By Dr. Ronald Hirokawa, pediatric resident at CHOC Children’s
It’s no secret that adolescence is one of the most difficult phases in someone’s life. As a parent, you might feel just as confused as your teenager when trying to navigate this stage. You want to support your child and help them navigate what can be a confusing time. To do that, you need information you can rely on. The problem is, most parents are experiencing information overload and don’t know what source to trust.
At CHOC Children’s, we believe parents should feel like they’re the experts in their child’s health. We know it can be stressful to navigate puberty with your children. Every year, we care for 250,000 kids and teens in Orange County and beyond. We’re committed to providing quality education around the topics parents ask us about the most.
Major physical changes can cause major stress for teens. Unlike the hormonal and psychological changes that are mostly unseen, these physical changes are visible every morning when they look in the mirror.
This parents’ guide to puberty will help you prepare for changes you can expect in your child, but also for answering their questions.
Your teen will likely experience many physical changes during puberty. Here are a few to expect:
Growth spurt: About 20 percent of our height is obtained during puberty. Most girls start their growth spurt between ages 10 to 14, or about a year after puberty begins. Males have their growth spurt on average two years after the start of puberty. Males also tend to grow faster.
Bone growth: As teens get taller, their bones growth accelerates as well. Bones first grow in length, then width, and then density. Due to this growth pattern, there is a high risk of fracture as teens’ bones get longer before they get stronger.
Changes in body shape: While both males and females see increases in their body mass index (BMI), girls see more of an increase in body fat. Boys, however, tend to have increased levels of lean body mass. This can cause high levels of stress in adolescent females, especially in a culture that promotes thinness. Conversely, puberty leads to fat distribution in the hips and butt, which can lead to unwanted attention. Parents may worry that this may be a sign of future obesity, but they should be reassured that the body redistributes the fat to other parts of the body as it progresses to adulthood.
Changes in Sexual Characteristics
Breast development: The first phase of puberty in females is the development of breast buds, which appear as coin-sized lumps under the nipples. This phase normally occurs around age 9 or 10. Studies have shown that African American girls usually enter puberty a bit earlier, around 8 to 9 years of age. Girls should be evaluated by their pediatrician for early puberty if breast development starts earlier than age 8 for Caucasians and 7 for African Americans.
- Breasts may be uneven during early development but should even out within about a year. Consider options like padding one side of your teen’s bra if uneven breast size is causing stress.
- Training bras are not critical at this period and can actually cause discomfort to sensitive early breast tissue. Consider alternatives such as soft, light, gentle undergarments like an undershirt or sports bra.
Pubic hair: In the second phase of puberty, your teen will develop pubic hair. Ten to 15 percent of girls will see public hair before they develop breast buds. Initially, the hair starts off soft, straight, sparse and in close proximity to the vagina, but will begin to spread to the lower abdomen and inner thigh areas and take on a triangular pattern. The hair will also begin to appear darker, curlier and coarser.
Menstruation: Most girls get their first period around age 12 or 13. African American pre-teens tend to start menstruating one year earlier. Parents can expect their daughters to start menstruating two to three years after breast bud development. Cycles will often be irregular, especially between the first and second cycles. On average the first cycle for most girls lasts 34 to 40 days. A cycle length is measured from the start of one period to the day before the next flow. About two years after the first period, cycles should regulate, occurring once every 21-45 days, lasting no more than seven days. Most girls need an average of four to five regular pads on the day their flow is heaviest.
- Consider discussing menstruation when teen starts breast development, so they know what to expect. Helpful strategies include using visual aids such as books and pamphlets while trying to describe and explain the female reproductive system. Your daughter’s pediatrician or an adolescent medicine specialist can help provide education.
- It is vital that female teenagers are prepared and educated on what to expect. Make sure that your teenage has pads available at school in case of emergency. Deciding between tampons and pads should be left up to the comfort and preference of your daughter. Although there is no way to pinpoint exactly when your daughter will get her first period, it often occurs at around the same time it did for her mother or older sisters. If menarche has not occurred by age 16, seek a medical evaluation by your primary care physician.
- See your doctor if periods are infrequent, too frequent, flow is extremely heavy, or periods are painful.
Testicular and scrotal enlargement: At around 11 to 12 years of age, males experience a near doubling in testicular volume in this first phase of puberty. This occurs on average six months prior to increase in penile size. The scrotum also starts to darken, enlarge, hang down from the body, and develop tiny bumps or hair follicles. Males should be evaluated by their pediatrician if puberty starts before age 9 or shows no signs of puberty by age 14.
Pubic hair development: This usually develops at age 12 or 13. Hair starts off light, sparse, soft and mostly located at the base of the penis. The hair will start to become darker, curlier and coarser. It will also start to spread to the rest of the pubic region, toward the thigh, and towards the belly button in a diamond-shaped pattern. Around two years later, they will begin to develop hair on other parts of the body such as their face, legs, arms, underarms and chest.
Penis growth: Males may achieve adult-sized genitalia between the ages of 13 and 18. Penile size increases first in length and then width. Size can vary greatly from male to male. Many male teens may become distressed with penile size as they compare themselves to other males. Remind your teen that function does not depend on size.
Adolescent Cognitive Development:
During puberty, your teen will also undergo significant cognitive changes. Before puberty, your teen still thinks in concrete terms: Things are black and white, right or wrong. They often only think about what is going on in the present moment and only consider the immediate consequences of their actions, rather than thinking long term.
During the mid-teen years there may actually be a drop in the level of maturity and judgment for certain teens. This is not always a bad thing, as teens will experiment in their own way to learn about the world. They typically put this information to good use, learning about their mistakes. However, risk-taking behavior may lead to violence or experimenting with alcohol or drugs in some cases.
By late adolescence, teens begin to think more abstractly and in shades of grey. They are also now able to analyze situations logically, reason effectively, solve complex problems, and achieve increased empathy, allowing them to get a sense of what others are thinking.
This higher level of cognition allows them to start planning for their future and think about the more long-term consequences of their actions. Teens still have very little experience with this level of decision making and may need assistance directing these newly gained cognitive skills.
Learn more about understanding the teen brain.
How can I help my teen during this phase?
Teens often make snap decisions, leading to risky behaviors. Expand their range of options and teach them to consider multiple choices and to weigh the potential risks and benefits of each decision. During this time, it’s important to help your teen understand that emotions, good or bad, may affect their ability to make rational decisions.
Teens are often influenced by social pressures from other teens, which can lead them to participate in risky behaviors. Instead of imposing your opinions on your teen, provide them with objective information about these behaviors.
Concerns about popularity and acceptance are most intense during the early teen years and may lead teens to participate in risky behaviors. Parents can help teens resist these pressures and find alternative groups. Explain your family’s set of values, like respecting yourself and others, the importance of trust, etc.
Although during the teen years there is often less time being spent with family, family closeness is still an extremely important component of adolescent development and has been associated with a lower incidence of smoking, alcohol and drug usage, and suicide attempts.
How to Talk to My Teenager:
Simply asking questions and listening without judgment can be majorly influential. Ask non-threatening questions that help them define their identities, such as:
- Who do you admire and why?
- What are your hopes for the future?
- What are your strengths?
To create a nonjudgmental environment, listen more than you speak. Ask open-ended questions to encourage them to think through their answers as opposed to just saying yes or no. Match their mood to help your teen feel like you understand where they are coming from.
Changes caused by the COVID-19 pandemic and social distancing have greatly impacted teens. They’re not in school or seeing friends in person, and many are struggling with the reality of ...
By Dr. Mery Taylor, pediatric psychologist at CHOC Children’s
To high school seniors, schools being closed doesn’t equal a vacation – to them, this is time they won’t get back with ...
Cyberbullying has become an increasingly common and serious issue in recent years largely due to the easy access, and in some cases the anonymity, of digital devices. As children and ...