by Shalon Nienow, MD
Body autonomy is the right for a person to govern what happens to their body without external influence or coercion. This is an important concept for all children to be taught and to understand. A child who knows that they are in control of their body is less likely to fall victim to sexual abuse, sexual assault and later intimate partner violence. They are also more likely to disclose any abusive events that should happen to them. The idea of abuse happening to our children is very difficult to accept, but the reality is that it happens all too frequently. Statistics show that one out of every three females and one in every 20 males will fall victim to unwanted sexual contact by their 18th birthday. The people that will perpetrate this violence, in most cases, is someone that the child knows and trusts.
In recent years, there has a been a great deal of discussion in the media surrounding sexual abuse and assault, which highlights the prevalence of the issue. As adults, we are in a position to help prevent abuse from happening to our kids, and to empower them to disclose if it does. One of the most important prevention tools, in my opinion, is to teach them body autonomy. This concept is one that adults do a particularly poor job of teaching — in fact, adults often force children into situations in which their body is treated as the property of others. As a parent, this is an area that I could do better in, one that I might not have identified as a problem if I wasn’t also a child abuse pediatrician. Think about the number of times that we force our children to hug a family member or a friend, even when they don’t feel comfortable doing so, or when this isn’t done spontaneously. My children have not lived close to family since they were infants/toddlers, and only see said family members once or twice a year. My first instinct when visiting with family is to tell my children to give these people a hug. When I do this, I fail to recognize that this person is virtually a stranger to them. Although I have a longstanding history with these people, my girls do not. They often do not remember them from year to year. How uncomfortable that must be for them.
What does this teach kids? This tells them that their body is not under their control and that they must yield it to an adult if told to do so. Wow — that is a heavy realization. Yet, not only do we do this with adults, we also do this with other children. Our kids fight with one another and we tell them to apologize and give hugs. Why do we think either one of these children want to hug? We also make excuses for interpersonal violence. A boy pulls a girl’s hair, and we have been taught to say something like, “well, that just means he likes you.” No. People who like you, who respect you and who are your friends, will not deliberately hurt you, nor will they force you to do something that you don’t like, or don’t feel comfortable doing. So, what should we be teaching our children instead? Here are some quick tips on introducing your kids to the concept of body autonomy.
- Teach children the anatomic names for their body parts, to include their genitalia. This should be done from the beginning. There is no age that is too young to be told the truth. The well-child visit is a great time to reinforce this, and to talk with children about who is allowed to look at and touch their body and under what circumstances. In fact, the American Academy of Pediatrics describes the genital exam as a standard of care in all well-child visits, and a priority at one year and every age between 6 and 21. This is one more way that physicians can help normalize the conversation and can reinforce that genitals are not something to be ashamed of.
Additional reasoning for using anatomic names includes the following:
- They are correct. Genitals are just another body part, like your nose or your elbow. We do not have to speak in code to describe those parts, so why must we speak in code to describe genitals? Each body part serves a function, and none are shameful. Genitals are used for urination, defecation, and feeding and birthing children. Although young children may not need to understand all of these functions early in life, they should understand that their bodies are healthy and normal.
- They are empowering. Children who know anatomic names for their body parts, and are encouraged to use them, are more likely to speak up and say “no” if something happens to their body that they don’t like, or to disclose to someone if anything abusive takes place. Children who do not have words to describe these places may be less able to adequately verbalize when abuse occurs. Additionally, when we as adults teach children that certain body parts can’t be spoken of, or if they are, must be spoken of in code, this instills a feeling that they are secret and shameful. Perpetrators can use this to their advantage and reinforce these themes, potentially preventing a child from disclosing abuse and allowing it to continue indefinitely.
- They are unambiguous. When “cute” names are used to describe genitals, the terms may not be easily understood by others, and therefore may not garner an appropriate response if a child discloses inappropriate touch and/or abuse. For example, if a child tells a teacher that someone touched her “cookie,” they may misinterpret this term and brush it off. If the same child says that someone touched her vagina, a very different response ensues.
- Teach children that it is okay to say “no,” even to adults. If a child is uncomfortable with something that is happening to them, they should be empowered to stop it. Children can be provided with alternate ways to show affection and respect that does not require yielding control of their body. Some examples are handshakes, thumbs-ups or high-fives.
- Educate children that they should ask permission of others before touching their body. Not everyone appreciates hugs or physical contact. In the same respect that children should not yield control over their body, they should learn to use consent before touching others.
- Help children understand the difference between okay touches (those that make them feel happy) and not-okay touches (any touch that makes them feel uncomfortable, scared or confused).
- Explain to children that there are okay secrets (e.g., things that aren’t harmful, like what you are getting mommy for Christmas) and not-okay secrets (e.g., those that hide their own hurt or the hurt of others, or have anything to do with private parts), and enforce that they have to tell an adult when someone asks them to keep a not-okay secret. That applies even if that person is someone that they love and trust, even if they are told not to tell, and even if they are told that something bad will happen if they tell. This includes when a friend asks them to keep a secret involving something bad happening to the friend.
- Teach children that if anything ever happens to their body that they don’t like, it is not their fault, and they will not be in trouble for telling — even if someone says that they will. Parents should be educated that the first response to any child’s disclosure of abuse is belief, and that they should respond in a protective manner.
- Help children identify five adults they can turn to if something happens that they don’t like. At least three of these adults should not be family, as in cases of abuse, children generally do not tell their parents or family members first. Parents should empower their kids to tell a trusted adult, even if it is not themselves. Children should also know that if they tell an adult and that adult doesn’t believe them, or doesn’t do anything about it, they should keep telling adults until someone believes them.
Dr. Nienow is the medical clinical director at The Chadwick Center for Children & Families at Rady Children’s and an assistant clinical professor of pediatrics at University of California San Diego School of Medicine. For more on Dr. Nienow’s work and services at the center, visit www.rchsd.org/programs-services/chadwick-center.
 Finkelhor, D., Shattuck, A., Turner, H. A., & Hamby, S. L. (2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55(3), 329-333.