In Shakespeare’s play “The Winter’s Tale,” an old shepherd gives this lament about teenagers: “I would that there were no age between ten and three-and-twenty, or that youth would sleep out the rest; for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing, fighting.”
As an adolescent medicine physician at the Children’s Hospital at Montefiore, I hear this sentiment from many parents. The famous psychologist G. Stanley Hall described adolescence as a time of “storm and stress.” It’s a period of enormous physical, emotional and social change; your child’s friend groups, interests and self-expression may change in ways that you could never predict. However, for most children, at least the physical changes of puberty that herald adolescence do happen in a predictable pattern and time course. I can’t promise to take away all of the storm and stress that my patients and their parents undergo during the teenage years, but by understanding the physical changes of puberty, parents can help teens be as healthy as possible during the ages “between ten and three-and-twenty.”
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Regular primary care visits during the early teen years are essential, since one of the pediatrician’s most important jobs during that time is to ensure puberty is occurring normally. At any middle-school dance, one can see tall girls towering over their shorter male dance partners. The first physical change of female puberty is breast development, often around age 9 or 10, followed by a growth spurt around age 12. In other words, early pubertal changes in girls are very visible to the outside world, which can make teen girls (especially early developers) particularly self-conscious. The early pubertal changes in boys are much more “beneath the clothes,” and so boys do appear younger for a longer time. Growth of the testicles heralds puberty in boys, sometime between the ages of 10 and 13. The growth spurt happens much later in boys than in girls — around age 14 — with some boys continuing to grow taller throughout the high school years.
Boys are more likely than girls to be “late bloomers,” a condition referred to as “constitutional delay of puberty.” Fathers of such boys will often give a history that they, too, were late bloomers, and seemed to grow even into their post-high school years. Usually, late-blooming boys require nothing more than reassurance and monitoring. Late-blooming girls can also be on the normal spectrum of development, but delayed puberty in girls is less likely to be a normal variant, and more likely to signal an underlying medical condition such as an undiagnosed eating disorder. Pediatricians use carefully maintained growth charts, a family and patient history, vital signs, a thorough physical exam and basic blood work to distinguish normal from abnormal pubertal development.
Around two years after breast development, most girls will get their first menstrual period. Menstruation may seem daunting, unpleasant or undesirable, but it’s a healthy sign of female development. In fact, the American Academy of Pediatrics has stated that menstruation should be considered a “vital sign” when evaluating the health of teen girls. Mothers can help daughters by normalizing menstruation as a “fact of life” rather than something to be feared or dreaded, especially since menstruation remains a part of most girls’ lives for several decades. In the first two years of menstruation, periods are often irregular and unpredictable, since young girls do not often ovulate once a month as do older teens and women. This is usually normal and not worrisome, as long as periods are not too prolonged or too heavy. Keeping a menstrual calendar, either on paper or one of the many menstrual calendar smartphone apps, such as “My Days,” can help your pediatrician decide whether your daughter’s periods are within the range of normal.
[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]
Around a couple years after the start of menstruation, periods should start to change in two ways as ovulation becomes more common. First, they should start to become more regular, happening more or less monthly. Second, menstrual cramps develop, again as a result of ovulation, which leads to a release of prostaglandins. Daughters are enormously influenced by their mothers’ attitudes about discomfort and pain, and so mothers can do their daughters a great service by teaching them how to handle menstrual cramps. For most girls, cramps are predictable in their timing and can be treated with ibuprofen. As a prostaglandin inhibitor, ibuprofen is more effective for menstrual cramps than is acetaminophen, and it treats other prostaglandin-related discomforts of menstruation, such as loose stools.
Yoga stretching has also been shown to help relieve cramps in several medical studies. Tell your doctor if cramps cause your daughter to miss out on activities such as school or sports, since she may need stronger treatment with a hormonal medication, or an evaluation for an underlying medical condition such as endometriosis. As I often tell patients, the boys are not missing school once a month, so we shouldn’t expect girls to miss school due to a very treatable condition. Menstrual cramps may be the first major physical discomfort that an otherwise healthy girl experiences in life. If your daughter can develop a positive approach that focuses on returning to normal functioning, it will help her in the future when she encounters backaches, headaches and other discomforts that are an inevitable part of life.
While most teens may not be thinking about their bones during adolescence, their doctors are. In fact, the teen years are the most important time for building strong bones and developing bone-friendly habits. Our peak bone density is established by our early 20s, and whatever we have built up by then acts as our “bone bank” for the rest of life. Teens should aim for four servings of high-calcium food or drinks per day — for example, three 8-oz glasses of milk and a yogurt. Over-the-counter calcium supplements exist for teens who can’t fit in four servings per day. Vitamin D is an essential part of good bone health — it’s great to get vitamin D from fortified foods or from time spent outdoors, but many teens benefit from a vitamin D supplement. Talk to your doctor about the proper dose, usually somewhere between 1000 and 2000 IUs daily based on your child’s vitamin D level, weight, skin color, local climate and other bone health risk factors. Regular weight-bearing exercise is great for your child’s health and longevity overall, and it’s especially good at making bones stronger by causing increased bone turnover. Finally, for your daughter, having regular menstrual cycles is good for her bones — so if periods come too infrequently or not at all, you should tell your doctor so she can be evaluated.
[See: 9 Sports Injuries That Sideline Kids.]
In one clever medical study, researchers found that a reliable indicator of the first rise in pubertal hormones is a mother’s report of having to frequently buy shoes due to her child’s rapidly growing feet. When our children are little, we pay attention to their growing bodies, from head to toes. As they go through adolescence, we gradually hand over more and more of that responsibility to our child, and hopefully we can impart healthy attitudes and good habits that will follow them into adulthood.
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How to Prepare Your Child (and Yourself) for Puberty originally appeared on usnews.com
