To gain an overview of the situation, obstacles and needs regarding childhood SE in Finland, we first conducted two online surveys of ECEC professionals (study A) and parents of 1–6-year-olds (study B) (Figure 1). The surveys explored adults’ experiences of, thoughts on and attitudes to sexuality and SE among 1–6-year-old children.

We analysed the open-ended questions in Questionnaires A and B qualitatively, first inductively and then deductively. Inductive and deductive reasoning approaches in the process of qualitative data analysis are described by Elo and Kyngäs (2008:107–115). In the inductive analysis, we conventionally read the material several times to understand the pros and cons of children’s SE. Surprisingly, the term ‘sexuality education’ was one target of criticism: ‘We do educate, but we won’t call it SE’. ‘In my opinion, childhood sexuality is the wrong word and gives the wrong impression’. In the deductive or directed thematic content analysis, we read the material through again, searching for comments that criticised, misunderstood or challenged more the term ‘sexuality education’ than the education. A presentation of this criticism appears in the ‘Results’ section.

Secondly, we examined the possibility of replacing the Finnish term for ‘sexuality education’ for this age group in order to distract attention from adult-like sexuality and better reflect the content of childhood SE. We constructed a new term based on the most common topics of children’s verbal expressions and behaviours related to SE themes in day care (Cacciatore et al. 2020). Over 50% of professionals and parents had stated that children in the groups they taught or at home asked daily or weekly questions about different body parts and their functions (such as the navel, ear, ‘willy’/genitals, buttocks) and hygiene (such as the appropriate way to clean the buttocks/genitals, teeth and hands). Over 50% of professionals and parents had stated that children talked daily or weekly about liking, infatuation or love for other children or familiar adults (Cacciatore et al. 2020). On the behavioural level, children were most commonly observed to express their emotions easily and to show lots of feelings of infatuation, affection and liking towards each other, for example, by ‘kiss chase’ games. All these related to the SE topics ‘The Body’ and ‘Emotions’ in The Standards (WHO 2010). We, therefore, decided to call young children’s SE, Kehotunnekasvatus [body–emotion education], to focus on their major expressions and interests.

To test the new term’s acceptability and usefulness as an alternative to SE in the youngest age groups, we conducted surveys among three different groups of professionals. We formulated a written questionnaire (C) to assess the pros and cons of the new term.

In Questionnaire C, we introduced the new term as a possible alternative to ‘sexuality education’ for 1–6-year-olds. The new concept would stress providing age- and development-appropriate SE following the instructions of The Standards (WHO 2010). We also noted that what was central in this age group was becoming confident about one’s own body, learning to control emotions, learning safety skills and acquiring the skills to negotiate about these.

Questionnaire C consisted of seven questions with Likert scale alternatives (Table 2): ‘Do you think that the new term Kehotunnekasvatus [body–emotion education] as an alternative for use in young children’s SE is appropriate, necessary, easy/difficult to use, suitable for parents, suitable for professionals, better/worse than SE, and you would/would not use it’. In all questions, responses ranged from 1 (positive to the new term; ‘easy to use’, ‘appropriate’, ‘I would use’, etc.) to 5 (negative to the new term; ‘difficult to use’, ‘inappropriate’, ‘I would not use’, etc.). In the analyses, response alternatives 1 and 2 were considered positive to the new term, and response alternatives 4 and 5 negative. In addition, there was one open item: ‘You may write your thoughts here’.

The proportions of those positive and negative to the new concept on each question among the ECEC professionals, nurses and specialists were compared by cross-tabulations with Fisher’s exact test statistics. We did statistical analysis using IBM Statistical Package for Social Sciences statistics for Windows version 25 (IBM Corp., Armonk, New York). Statistial significance was set at p < 0.05.

Finally, the comments expressed in the open-ended question will be described.

The University of Helsinki Ethical Review Board in the Humanities and Social and Behavioural Sciences approved the parents’ study (B). The authors confirm that ethical clearance was not needed/required for the studies A and C.

In responses to Questionnaires A and B (Appendix 1), altogether 27 comments about the terms ‘childhood sexuality’ and ‘sexuality education’ were identified, and they were all critical: 9 from professionals, 18 from parents (Table 1). Such critical comments were found in response to the following questions:

What forms of expressing themselves and games that you consider sexual have you observed among children? What type of emotional responses does childhood sexuality raise in you? What kind of sexual behaviour do you think is acceptable for a child, and what kind of behaviour requires intervention? Please also justify your answer.

What are your thoughts on SE for young children? What are the difficult topics in SE? How do you implement childhood SE? How do you act in a situation where the child expresses sexuality? Please give examples. Is there anything else you would like to mention?

We categorised these comments in order of prevalence into five mutually exclusive groups: (1) no ‘sexual tone’ was observed in children’s actions; (2) children’s actions are natural, not ‘sexual’; (3) the word ‘sexuality’ has inappropriate connotations with adult-like sexuality; (4) ‘SE’ is too complicated as a concept for children; and (5) children already receive too much sexuality-related information. Table 1 shows examples of the critical comments.

The alternative term for childhood SE, Kehotunnekasvatus [body–emotion education], was subsequently introduced to three groups of professionals in Questionnaire C. Acceptance of the new term was excellent, as shown in Table 2. The majority of all respondents considered it appropriate (82%, 97%, 59%, respectively, among ECEC professionals/nurses/specialists), necessary (70%, 79%, 59%) and usable in their work (86%, 79%, 53%). Only two specialists (12%) and 5% of ECEC professionals, but none of the nurses, reported that they could not use the term at all.

A majority of ECEC professionals (63%) and nurses (71%), but fewer SE specialists (41%), considered the new term easy to use. Likewise, 76% of ECEC professionals and 65% of nurses in the field considered the new term even better than ‘sexuality education’, whereas of the specialists, 47% considered it better.

Eighty-six per cent of ECEC professionals, 90% of nurses and 71% of specialists considered the new term suitable for professionals’ use. The suitability of the new term for use with parents caused more division of opinion: of the nurses, 93% considered it suitable for parents to use; of the ECEC professionals, 73%; but of the specialists, only 47%. However, no one found the new term totally unsuitable for use with parents.

The differences between the groups were statistically significant in concepts of ease, attitude toward use and suitability for use with parents (Table 2).

To the open-ended item in Questionnaire C, we received opinions from 12 specialists and 4 ECEC professionals and 4 nurses.

Of these, some comments highlighted the benefits of the new term:

Some comments favoured ‘SE’:

Some respondents shared pros and cons:

Some respondents also proposed alternative concepts in Finnish.

Two comments described a practical experience:

Our online studies indicated that one factor impeding the implementation of childhood SE in Finland was the adulthood connotation of the term ‘sexuality’. Our finding concurs with those of studies in Europe, New Zeland, Australia and the United States of America showing that for many adults the words ‘children’ and ‘sexuality’ are incompatible and have risky connotations (Brilleslijper-Kater & Baartman 2000; Flanagan 2014; Hornor 2004; Robinson, Smith & Davies 2017). ‘Sexuality’ in the standard language is associated with sex and reproduction (Flanagan 2014; Kurtuncu et al. 2015). Our findings are in line with those presented by Leander, Larsen and Munk (2018), who quoted a kindergarten director: ‘When children play doctor games, they don’t think of it as something sexual. The thoughts of the adults/parents make it something bad’. Adulthood-connected misunderstandings impede the promotion of SE in childhood and even negotiations about it among parents and professionals (Flanagan 2011; Kaeser, DiSalivo & Moglia 2000; Merghati-Khoei et al. 2014). For this reason, the topic is frequently avoided and overridden in everyday life.

Taboos associated with the word ‘sexuality’ even impede SE for adolescents (Walker & Milton 2006), and using less sex-loaded terms such as ‘health education’, ‘relation education’, ‘life-skills education’ or ‘youth education’ has often been necessary in order to initiate SE (Ketting et al. 2018). Sexuality education for young children is even more taboo. The time intended for guiding parents to provide appropriate SE was often wasted in explaining the term and calming abrupt responses, emphasised some respondents in our study. Parents were easily alarmed, and fear and erroneous beliefs were common, as also claimed by Robinson et al. (2017).

Early childhood education and care professionals and nurses expressed a marked preference for the new term over ‘sexuality education’. Possibly they had experiences of obstacles to discussing childhood sexuality with parents and co-workers, who were unprepared and lacked training to understand and to negotiate about childhood sexuality and SE, under several misapprehensions and harbouring prejudices.

Nevertheless, children play sexual games and ask abundant questions in day care (Cacciatore et al. 2020; Larsson & Svedin 2002; Sandnabba et al. 2003), where professionals need to make spontaneous decisions about what are developmentally and culturally correct and health-promoting, age-appropriate answers to infants and with a wide diversity of children (Davies, Glaser & Kossoff 2000; Leander et al. 2018). They need tools and competencies to enhance parents’ and co-workers’ knowledge and acceptance of the subject and to foster children’s rights and healthy development. Using simple language is one means to promote health literacy (Geboers et al. 2018).

The sexual health specialists found the new term easy to use significantly less often and expressed less commonly positive attitudes towards using it. The specialists’ work was different from what the other professionals did among families with young children. They met people who were prepared to discuss sexuality-related topics. Many specialists preferred to use the term ‘sexuality education’ and to make it more known, as Goldman also found to be the case in Australia (2013). The specialists’ viewpoint may be biased by a lack of experiences of obstacles in the field.

Words create associations, images and emotions. Because of the sensitive nature of childhood SE, professionals may need words to explain child sexual development and behaviours to parents while avoiding harmful misunderstandings. The difference of childhood sexuality from that of adults becomes more noticeable using age-specific concepts.

Adult words lead to adult-like ideas of children’s behaviour (Flanagan 2014). LeFrancois (2013) talked about adultism as adult-centric policies and practices harming children’s lives. Adultism results in disadvantage and oppressive social relations. In the case of sexual health, adultism prevents children from receiving the education, information and protection they need and are entitled to (UN 1989). The ECEC professionals’ perturbation, confusion and distress regarding the term ‘sexuality’ contributes to refusal to implement childhood SE (Merghati-Khoei et al. 2014). In a study in the United Kingdom, parents felt that they were interpreting some behaviours and questions from their 3–7-year-old children using adult sexual scripts rather than considering the 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 adult perspectives on sexuality, which led to adult constructions and judgements of childhood sexuality.

One problem impeding the promotion of childhood SE has been the lack of terms free from adulthood connotations. Child-centred frames of sexuality, created with child-centred words, may enable ECEC professionals, parents and policymakers to negotiate and plan childhood SE without serious negative prejudice.

In some languages, words describing childhood sexuality are different from those applied to adults or adolescents. This makes it easier for parents to understand that childhood sexuality is different (Cacciatore et al. 2019). For example, the term ‘masturbation’ may be offensive to parents unfamiliar with the concept of sexuality in young children (Mallants & Casteels 2008; Nechay et al. 2004). Using words such as ‘self-soothing’ have been shown to be more acceptable. In fact, childhood masturbation is mostly aimed at calming (Mallants & Casteels 2008; Sandnabba et al. 2003) as opposed to becoming excited. Unnutus is a new Finnish term to refer to childhood masturbation, introduced by the Family Federation of Finland 2000 (Cacciatore & Korteniemi-Poikela 2000). It stems from the Finnish word for ‘sleep’. To refer to a child’s genitals, there are already traditional words in everyday Finnish, pimppi [girls’ genitals] and pippeli [boys’ genitals]. Similarly, in Swedish there are snippa and snopp, in 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 special term can make childhood SE easier for parents to understand and accept.

Child-centred words are not euphemisms, but options and synonyms for describing childhood sexuality. Child-specific terms highlight that children have their own kinds of bodies, experiences, intentions, perspectives and needs. Using different words for children’s sexuality is not a repressed, evasive or euphemistic representation, but can help adults to see the difference and to overcome their rejections, misunderstandings and objections.

The Family Federation of Finland has introduced the new term, ‘body–emotion education’, on its Child and Sexuality webpages, in materials, training sessions and in the media since 2015. At the end of 2019, a Google search yielded over 30 000 hits.

In October 2016, the new National Core Curriculum for Early Childhood Education and Care was delivered, which for the first time was an official and binding document based on the legislation (Finnish National Agency for Education 2018). 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. In 2017, the Family Federation of Finland encouraged all municipalities to implement SE in their local curricula, at the same time introducing the new term. As a result, at least 21 municipalities out of the 311 in Finland included SE as a part of their mandatory local curricula – 18 using the new term alone or together with SE. These municipalities cover 37% of Finnish 0–6-year-olds.

Two Finnish Members of Parliament tabled a written question to the Speaker of Parliament on body–emotion education and the prevention of sexual harassment starting in early childhood education in December 2017.

A limitation of the online studies is that we do not know how widely the links to Questionnaires A and B were distributed. We know how many times the link was opened, but we do not how many individuals received the link without opening it. Individuals uncomfortable with sexuality issues may have avoided the study, resulting in a bias towards respondents willing to communicate about sexuality.

The results in testing the new term are preliminary as the respondent groups were small, and we tested a new Finnish term among Finnish professionals. The new term may not be directly transferable to other languages.

The new term, Kehotunnekasvatus, was built on extensive research among ECEC and parents.