Coping with Puberty

What's normal, what's not - and can you make it any easier for your child?

If you're dismayed by the body changes of midlife, get a grip.

This is minor-league compared to what your adolescent son or daughter is going through. "Puberty," says adolescent medicine specialist Sarah Stevens, M.D., of Lehigh Valley Hospital and Health Network, "is a major physical transformation — and you don't have any control over it."

What happens in girls

The first signs of female puberty — a growth spurt, budding breasts, acne and body hair — are visible around age 11 on average, but sometimes as young as age 9. Menstruation (menses) begins within a couple of years. Puberty is a gradual process that can take until age 18 or so.

If your 6- or 7-year-old shows signs of puberty, Stevens says, call the doctor. "When estrogen production begins, it closes off bone growth. Girls with premature puberty run the risk of losing their peak growth." Likewise, if periods don't start by age 16 or within two years after the start of breast development, the young woman should be examined for underlying illness.

About breasts — What 12-year-old hasn't asked, "When do I get to wear a bra?" For most teens, it's a matter of choice (and what the other girls are doing) rather than need, Stevens says.

The biggest worry for many girls is uneven breast development. "It's fairly common for one side to bud first or for breasts to grow asymmetrically," Stevens says. "Often, things will even out. Most of us aren't completely symmetrical."

While breast cancer is extremely rare at this age, Stevens teaches her patients to do self-exams so they'll get familiar with the feel of their breast tissue. Small benign lumps are not uncommon in adolescence.

About periods — The average age for first menses — about 12 1/2 today — has gotten younger over the decades, Stevens says, probably due to better nutrition. Menstrual bleeding starts when hormone production kicks in, and ovulation may begin at the same time or later. Periods are often irregular at first, but even with skipped months there is still the potential for pregnancy. "If your daughter's periods are irregular and she has severe acne and body hair growth, she may have PCO, or polycystic ovary syndrome," Stevens says. "Underdiagnosed in teens, PCO is a leading cause of infertility in adult women. It's due to a hormone irregularity, and it can be treated."

A word about cramps: "No one should have to suffer from them," Stevens says. "If your daughter is so uncomfortable she's missing school, ask your doctor about medication."

What happens in boys

As anyone knows who's chaperoned a seventh-grade dance, boys hit puberty about two years later than girls. It typically begins around age 13, but anywhere from 10 to 14 is normal, says pediatrician Donald Levick, M.D., of Lehigh Valley Hospital and Health Network.

As with girls, puberty in boys is a long, gradual process. First, the testes develop in preparation for male hormone production. Then comes a surge in height, oily skin and acne, cracking and deepening of the voice, genital growth and body hair.

The classic pubescent male is lanky and awkward, stumbling over his own feet. Indeed, Levick says, boys' hands and feet grow to adult size before the rest of them. "It's also not unusual for boys in mid-puberty to develop breast tissue, a condition called gynecomastia," Levick says. Typically, this is more an embarrassment than a medical concern and goes away over time. But have your doctor make sure the boy's development is otherwise normal.

Another key job for the teen boy's physician is to teach testicular self-exams. Testicular cancer is most common in the late teens and early 20s.

What can a parent do?

Puberty, of course, isn't just physical — it's also a time of emotional turmoil and self-discovery. The best thing you can do as a parent is to educate yourself and open the lines of communication — early.

"Get the facts straight," Stevens says. "Your child may not get accurate information from other sources. And I don't think it's wrong to be clear about your opinions and values, even if you and your child differ. Often, kids come around to the parent's values in the end."

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