What to expect and how to help your child through puberty

Adolescence is a time when youth typically want to fit in with their peers and be seen as similar to their peers.  Yet, when adolescents don’t understand the changes their bodies are going through during puberty, many are left feeling different from their peers, and worry that they are not “normal.” 

The truth is that puberty is unique for everyone, yet everyone does go through puberty at some point.  The more adolescents know what to expect around puberty, the less anxiety they have around puberty, and the more confidence they have to navigate these complex years successfully. You do not feel to get involved in any family-friendly activities.

Though people often think about the physical changes happening during puberty, it can help to first understand that there’s also a lot of mental and emotional development occurring simultaneously like avoiding family-friendly activities and gathering.  During adolescence, the part of the brain that is responsible for emotions and reward-seeking (the limbic system) is more developed than the part of the brain responsible for rational logical thinking and decision-making (the frontal lobes).  In fact, the frontal lobes are not fully developed until the mid 20s.  

Though adolescents are capable of making rational logical decisions, they often make decisions based on emotions and rewards (particularly in social situations) rather than on logical thinking.  Learning to regulate big emotions as well as to make thoughtful decisions is a natural and important task of adolescence. 

But now on to the physical changes that people more typically think about when we talk about puberty …

In addition to the brain maturing, the brain also starts to send out specific hormones to the rest of the body leading to the many different physical changes of puberty and then you know the importance of youth mental health awareness.  One of the earliest physical changes that happens during puberty occurs with the skin. 

Hormones as well as genetics are both major players here.  Pubic hair around the genitals usually grows before hair in other places, like armpits, nipples, legs, and face.  For kids who have testicles and make a lot of testosterone, they’ll grow more hair on their face and later in puberty may also grow hair on their chest, abdomen, and back.  With all this new hair growth, some adolescents may choose to remove their hair by shaving; some may prefer to let it grow.

In addition to increased hair on the skin, apocrine sweat glands start to secrete an oily substance along with sweat in the armpits, feet, palms, and around the genitals which often creates a strong odor, often referred to as body odor.  Washing with soap regularly is necessary to remove the oily substance and the odor.  Taking a trip to the store together and letting them choose which soap and deodorant they’d like to try is a great way to help them prevent body odor includes in Children’s health tips.  (Despite the marketing, anyone can choose any soap or deodorant, regardless of gender.)

Acne can start as young as age 7 but is more common later in puberty during the growth spurt.  Acne is not caused by dirt or certain foods; hormones and genetics are the main players yet again.  Washing with a mild cleanser twice a day, avoiding picking or popping pimples, and keeping other products off the face such as hair spray are the best ways to help control acne.  If acne is still bothersome, it’s important to see a healthcare provider as there are many medical options to improve acne.

If an adolescent has ovaries, the puberty hormones from the brain tell the ovaries to start making estrogen.  The first visible sign of this estrogen is breast development which typically begins between age 8 through 13, with the average age being 10.  Each breast starts with a small hard knot under the areola and nipple called a breast bud that is usually about the size of a blueberry.  Breast buds can be tender or sore. 

One breast often develops before the other; the second breast usually starts to develop within 3 to 6 months.  It’s normal for breasts to be slightly different sizes during puberty, as well as throughout life.  Kids with testicles also make a small amount of estrogen that can lead to a small amount of breast development, called gynecomastia.  This is normal and usually resolves within a year.  

Periods often start 2 to 3 years after breast development begins, often following a pubertal growth spurt.  Periods typically begin between age 10 to 15, with the average age being around 12 years old.  Many adolescents may have some thin white vaginal discharge starting a few months to a year before beginning their first period.  

During puberty, the ovaries release an egg about once a month.  The uterus responds by gathering blood and nutrients along its inner lining so that it could support a growing fetus if the egg becomes fertilized by sperm.  If there is no fertilization of the egg, the strong muscles of the uterus contract (sometimes causing menstrual cramps) to release this inner lining.  As a result, a small amount of bloody fluid passes out through the cervix and vagina. 

This is what is commonly known as a period.  The bloody fluid may trickle out of the vagina for 3 to 7 days.  Then the lining starts to build up again and the cycle repeats.  The timing of periods can be quite irregular for the first few years before developing into a more predictable pattern.  It’s a great idea to have some period products (pads, tampons, special period underwear) handy to be prepared for that first period since there’s no way to know exactly when it will happen.

If an adolescent has testicles, the puberty hormones from the brain tell their testicles to make testosterone.  The first visible sign of puberty in kids with testicles is the testicles beginning to grow bigger.  This typically begins sometime between the ages of 9 and 14 with the average age being around 10.  As the testicles grow, the scrotum stretches and eventually looks darker in color.  One testicle often hangs lower than the other (more commonly the left).  Soon the penis begins to grow longer and pubic hairs grow at the base of the penis. 

Erections start to happen more frequently (babies and young kids have erections also, but erections happen a lot more during puberty).  Erections may happen when having romantic or sexual thoughts, when there is physical contact to the genitals, or for no reason at all.  Ejaculations also may start to happen, including at night (often referred to as wet dreams).  In addition to these changes, testosterone also makes the vocal cords grow longer and thicker, leading to the initial voice cracks that can last a few months, ultimately lowering the voice.  

On top of all these changes in the brain and throughout the body, adolescence is also a time when many youth are questioning and exploring their sexuality and gender identity.  Having supportive parents or trusted adults in their life with whom they feel comfortable sharing their thoughts and feelings with is the best way to help adolescents navigate these complex years.  Professional help from medical providers or mental health therapists can also be a great resource for many adolescents during these years. If you have effective parenting techniques your do not requires this.

Given all that is changing during these formidable years mentally, emotionally, socially, and physically, it is incredibly important that every adolescent feels grounded by the constant unconditional love and support from their families at home.

Kathryn Lowe, MD, FAAP (she/her) is a board-certified pediatrician, a clinical assistant professor at the University of Washington School of Medicine, and a proud mother of two middle school kids. She has served as a member of the American Academy of Pediatrics Executive Committee of the Section on LGBT Health and Wellness and is the coauthor of You-ology: A Puberty Guide for EVERY Body, available online or wherever you buy books: https://www.amazon.com/You-ology-Puberty-Guide-Every-Body/dp/1610025695/.