2017). It has
been reported that over 16 million teenage women
give birth each year, which accounts for around
11% of all births (Cook and Cameron, 2020).
Young people aged between 15 and 24 years also have the
highest rates of sexually transmitted infections (Hughes
and Field, 2015). According to a report by Ofcom
(2018), 41% of 3–4-year-olds and 67% of 5–7-year-olds
in the UK are now exposed to online pornography. is
exposure inuences the way children understand sex and
relationships and may encourage them to emulate what
they have seen (Martellozzo et al, 2016). Additionally,
a third of child sexual abuse is committed by other
children or young people (Hackett et al, 2016). erefore,
education about sex for young people is still a public
health and safeguarding priority.
Young people have a right to be informed about their
health and wellbeing, including education about sex and
relationships (Howe and Covell, 2005). Communication
between parents, particularly mothers, and children
provides a protective role in safer sex behaviour
(Widman et al, 2016). Parental connectedness is
also strongly associated with sexual health among
transgender and gender-diverse young people (Brown
et al, 2020). What is not clear, however, is the ideal age
to start addressing these topics, so that children begin
to understand the concepts and learn how to protect
themselves from harm. Early childhood is a period
of rapid growth in all areas of development. Primary/
elementary school-aged children are naturally curious
and have a strong desire to belong to a particular group,
seeking relationships outside of the family (Brigden et al,
2019). Children at this age appear to want their parents
to talk to them about sex (Byers et al, 2008; Pariera
and Brody, 2018). e purpose of the primary school
curriculum ‘Relationships Education, Relationships
and Sex Education and Health Education’ (Department
of Education [DfE], 2019) is to teach children about
the characteristics of healthy, positive relationships in
an age-appropriate way. However, teaching about the
Abstract
Background: Parental confidence and attitudes towards a young
child’s readiness to receive sex education are varied and complex.
There is growing global concern about increased sexual activity
among younger children and related discussions about how families
address sex education in the home.
Aim: The purpose of this study was to identify determinants of
parents’ communication about sex with their primary school-
aged child/ren.
Methods: The study employed a cross-sectional design for UK
parents with at least one child aged 5–11 years using an online
questionnaire which incorporated validated scales.
Findings: A total of 205 parents participated with a total of 405
children. Parents with more than one child were more likely to
have had a conversation with their child about sex and were more
confident in talking about the reproductive process and healthy
sexual relationships.
Conclusions: Parents with the confidence to engage children in
conversations about sex can support targeted risk behaviour,
pubertal development and sexuality.
Key words
Sex education, communication, child health, primary school,
parenting, attitudes to sex.
Jessica Jackson, public health research nurse, University of Derby, Derby, United
Kingdom
Dr Christine Rhodes, lecturer in counselling and psychotherapy, University of
Derby, Derby, United Kingdom
Dr Yasuhiro Kotera, associate professor, Faculty of Medicine & Health Sciences,
University of Nottingham, Nottingham, United Kingdom
Email: j.jackson2@derby.ac.uk
Parents’ attitudes towards
conversations with their
young children about sex:
A cross-sectional study
act of human reproduction or sex is not compulsory.
erefore, the decision is le to individual parents to
communicate or not with their primary/elementary
school-aged children. Parents rely on self-judgement or
are inuenced by friends and relatives: these can vary
greatly (Pop and Rusu, 2015).
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Research
184 British Journal of Child Health August/September 2022 Vol 3 No 4
© 2022 MA Healthcare Ltd
Parents aitudes
to sex communication
The level of family communication about sex has
been identified as a significant predictor of sexual
attitude, experience, and behaviour in a Malaysian
study (Tan and Gun, 2018). Additionally, while parents
may have a positive attitude towards sex education,
it has been highlighted that they need help to build
confidence and to find the appropriate language for
such discussions (Jewett, 2021; Mahmoud et al, 2021;
Shin et al, 2019). Besides teaching their children about
intimate relationships and childbirth, parents want to
communicate with their children about sex in order to
protect them from harm and to safeguard them from
exploitation (Stone et al, 2017). Parents of young children
have concerns about the child’s readiness and assume that
if a child does not ask for information about sex, they are
not ready to receive it (Wilson et al, 2010). Discussions
about sex, therefore, oen occur as a reactive process
where the child initiates the conversation through a
variety of prompts. For example, a child may share
knowledge about sex learned at school or on a television
programme, and the parent feels compelled to rectify
false information. In a study about parents’ perspectives
on children’s sexuality education (Robinson et al, 2017)
positive sexuality education was reported as a means to
counter negative information about sex as shameful or
dirty. Myths about storks delivering babies, for instance,
originally perpetrated to sanitise the narrative about
childbirth, were dispelled in favour of factual discussions.
Some parents are motivated by a wish to be
open and honest in response to their young child’s
questions, such as ‘How did I get out of my mummy’s
tummy?’ However, views between both parents can
differ regarding what exactly ‘openness and honesty’
entail and when these discussions should take place
(Stone et al, 2017). Although parents may agree that
their children need information and guidance, the
level of detail they are prepared to share can vary.
For example, a description of how a baby is born may
omit the word ‘vagina,’ highlighting the social taboo
regarding its usage (Riad and Forden, 2021; Stone
et al, 2013). According to Ballonoff et al (2016), it is
important for parents to discuss any differences of
opinion in order to present a unified approach when
talking to their children about sex.
There is no single accepted strategy for parents
who wish to educate their children about sexual
matters. Whereas Walker (2004) found evidence of
communication occurring as a single ‘big talk,’ Morawska
et al (2015) found that parents tend to be mindful of
the child’s ability to process large chunks of complex
information, and instead employ a more gradual ‘drip-
feed’ approach. Some parents use everyday activities such
as bath time or getting dressed as an opportunity for
discussions about sex to occur. Increasingly, discussions
about sexuality are initiated by parents who are concerned
about the exposure of young children to questionable
sexual attitudes and values presented online (Bragg et
al, 2012). Parents also expressed concern that talking
openly about sexual matters could potentially harm the
‘innocence of childhood’ (McGinn et al, 2016; Robinson,
2013) yet, conversely, they were particularly keen that
interpersonal and emotional aspects of sexuality (positive
relationships, love, intimacy, emotions) are nurtured
from an early age.
Barriers to communicating about sex
Existing research indicates that parental knowledge,
communication skills and confidence are important
aspects of discussions about sex and are connected to
the frequency of discussions and the number of topics
covered (Jaccard et al, 2000; Pluhar et al, 2006). ese
ndings are in line with social cognitive theory (Bandura,
1989) positing that if an individual has knowledge,
skills and condence about a certain behaviour, they
will be more likely to initiate the behaviour. rough
discussions about sex, a child can gain knowledge, skills,
and condence about healthy sexual behaviour, leading
to a higher likelihood of safe sexual behaviour (Pariera
and Brody, 2018). On the other hand, parents who
have limited knowledge and feel less condent during
discussions about sex tend not to discuss sex with their
child (Miller et al, 2009). ese ndings suggest that
parents’ lack of knowledge and negative attitudes about
sex communication with their child can be barriers for
sex communication, possibly leading to unsafe sexual
behaviour in their child. Barriers can also exist on the
child’s side. Readiness to learn about sex and being female
were positively associated with more communication
about sex (Miller et al, 2009). is suggests the timing of
sex communication is important, and sex communication
with boys needs to be addressed. Religious beliefs can
play a key role to decide the timing (Coakley et al,
2017). However, this study only included father-son
relationships in an African American population: more
diverse populations need further exploration.
Cultural awareness can help to contextualise sex
education in the UK. e World Index of Moral Freedom
(Álvarez et al, 2020) provides an international ranking
system for a variety of categories, indicating the level
of freedom from state-imposed constraints, depending
on the area of residence. Out of 160 countries, the UK
ranked 36th overall. However, in the category related
to sexual freedom, based on how free from constraints
activities are such as sexual intercourse, pornography and
sex services among consenting adults, the UK scored 52
points, where 40 to 50 points is classied as insucient
moral freedom and 50–60 points suggests acceptable
moral freedom. In particular, sexual morality in the UK
is ranked as substantially lower: 112th among the 160
countries researched. Unsurprisingly, empirical studies
reported shame about sex in young people in the UK
(Ringrose and Harvey, 2015).
For many parents, communicating about sex oen
occurs when their children reach puberty (Astle et al,
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August/September 2022 Vol 3 No 4 British Journal of Ch ild Health 185
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2022). It is possible that parents feel they have neither the
knowledge nor the condence to discuss this sensitive
subject: fear of criticism, doing harm or exposing the
child to unnecessary information which they believe
could lead to their loss of innocence (Grossman et al,
2018). Additionally, parents with both girls and boys may
have a dierent attitude and take a dierent approach as
there are wider social and cultural complexities related
to gender (Evans et al, 2020). In this study, we aimed to
determine whether a parent’s attitude towards sex aects
their condence to communicate with their primary
school-aged child about the act of sex. A secondary
aim was to identify correlations between dierent types
of families (age, gender, relationship status, education,
ethnic group, and religion) and to explore how/if they
communicate about sex with their child. A null hypothesis
was proposed in which there is no relationship.
Study design
The study sought ethical approval from the Health,
Psychology and Social Care Ethics Committee. It
employed a cross-sectional design for parents with at least
one child aged 5–11 years (primary school age) using an
online questionnaire. e cross-sectional design was
conceived to incorporate a validated scale which measures
participants’ attitudes to sex for statistical comparisons
to how parents choose or choose not to communicate
about sex with their child. A recruitment e-poster was
used to advertise for potential participants on social
media via administrators on Facebook, parenting closed
groups or parenting organisations on Twitter. is was
accompanied with a link to the participant information
which was downloaded onto the potential participant’s
device. Informed consent was obtained online prior to
completing the questionnaire. Once the participants
completed the online questionnaire, they were directed
to debrief information.
e inclusion criteria required that participants were
guardians with parental responsibilities of at least one
primary school-aged child (5–11 years old) who lived
in the UK. The questionnaire included a validated
scale: a Brief Sexual Attitudes Scale (BSAS) (Hendrick
et al, 2006). is is a 23‐item measure with four sexual
attitudes subscales of Permissiveness, Birth control,
Communion, and Instrumentality. Demographic
data included UK country (England, Scotland, Wales,
Northern Ireland), age, gender, relationship status,
number of children, type of school attended, gender
of the child, religious affiliation, education and
employment status. e variables in validated scales and
questions were analysed using IBM SPSS to calculate
relationships in the way in which parents communicate
with their child about sex to test the null hypothesis.
e tests were performed to explore the relationship
between those who had (yes: n=119) and those who had
not (no: n=79) engaged in conversations about sex (the
human act) with their child/ren. ose which revealed
an alpha level of p≤0.05 are considered signicant.
Statistical tests included nonparametric testing such
as Chi-square, Mann Whitney-U Test, Spearman’s
correlation or Kruskal-Wallis, because the data was
not evenly distributed (Pallant, 2013). We checked for
reliability of the data and performed post-hoc tests to
calculate the eect size. A binary logistic regression was
then performed to identify any signicant relationships
when all other variables are considered.
Results
A total of 205 consented to participate and had at
least one child between 5–11 years old (including
stepchildren) indicating a 91% response rate (Bryman,
2016). e participants had a total of 405 children,
204 identied as female child/ren, 200 identied as
male. The majority of the participants were female
(n=185, 90.2%), aged 36–45 (n=121, 59%), identied
as heterosexual or straight (n=180, 87.8%), were
married or in a domestic partnership (n=170, 82.9),
had an ethnic background of white (n=184, 89.8%),
an educational qualication (n=190, 92.7%) and were
in full or part-time employment (n=165, 80.5%) and
stated that their child went to a primary school which
was funded by the local authority (n=139, 67.8%).
ere were 49 participants (23.9%) with one child,
109 (53.2%) with two children, 34 (16.6%) with three
children (see Table 1 for full participant characteristics).
Participants who have engaged with their
child in a conversation about sex
Participants were asked if they had engaged in
conversations about sex (the human act) with their
child/ren. 119 (58.0%) stated yes, 79 (38.0%) stated no
and 8 (3.9%) did not answer. In the participant group
who said yes, the age of their child/ren when they had
the conversation was 10–11 years (n=23, 11.2%), 7–9
years (n=50, 24.4%), 4–6 years (n=29, 14.4%), and
less than 4 years (n=15, 7.3%). 71 (59%) stated that
their child prompted this conversation and 46 (41%)
stated that they prompted the conversation with their
child. In the group who stated that they had not had a
conversation with their child, participants were asked
when they thought they might have this conversation.
Most participants stated that they would have this
conversation when their children were between the
ages of 7–11 years. A Spearman’s correlation between
age and communication about sex displayed a positive
correlation between the two variables (rho=.53, n=196,
p=.03). is indicates that as the age of participants
increases, they are more likely to have communicated
with their child about sex. A Mann-Whitney U Test
indicated that the distribution of the number of
participants’ children is signicantly dierent for those
who had spoken to their child about sex (yes: md=2,
n=117) and those who had not (no: md=2, n=78),
u= 5541, z=-2.81, p=0.005. ose participants with
more than one child were more likely to have had the
conversation about sex with their child.
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186 British Journal of Ch ild Health August/September 2022 Vol 3 No 4
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Parents’ confidence in talking about sex
A Mann-Whitney U Test indicated that the distribution
across the ranking of condence in talking about sexual
relationships (0 is not condent at all, and 5 is very
condent) is signicantly dierent for those who had
spoken to their child about sex (yes: md=4, n=114) and
those who had not (no: md=5, n=73), u= 5950.5, z=-2.72,
p=0.007. is indicates that those participants who were
more comfortable talking about this subject had engaged
in a conversation with their child (see Figure 1).
A Mann-Whitney U Test indicated that the
distribution across the ranking of condence on talking
about the reproduction process (0 is not condent at
all, and 5 is very condent) is signicantly dierent
for those who had spoken to their child about sex (yes:
md=5, n=114) and those who had not (no: md=5, n=73),
u=3488.5, z=-2.16, p=0.03. This indicates that those
participants who were more condent talking about this
subject were more likely to have had the conversation
about sex with their child (see Figure 2).
Parents aitude to sex
All nonparametric tests were performed against the
demographics, the BSAS indicated the null hypothesis
should be obtained. Therefore, the study found no
relationship between parents’ overall attitude to sex and
their conversation with their child about sex. However, a
binary logistic regression model was used to explore the
relationships of the four signicant variables:
● Participant age
● Number of children per participant
● Confidence in talking about healthy sexual
relationships
● Condence in talking about the reproduction process.
e result indicates that those with more than one child
were more condent in talking about healthy sexual
relationships (p=0.01, Exp[B]=1.8) and were more
than one and a half times more likely to have had a
conversation with their child about sex (p=0.03, Exp[B]=
1.52). However, the variables ‘age of participant’ (p=0.08)
and ‘condence in talking about the reproductive process’
(p=0.67) are not signicant when all other signicant
variables are taken into consideration (see Tab l e 2 ).
Discussion
Despite the growing concern about sex knowledge among
young children, how parents engage in a conversation
with them remained to be understood. We aimed to
appraise this using a cross-sectional study design. Our
key ndings were that parents with more than one child
were more likely to have had a conversation with their
child about sex and were more condent in talking about
the reproductive process and healthy sexual relationships.
We found no correlations between parents’ overall
attitude to sex and their conversation with their child
about sex. This could be explained in part by the
characteristics of the sample. For example, 90% of the
sample were female and it has already been established
Table 1. Participant characteristics
Characteristics n (%)
Participant
sex Female 185 (90.2)
Male 17 (8.3)
Preferred not to say 2 (0)
Participant
age range Under 18 years 1 (0.5)
36-45 121 (59)
26-35 60 (29.3)
46+ 16 (7.8)
Preferred not to say 1 (0.5)
Total children Female 204 (50.5)
Male 200 (49)
Self-described 1 (0.5)
Country England 191 (93.2)
Northern ireland 3 (1.3)
Scotland 10 (4.5)
Sexual
orientation Heterosexual or straight 180 (87.8)
Asexual 3 (1.5)
Bisexual 9 (4.4)
Pansexual 3 (1.5)
Preferred not to say 9 (4.4)
Relationship
status Married/partnership 170 (82.9)
Single 17 (8.3)
Divorced 9 (4.4)
Separated 4 (2)
Preferred not to say 4 (2)
Ethnic
background Asian or asian british 9 (4.4)
Black/african/caribbean/black british 2 (1.0)
Mixed/multiple groups 7 (3.4)
White 184 (89.8)
Other 1 (0)
Educational
qualification Total with educational qualification 190 (92.7)
Degree or above 163 (79.5)
Other 26 (12.7)
No qualifications 7 (7)
Preferred not to say 3 (1.5)
Employment
status Full/part-time 165 (80.5)
Self-employed /contractor 19 (9.3)
Parent at home 6 (2.9)
Retired 1 (0.5)
Seeking opportunities 5 (2.4)
Preferred not to say 8 (3.9)
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that women are more likely to communicate with their
child about sex (Miller et al, 2009). e sample is limited
to British, white, educated, heterosexual, older parents
(ages 36–45), mostly in a domestic partnership. e
limitations of this self-selected online participant group
mean that it is dicult to judge how representative it may
be and they may already have a positive attitude to sex.
However, age may be a factor specically towards attitude
to sex education because these ndings did indicate that
as the age of participants increases, they were more likely
to have communicated with their child about sex. Watt
and Elliot (2019) highlighted that in England there is a
general liberalisation in attitudes towards non-traditional
sexual relationships. However, further research of a
sample with broader characteristics could provide
dierent results.
Despite retaining the null hypothesis, there are still
some important contributions these findings have
made to the body of knowledge. It arms what the
wider literature has highlighted: if a parent feels more
condent about this subject, they are more likely to have
a conversation about sex with their child (Ballono et al,
2016; Stone et al, 2013). However, the most signicant
nding indicated that those with more than one child
were more condent in talking about healthy sexual
relationships and were more than one and a half times
more likely to have had a conversation with their child
Table 1. (Continued)
Characteristics n (%)
Type of primary school Local authority 139 (67.8)
Local academy 37 (18.0)
Faith school 11 (5.4)
Private school 7 (3.4)
Free school 2 (1.0)
Preferred not to say 8 (3.9)
No. of children per
participant 1 49 (23.9)
2 109 (53.2)
3 34 (16.6)
4+ 10 (4.9)
Preferred not to say 3 (1.5)
Figure 1. Confidence talking about sex and those who had a conversation about sex
Independent-samples Mann-Whitney U test
Conversation with child about sex
Confidence talking about healthy sexual relationships
Confidence talking about healthy sexual relationships
No Yes
6
5
4
3
2
1
6
5
4
3
2
1
60 40 20 0 20 40 60
n=73
Mean rank = 81.51 n=114
Mean rank = 102
about sex. is might be explained because the parent
who has previously had the discussion with their older
child is then more condent to explore the subject with
their youngest. It is therefore crucial to consider that the
parents of one child have a greater need for guidance
in order to build their communication confidence.
Frequency Frequency
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is again arms the wider literature which highlights
that many parents who recognise the importance and
ecacy of talking to their children about sex, refrain
from initiating the conversation due to concerns about
the child’s readiness to learn about the abstract terms
and complex terminology associated with the subject
(Wilson et al, 2010). Parents of young children are oen
concerned about the child’s readiness to receive sex
education and presume that a lack of questions about
sex indicates their child is not ready to learn about it
(Walker, 2004). is concern is exacerbated by a lack of
age-appropriate vocabulary (Muhwezi et al, 2015).
Regarding the child’s age of communication, the
participants in this study were most likely to discuss
sex when their child/ren are between 9 and 10 years
old. A second nding indicated that the majority of
participants in this study who had not yet initiated a
conversation about sex with their child felt they might
have this conversation when the child was between 7
and 11 years old. ese two ndings concur with other
studies, indicating that discussions about sex most oen
take place at the onset of puberty (Beckett et al, 2010;
Muhwezi et al, 2015; Svodziwa et al, 2016). However,
these ndings reect the idea that parents are reluctant
to discuss the topic too early and wait until the onset of
puberty. It may then be too late to ensure preventative
benets (Svodziwa et al, 2016).
While this study offered helpful insights, several
limitations should be acknowledged. First, the study
employed a cross-sectional study using a self-report
Figure 2. Confidence talking about the reproductive process and those who had a conversation about sex
Independent-samples Mann-Whitney U test
Conversation with child about sex
Confidence talking about the reproduction process
Confidence talking about the reproduction process
No Yes
6
5
4
3
2
1
6
5
4
3
2
1
80 60 40 20 0 20 40 60 80
n=73
Mean rank = 84.79 n=114
Mean rank = 99.90
Frequency Frequency
Table 2. Logistic binary regression equation
Logistic binary regression equation B Sig. Exp(B)
Step 1aNumber of children per
participants 0.588 0.01 1.8
Age of participants 0.475 0.08 1.6
Healthy sexual relationships 0.418 0.03 1.52
The reproduction process 0.093 0.67 1.1
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KEY POINTS
● This study has armed that parents want to be able to nurture
positive relationships, love, intimacy, emotions, but need support to
do this.
● Parents with more than one child are more than one and half times
more likely to have had a conversation with their child about sex
then those with only one child.
● Parents find it easier to talk to their children about sex if they have
a good parent-child relationship and begin having the discussions
when their children are young
measure. Response bias might have been present (Kotera
et al, 2020). Second, an opportunity sampling method
was used for recruitment, and our sample had less
diverse demographics. More representative and diverse
sampling is needed. Lastly, our investigation was limited
to the quantitative understanding, therefore thoughts and
experiences behind the attitudes might not have been
captured in this study. An additional qualitative appraisal
can further support our understanding.
Conclusions
e purpose of this study was to identify any correlations
between dierent parental attitudes towards sex and
confidence in communication about sex with their
primary school-aged child. e results indicated that
parents with more than one child were more than one
and a half times more likely to have had a conversation
with their child about sex. ey were also more condent
in talking about the reproductive process and healthy
sexual relationships. Parents find it easier to talk to
their children about sex if they have a good parent-child
relationship and begin having the discussions when
their children are young. However, the lack of guidance
and education for parents on how to communicate
with their child in an age-appropriate manner means
they are le to make their own judgements. is can
be dicult if they lack condence and can potentially
have a negative consequence for the child. is study
has armed that parents want to be able to nurture
positive relationships, love, intimacy, emotions, but
need support to do this. While the UK have taken steps
to develop relationships and sex education in primary
schools (DfE, 2019), in the US, there is a need to update
teaching methods and government legislation to help
reduce sexual health disparities (Cameron et al, 2020).
Parents can also apply for educational programmes
for both parents and children. Parents who engage
in such programmes are significantly more likely to
communicate successfully with children about targeted
risk behaviours, pubertal development, and sexuality
(O’Donnell et al, 2005; Wilson et al, 2010). Programmes
should ideally educate parents about the dierent stages
of sexual development and equip them with a range of
strategies that complement discussions about sex (Wilson
et al, 2010). CHHE
Conict of interest: None to be declared
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