When Puberty Chimes In
Common health problems affecting your tween.
by Andrea Marks, M.D. and Betty Rothbart, MSW

PARENTGUIDE News September 2003

Many preteens resist change. They like their friends, school, home, and yes, their bodies, to stay pretty much the same, year in and year out.

Yet, change they must. There’s that exciting but scary switch from elementary to middle school. And the hallmark of the tween years is the onset or anticipation of puberty. Tweens’ biological clocks are in puberty countdown, with everyone’s clock ticking at a different rate, seemingly out of control.
But most tweens discover that they like growing up, experiencing changes in their bodies, activities and privileges over the years ahead.

Girls Take the Lead
Puberty chimes in first for girls. Between ages 8 and 13, their hypothalamic and pituitary glands kick into action, releasing hormones that spur the ovaries to produce estrogen. Breasts bud, a few hairs grow in the pubic area and underarms, and girls grow curvier and taller, towering over the boys. Before long, puberty is in full swing, crowned by the occurrence of a girl’s first period, which happens about two to three years after the onset of breast development.

While 10 and 11 year old girls are debating their readiness for a bra, most boys around them are oblivious to such dramas. Puberty for boys kicks in at about age 12 (though as early as 9 or 10 for some, or as late as 14). Now it’s the boys’ turn to notice changes— pubic hair, cracking voices, growth of testicles and penis. By age 14 or 15, most boys are taller than most of the girls.
For both boys and girls, puberty brings other challenges, too. Hormonal changes stimulate glandular changes that make showers urgent, deodorant a necessity and skin no longer reliably smooth. Early signs of acne torment some tweens. A pimple or two doesn’t seem like such a big deal to most parents. But for many pre-teens, any mirror is a magnifying one and any parental attempt to reassure them that they are still attractive is futile.

Ironically, tweens are often so self-conscious, they fail to notice that their friends have zits too.
For all the discomforts associated with puberty, at least most adolescents go through it together. But there’s a wide range of normal in the age of puberty onset, and those entering early or late have an additional burden to bear.

Early bloomers may feel embarrassed, looking but not feeling or acting like much older teens. Late bloomers feel like odd ones out— girls flat-chested, boys high-voiced until further into their teens.
Many early or late bloomers simply inherited their timetable from their parents. Tweens may find this news reassuring; at the very least it gives them someone to blame.

Health Problems to Watch For
Most tweens— and their parents— manage to survive and even enjoy these transitional years. There is no “natural law” that all pre-teens will suffer serious clashes with their family or get into serious trouble.
But there are some potential bumps in the road that parents should look out for:
When the Basics are Out of Whack. Nutrition, exercise and sleep are the three cornerstones of maintaining good health. But as tweens eat fries with their friends, instant-message on their computers instead of riding their bikes, and stay up late to study or watch TV, their health can take a dive. Not all of the effects are short-term. For example, these years are crucial for building strong bones; calcium deficits will show up years from now.
Body Image Concerns. In the best-case scenario, adolescents come to appreciate their changing bodies. But the media often holds up unrealistic standards. A girl whose tummy still sports baby fat despairs that she’ll never attain the waif-like thinness of top singers and actresses. Although there are encouraging signs that the obsession with super-thinness may be on the wane, plenty of girls still lapse into eating disorders (anorexia nervosa, bulimia, binge-and-purge cycles) in a desperate attempt to shrink themselves into a “better” body.

Boys are not immune to such pressures. Those impatient to attain a “ripped” muscular look may turn to steroids in an attempt to accelerate the process.

• Stress and Mental Health. Many tweens have a hard time adjusting to middle school. They resist the leap from their smaller elementary school, where they felt known and secure in self-contained classrooms. In middle school, they feel like pinballs sprung into a larger setting where they must make new friends and cope with demanding teachers. Social and school pressures make some tweens feel stressed-out, anxious or depressed.
• Substance Abuse. Some tweens turn to substance abuse to relieve stress or just to explore something new. Indeed, use of inhalants is more prevalent among pre-teens than teens, and many smokers and drinkers started in their tween years. Substance use of any kind at such an early age is cause for concern.

Sexual Experimentation. Some tweens explore their newly discovered sexuality in ways that may put their health and self-esteem at risk. Inclined to dismiss warnings of pregnancy and sexually transmitted diseases as things that happen to “other people,” young people are shocked to find that they are vulnerable. And as proud as they may feel of their beautiful new bodies, most pre-teens feel better about themselves when they keep their new curves private for a while.

Health Care for Tweens
Many adolescents continue to see their pediatrician throughout puberty and beyond. This relationship builds on its past (often since infancy) and may meet their health needs. But the field of adolescent medicine evolved specifically because pre-teens and teens have unique needs to which not all pediatricians are finely attuned.

An adolescent medicine specialist is skilled at assessing patients’ development and
identifying any health problems common to ages 10 to 21, like those described above.
Here the precocious tween and the late bloomer feel equally at home. The adolescent medicine specialist is not only current with tween trends, but knows how to draw out adolescents and help them navigate through the health risks that confront young people today.

The setting is more mature than a pediatrician’s office, where tweens may feel out of place among the blocks and crawling babies.

And as tweens turn into teens, they appreciate having a doctor who knows how to involve and educate parents while also respecting their patients’ confidentiality. The specialist supports family ties, while also gradually encouraging adolescents to take increasing responsibility for their own health.

Andrea Marks, M.D., and Betty Rothbart, MSW, are the authors of Healthy Teens, Body and Soul (Simon and Schuster). Marks is a specialist in adolescent medicine, directed academic programs and has a private practice for patients ages 9-30. Rothbart is a psychiatric social worker and educator and is the author of several books about parenting and health. Both authors have adolescent children and live in New York City.