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DESCRIPTION
Puberty is the time of hormone changes in both sexes. It begins nearly 2 years earlier in females than males. In females, it usually takes place anywhere between the ages of 8 to 14 and may last for 2 to 3 years. At puberty, the hypothalamus and the pituitary glands produce hormones that stimulate the ovaries to increase production of female sex hormones (estrogen hormones). This causes the reproductive organs to mature in both size and function, allowing reproduction to become possible. Adolescence is the period of transition from childhood to adulthood and is generally considered to last from the beginning of puberty to age 18 or 20.
The teenage years are also called adolescence. During this time, the teenager will see the greatest amount of growth in height and weight. Adolescence is a time for growth spurts and puberty changes. An adolescent may grow several inches in several months followed by a period of very slow growth, then have another growth spurt. Changes with puberty may occur gradually or several signs may become visible at the same time. There is a great amount of variation in the rate of changes that may occur. Some adolescents may experience these signs of maturity sooner or later than others. It is important to remember that these changes happen at different times for everyone. Being smaller or bigger than other girls or boys is normal as each child experiences puberty at his/her own time. The following are the average ages when puberty changes may occur:
- Growth increases between 10 to 14 years, with height increases from 2 to 10 inches.
- Weight gain: 15 to 55 pounds.
- Age of puberty: 8 to 13 years of age.
NORMAL GROWTH RATES
Growth not only involves length and weight of a body, but also includes internal growth and development. A child's brain will grow the most during the first five years of life, reaching 90 percent of its final size. Growth also affects different parts of the body at different rates; the head reaches almost its entire size by age 1. Throughout childhood, a child's body becomes more proportional to other parts of his/her body. Growth is complete between the ages of 16 and 18, at which time the growing ends of bones fuse.
Normal growth is categorized in a range used by pediatricians to gauge how a child is growing. The following are some average ranges of weight and height, based on growth charts developed by the Centers for Disease Control and Prevention (CDC):
Age Height - Females
(In Inches)Height - Males
(In Inches)Weight - Females
(In Pounds)Weight - Males
(In Pounds)1 27 to 31 28 to 32 15 to 20 17 to 21 2 31.5 to 36 32 to 37 22 to 32 24 to 34 3 34.5 to 40 35.5 to 40.5 26 to 38 26 to 38 4 37 to 42.5 37.5 to 43 28 to 44 30 to 44 6 42 to 49 42 to 49 36 to 60 36 to 60 8 47 to 54 47 to 54 44 to 80 46 to 78 10 50 to 59 50.5 to 59 54 to 106 54 to 102 12 55 to 64 54 to 63.5 68 to 136 66 to 130 14 59 to 67.5 59 to 69.5 84 to 160 84 to 160 16 60 to 68 63 to 73 94 to 172 104 to 186 18 60 to 68.5 65 to 74 100 to 178 116 to 202
Although a child may be growing, his/her growth pattern may deviate from the normal. Ultimately, the child should grow to normal height by adulthood. If you suspect your child or adolescent is not growing properly, always consult your child's health care provider.
CHARACTERISTICS
Sexual and other physical maturation that occurs during puberty results from hormonal changes. As the adolescent nears puberty, a gland in the brain called the pituitary gland increases the secretion of a hormone called follicle-stimulating hormone (FSH). This hormone then causes additional effects. In girls, FSH activates the ovaries to start producing estrogen. In boys, FSH causes sperm to develop. Girls experience puberty as a sequence of events, but their pubertal changes usually begin before boys of the same age. Each girl is different and may progress through these changes differently. The following are average ages that changes may occur:
- Beginning of puberty: 8 to 13 years.
- First pubertal change: breast development.
- Pubic hair development: shortly after breast development.
- Hair under the arms: 12 years of age.
- Menstrual periods: 10 to 16.5 years of age.
There are specific stages of development that both boys and girls go through when developing secondary sexual characteristics. The following is a brief overview of the changes that occur.
PHYSICAL CHANGES OVERVIEW
- In girls, the initial puberty change is the development of breast buds, in which a small mound is formed by the elevation of the breast and papilla (nipple). The areola (the circle of different colored skin around the nipple) increases in size at this time. It is usually the first sign (usually at about age 11). The breasts continue to enlarge. Eventually, the nipples and the areolas will elevate again, forming another projection on the breasts. At an adult state, only the nipple remains erect. The breasts often grow at uneven rates, which is completely normal, and the difference usually disappears by the time full maturity is reached. (See more about breast development below.)
- Growth of pubic hair (in some females, this may be the first sign of puberty). Pubic hair development is similar for both girls and boys. The initial growth of hair produces long, soft hair that is only a small area around the genitals. This hair then becomes darker and coarser as it continues to spread. The pubic hair eventually looks like adult hair, but in a smaller area. It may spread to the thighs and sometimes up the stomach.
- Growth of hair under the arms starts about 1 year after the pubic hair appears. The increase of hair growth not only in the pubic area, but also the underarms and legs occurs. Many adolescent girls and women may decide to shave this hairs.
- There is a significant growth spurt and increase in weight. During adolescence, body weight may double due to increased fat and height increases by 15 to 20%. Some girls attain their adult physique by age 13, others do not do so until age 18.
- The female body shape will also begin to change. There is not only a weight gain and an increase in height, but a Widening of the pelvis; fat deposits on the hips, buttocks, legs and stomach. These are normal changes that may occur during puberty. Her size will increase, with the feet, arms, legs, and hands beginning to grow in advance of the body. This may leave the adolescent girl to experience a time of feeling clumsy and awkward.
- As the hormones of puberty increases, adolescents may experience an increase in oily skin and the development of sweat glands under the arm and in the groin with an increase in sweating. This is a normal part of growing. It is important to wash daily, including the face. Acne may develop.
- An enlargement of the uterus occurs at puberty. Adolescent girls will also experience menstruation. Menstruation occurs at an average of 12 1/2 years, but it can begin as early as 8 or 9 years or as late as 16 or 17 years of age. Girls who are overweight tend to start menstruating earlier than the average. Menstruation may be delayed in girls who are malnourished, involved in strenuous sports or other physical activities (e.g., dancing) or have a chronic health disorder. Menstrual periods can be irregular for the first 1 to 2 years. the Menstrual cycle begins when the body releases an egg from the ovaries. If the egg is fertilized with a sperm from a male, it will grow into a baby inside the uterus. If the egg is not fertilized, the endometrial lining of the uterus is not needed and is shed through the vagina as fluid. The fluids are bloody and are usually released monthly. After a girl begins to menstruate, she is able to get pregnant. (See more about menstruation below.)
- Other aspects of puberty include an increased appetite, changes in the sleep-wake cycle, and temperament fluctuations. Intense emotions and mood swings are typical (which are probably attributable to hormone changes).
- The teenage years bring many changes, not only physically, but also mentally and socially. Children in these years increase their ability to think abstractly and eventually make plans and set long-term goals. Each child may progress at different rates, and show a different view of the world. In general, the following are some of the abilities that may be evident in your teenager:
- Developing the ability to think abstractly.
- Concerns with philosophy, politics, and social issues.
- Thinking long-term.
- Setting goals.
- Comparing oneself to one's peers.
Your adolescent's relationships with others changes as your adolescent begins to struggle for independence and control, many changes may occur. The following are some of the issues that may be involved with your adolescent during these years:
- He/she wants independence from parents.
- Peer influence and acceptance is very important.
- Peer relationships become very important.
- He/she may be in love.
- He/she may have long-term commitment in relationship.
NORMAL BREAST DEVELOPMENT
Breast development is a vital part of puberty in the human female. Unlike other mammals, however, human females are the only ones who develop full breasts long before they are needed to nurse their offspring.
Breast development occurs in distinct stages, first before birth, and again at puberty and during the childbearing years. Changes also occur to the breasts during menstruation and when a woman reaches menopause.
EARLY DEVELOPMENT
This first stage of development begins at about 6 weeks of fetal development with a thickening called the mammary ridge or the milk line. By 6 months of development this extends all the way down to the groin, but then regresses. At this time, solid columns of cells form from each breast bud, with each column becoming a separate sweat gland. Each of these has its own separate duct leading to the nipple. By the final months of fetal development, these columns have become hollow, and by the time a female infant is born, a nipple and the beginnings of the milk-duct system have formed.
PUBERTY CHANGES
As a girl approaches puberty, the first outward signs of breast development begin to appear. When the ovaries start to secrete estrogen, fat in the connective tissue begins to accumulate causing the breasts to enlarge. The duct system also begins to grow. Usually, the onset of these breast changes is also accompanied by the appearance of pubic hair and hair under the arms.
Once ovulation and menstruation begin, the maturing of the breasts begins with the formation of secretory glands at the end of the milk ducts. The breasts and duct system continue to grow and mature with the development of many glands and lobules. The rate at which breasts grow varies greatly and is different for each young woman. Generally, there are five stages of breast development in girls.
Female Breast Developmental Stages Stage 1 (Pre-adolescent) - Only the tip of the nipple is raised. Stage 2 Buds appear, breast and nipple raised, and the areola (dark area of skin that surrounds the nipple) enlarges. Stage 3 Breasts are slightly larger with glandular breast tissue present. Stage 4 The areola and nipple become raised and form a second mound above the rest of the breast. Stage 5 Mature adult breast; the breast becomes rounded and only the nipple is raised.
CYCLICAL CHANGES DURING MENSTRUATION
Each month, women experience fluctuations in hormones that make up the normal menstrual cycle. Estrogen, which is produced by the ovaries in the first half of the menstrual cycle, stimulates the growth of milk ducts in the breasts. The increasing level of estrogen leads to ovulation halfway through the cycle, and then the hormone progesterone takes over in the second half of the cycle, stimulating the formation of the milk glands. These hormones are believed to be responsible for the cyclical changes such as the swelling, pain, and tenderness that many women experience in their breasts just before menstruation.
During menstruation, many women also experience changes in breast texture, with breasts feeling particularly lumpy. These are the glands in the breast enlarging to prepare for a possible pregnancy. If pregnancy does not occur, the breasts return to normal size. Once menstruation begins, the cycle begins again.
THE MENSTRUAL CYCLE: AN OVERVIEW
When a young woman reaches puberty, she begins to ovulate. This is a process in which a mature egg cell (also called an ovum), ready for fertilization by a sperm cell, is released from one of the ovaries (two female reproductive organs located in the pelvis). If the egg is fertilized by a sperm cell as it travels down the fallopian tube, then pregnancy occurs and it becomes attached to the lining of the uterus until the placenta (an organ, shaped like a flat cake, that only grows during pregnancy and provides a metabolic interchange between the fetus and mother) develops. If the egg does not become fertilized as it travels down the fallopian tube on its way to the uterus, the endometrium (lining of the uterus) is shed and passes through the vagina (the passageway through which fluid passes out of the body during menstrual periods; also called the birth canal), a process called menstruation.
As the average menstrual cycle lasts 28 days (starting with the first day of one period and ending with the first day of the next menstrual period), most women ovulate on day 14. At this time, some women experience minor discomfort in their lower abdomen, spotting, and/or bleeding, while others do not experience any symptoms at all.
A woman is generally most fertile (able to become pregnant) a few days before, during, and after ovulation.
Menstruation is one part of a woman's menstrual cycle which includes the shedding of the endometrium (lining of the uterus) that occurs throughout a woman's reproductive life. With each monthly (on average) menstrual cycle, the endometrium prepares itself to nourish a fetus, as increased levels of estrogen and progesterone help to thicken its walls. If fertilization does not occur, the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum) make up the menstrual flow (also called menses) that leaves the body through the vagina.
MENARCHE
On average, menarche (a young woman's first menstrual period) occurs between the ages of 12 and 14 years old - generally two years after her breast budding, and, in most cases, not long after the onset of pubic hair and underarm hair. Stress, various types of strenuous exercise, and diet can affect the onset of menstruation and the regularity of the menstrual cycle.
The American College of Obstetricians and Gynecologists (ACOG) recommends that a young woman consult her health care provider if she has not started to menstruate by the age of 16, and/or if she has not begun to develop breast buds, pubic hair, and/or underarm hair by the age of 13 or 14.
For menstruating women, an average menstrual cycle lasts 28 days - starting with the first day of the last period (which, on average, lasts 6 days, with some women having a very light flow and others having a very heavy flow) and ending with the first day of the next menstrual period. However, the length of women's cycles varies, particularly for the first one to two years after menarche (a young woman's first menstrual period). Women may have cycles as short as 23 days, or as long as 35 days. However, anything that deviates from this range is considered abnormal and may require medical attention.
EXPECTED OUTCOME
The age at the time of puberty is variable and the onset can be especially troublesome in girls. There are physical, mental and emotional changes that make adolescence a particularly difficult time.
Early puberty and development toward physical maturity is normally not a cause for concern.
POSSIBLE COMPLICATIONS
Delayed puberty. The age varies, but may be first considered if a girl has no signs of sexual development by age 13. Usually no extensive medical workup to look for causes is recommended until after the age 16 is reached.
Severe acne.
Eating disorders (anorexia nervosa or bulimia nervosa).
Emotional disorders.
PROMOTING WELL-BEING
GENERAL MEASURES
A parent should prepare a pre-puberty child for the experience. If unsure about how to communicate, seek help from educational reference material on parenting, the health care provider, or other resources in the community.
As a daughter goes through puberty and adolescence, parents should try to keep the lines of communication open and keep discussions nonjudgmental and honest. There is no easy answer to the adolescent's complex problems dealing with family, friends, society and the additional life stresses on teenagers.
Tampons or sanitary pads are acceptable for use during menstrual periods. With good hygiene, there should be no problems with menstrual odor.
A girl's first pelvic examination should be at age 16 to 18 (if not done previously) to ensure normal reproductive anatomy and for Pap smear testing.
Seek professional help if an adolescent girl appears to have an eating disorder (anorexia nervosa or bulimia nervosa).
FEELINGS & BEHAVIORS
Most American adolescents are psychologically, socially, and physically healthy. A vast majority are good citizens who are free of major mental, behavioral, and addictive disorders. An increasing percentage of our adolescents volunteer in their communities while declining numbers are participating in violent behavior and actions, become pregnant, use drugs, consume alcohol or smoke cigarettes. Despite these encouraging facts, adolescence remains a time of considerable change and risk.
One of the most obvious changes during adolescence / puberty often coincides with moving from elementary school to new schools with larger social networks. Not only are peer groups larger in middle and high schools, but also homework tends to be more intensive, class sizes are larger, students are given more responsibility and independence, and teachers are less accessible than in elementary school.
There are also major changes at home during this time period. Parents try to strike a balance between monitoring their teen's behavior while at the same time giving them more independence. Young people spend less time at home around their parents and siblings and more time alone or with friends. Most launch an identity search to figure out who they are during this time period. Exposure to high risk situations, such as drug use, cigarettes, alcohol, negative sexual, mischievous or violent behavior and/or situations as well as other negative behaviors accompany these life changes.
Our young people need tools to navigate the inevitable challenges and opportunities of adolescence and the subsequent transition into adulthood. Effective initiatives to promote adolescent well-being can ease that transition, and research can suggest which strategies may work best. Many contributing influences and programs are available to adolescents and their families that lead to positive behavior are found in seven areas:
- Mental Health
- Emotional Well-being
- Educational Adjustment
- Physical Health & Safety
- Reproductive Health
- Social Competency
- Citizenship
Relationships are key to adolescent well-being. Child-parent interactions and bonding greatly influence adolescent choice and attitudes. Poor relationships, including positive ties among teens, are important. Siblings, teachers, and mentors can provide additional support to young people. Supportive relationships have more positive results with teen development than simply telling them "to do" or "not to do" something strategy. Adolescent supporters should view adolescents as whole people, not just students, patients, or delinquents, and not expect an easy solution to improve teens' lives. They should work to engage teens with targeted desired outcomes and start these programs when adolescents are young to ensure that the programs are well-implemented. It is important for those involved with youth to overcome the tendency to think of young people solely in negative terms.
MIDDLE SCHOOL AND EARLY HIGH SCHOOL ADOLESCENCE
Parents are often worried or confused by changes in their teenagers. The following information should help parents understand this phase of development. Each teenager is an individual with a unique personality and special interests, likes and dislikes. However, there are also numerous developmental issues that everyone faces during the adolescent years. The normal feelings and behaviors of the middle school and early high school adolescent are described below.
MOVEMENT TOWARDS INDEPENDENCE
Struggle with sense of identity. Feeling awkward or strange about one's self and one's body. Focus on self, alternating between high expectations and poor self-esteem. Interests and clothing style influenced by peer group. Moodiness. Improved ability to use speech to express one's self. Realization that parents are not perfect; identification of their faults. Less overt affection shown to parents, with occasional rudeness. Complaints that parents interfere with independence. Tendency to return to childish behavior, particularly when stressed.
FUTURE INTERESTS AND COGNITIVE CHANGES
Mostly interested in present, with limited thoughts of the future. Intellectual interests expand and gain in importance. Greater ability to do work (physical, mental, emotional).
SEXUALITY
Display shyness, blushing, and modesty. Girls develop physically sooner than boys. Increased interest in sex. Movement toward heterosexuality with fears of homosexuality. Concerns regarding physical and sexual attractiveness to others. Frequently changing relationships. Worries about being normal.
MORALS, VALUES, AND SELF-DIRECTION
Rule and limit testing. Capacity for abstract thought. Development of ideals and selection of role models. More consistent evidence of conscience. Experimentation with sex and drugs (cigarettes, alcohol, and marijuana).
Young teenagers do vary slightly from the above descriptions, but the feelings and behaviors are, in general, considered normal for each stage of adolescence.
LATE HIGH SCHOOL ADOLESCENCE
Parents are often worried or confused by changes in their teenagers. The following information should help parents understand this phase of development. Each teenager is an individual with a unique personality and special interests, likes and dislikes. However, there are also numerous developmental issues that everyone faces during the adolescent years. The normal feelings and behaviors of the late high school adolescent are described below.
MOVEMENT TOWARD INDEPENDENCE
Increased independent functioning. Firmer and more cohesive sense of identity. Examination of inner experiences. Ability to think ideas through. Conflict with parents begins to decrease. Increased ability for delayed gratification and compromise. Increased emotional stability. Increased concern for others. Increased self-reliance. Peer relationships remain important and take an appropriate place among other interests.
FUTURE INTERESTS AND COGNITIVE CHANGES
Work habits become more defined. Increased concern for the future. More importance is placed on one's role in life.
SEXUALITY
Feelings of love and passion. Development of more serious relationships. Firmer sense of sexual identity. Increased capacity for tender and sensual love.
MORALS, VALUES, AND SELF-DIRECTION
Greater capacity for setting goals. Interest in moral reasoning. Capacity to use insight. Increased emphasis on personal dignity and self-esteem. Social and cultural traditions regain some of their previous importance.
Older teenagers do vary slightly from the above descriptions, but the feelings and behaviors are, in general, considered normal for each stage of adolescence.
ADOLESCENT BEHAVIORS OFTEN CLUSTER
Considerable research evidence suggests that teens with one positive or negative characteristic have other corresponding characteristics. For instance, adolescents who are depressed often have anxiety disorders and use drugs or alcohol. And those who drink alcohol, often take drugs and smoke cigarettes and are more likely to take part in risky sexual behaviors, have poor sleeping habits and be physically unhealthy. Likewise, teens who have one positive characteristic are more likely to have other positive characteristics. These teens are those who engage in civic activities, tend to do better in school, to be in better psychological health, and to take part in fewer risky behaviors. These young people are also more likely to have good social skills and be friends with other teens with similar positive characteristics. Teen supporters can often bring about changes in a young adult by focusing on one or two positive areas. If a teen has one problem (like alcohol or drug abuse), parents and program providers should be alerted for additional behavior problems, such as risky sexual activity.
PARENT-CHILD RELATIONSHIPS
The relationship between a child and his or her parents is a vital component to adolescent well-being and development. There are four key factors:1. Relationships: Teens who have warm, involved, and satisfying relationships with their parents are more likely to do well in school, be academically motivated and engaged in positive activities. They have better and more positive attitudes towards their families and about themselves. They have better social skills and have lower rates of risky sexual and other negative behaviors than their peers. On the other hand, teens with poor relationships with their parents are more likely to have psychological problems and other problems which may include poor grades and risky, unhealthy behaviors.
2. Modeling: Teens whose parents demonstrate positive behaviors in a number of areas are more likely to engage in those behaviors themselves. Teens whose parents take part in risky behaviors are more likely to do the same.
3. Monitoring / Awareness: Parents who know about their children's activities, behaviors, and friends and monitor them in age-appropriate ways, have teens with lower rates of risky sexual and physical behaviors along with lower drug, alcohol and tobacco use than their peers. Adolescents who perceive that their parents are taking on this monitoring role are more likely to do well both socially and academically.
4. Parenting Approach: Parents who are supportive and caring, but consistently monitor and enforce family rules and limits, are more likely to have teens that are motivated and successful in school, as well being physically and psychologically healthy. However, parents who are overly strict and do not give them any independence to their teens will have a child that may be more likely to participate in risky behaviors. Similarly, those parents that are warm but overly permissive, are more likely to have teens that are impulsive and engage in risky behaviors.
Parents need to remain actively and positively involved in the lives of their teenagers, while also allowing them to take on greater independence and responsibility for their conduct, as appropriate for their ages. Teen programs supporters need to be aware of parental influences on teen development and make sure parents are involved in programs and activities whenever possible.
PEER RELATIONSHIPS
Too many adults think teen peers can only be a negative influence on their children. Teens have a need to "belong" in a social situation. They are developing their social skills at this age. Parents and other supportive individuals can help guide their teens toward positive peer influences. Evidence suggests that teens often influence each other in a positive way by either modeling behaviors or pressuring each other to behave in certain ways or adopt certain attitudes and goals. However, the direction of peer association is not as obvious as once perceived. For example, "bad kids" seem more likely to seek out and find other "bad kids" while "good kids" seem to be more likely to seek and find other "good kids." In addition, peer acceptance may be more likely for teens whose attitudes and behaviors correspond to those of the group. Peer relationships tend to perpetuate teen behaviors. Those adolescents whose friends smoke, drink alcohol, use drugs, engage in violent and deviant behaviors, and engage in risky sexual behaviors are more likely to take part in those behaviors themselves. While teens whose friends have high educational aspirations, achieve academically, and engage in other positive and healthy behaviors then to behave similarly.
OTHER SUPPORTIVE RELATIONSHIPS
Aside from parents and peers, teens often have connections with other people who may play an influential roles in their lives and social growth.
Siblings: Siblings can act as models for positive behaviors, such as physical activities, and negative behaviors, such as alcohol or drug use. Sibling relationships are a good training ground for conflict resolution and negotiation skills necessary in other parts of an adolescent's life.
Mentors: A positive mentor can offer friendship, guidance, and assistance, as well as a positive role model for teens. Close, long-term mentoring relationships are associated with reduced rates of drug and alcohol use and increased rates of high school completion and formal educational goals, volunteering in socially significant programs, and tolerance towards other people and lifestyles outside of the home and school environment. Mentoring can also teach social skills that are useful in a variety of settings.
Teachers & Adults: Teachers, coaches, religious leaders, and other adults can act as surrogate family members to serve as role models, teach social skills, and provide support that may not be available at home.
Teen supporters need to make sure that they view teens as whole people, more than just students, patients, or problem children and take a more complete and balanced approach to youth development while being aware of the many factors associated with adolescent well being. Schools, communities, socioeconomic status, the media, and public policies, among other factors, all have implications for adolescent development. Here are a few examples:
- The price of cigarettes influences teen smoking, with higher prices being associated with lower smoking rates.
- Moving children and teens out of high-poverty neighborhoods (often with high levels of teen-gang and criminal activity) into low-poverty areas (with much less gang and criminal activity and influence) is associated with improvements in physical and mental health and less delinquent behaviors, and behavior problems.
- Service-learning programs that incorporate volunteer activities reduce teen sexual activity and lower the risk of pregnancy.
- The school atmosphere - whether they place an emphasis on achievement, the level of per-student expenditure, and the over-all attitude of teachers - are associated with various measures of academic achievement and skills.
- Adolescents from economically poor families and poor neighborhoods are more likely to get pregnant, less likely to success in school, more likely to be involved with illegal criminal activity, and more likely to be injured unintentionally (drive-by gang affiliated attacks and shootings are a growing problem in many poor neighborhoods).
TEENS GETTING INVOLVED
Programs that have lectured to young people about various social issues have failed, whether it was meant to change behavior, target smoking, drug use, gun violence, or teen pregnancy. Nobody, whether it be child, teen or adult wants to listen to a lecture about what they should be doing or not doing with their lives. On the other hand, many programs that get teens involved with and take an active part in their programs find that the teens will build relationships, engage other young people, and provide well-implemented and structured positive activities. These involved teens tend to have lower rates of pregnancy, drug and alcohol abuse, tobacco use, and higher rates of civic engagement and school achievement. Teens want to be involved with important issues, if given the chance. Programs that engage teens also teach important social and life skills through activities that are either specific (resistance to peer pressure) or non-specific (sports) to a particular program's goals. Moreover, taking part in these activities during the high-risk hours of 3 to 8 p.m. gives teens something positive to do in a safe and supportive environment and leaves less time for getting into trouble.
Successful adolescent development programs tend to include a component that specifically targets desired outcomes. Some programs overlook a specific target for a desired outcome. For instance, a program that is meant to increase academic achievement contains all of the promising practices mentioned above, such as engaging teen activity and treating teens as whole people, but lacks a focus on increasing academic skills, may not have the desire effect. This is also the case for programs geared to promote positive reproductive health, physical and mental health, positive citizenship, and social competence in teens.
Although it is not too late to implement youth development programs and policies when children enter adolescence, starting earlier in a child's life can have impacts throughout the teenage years and into adulthood. Since the psychological, behavioral, and academic problems that start in childhood often continue for years, this strategy makes theoretical sense. Intensive preschool programs confirm this approach, they are associated not only with educational advances, but also with reduced pregnancy and childbearing years later.
The best program and policy ideas are unlikely to be effective if, among other considerations, they do not include proper staff training, a well-developed infrastructure, and participation from teens and their parents, including teen involvement in the program development. In addition, committed, involved staff seem essential. Staff turnover undermines adolescents relationships with staff. Program implementation is often ignored or understudies. If program staff and evaluators do not know how well their program was implemented, or what components were or were not implemented adequately, they will not be able to say why the program's design has been effective or ineffective. Nor will program providers know which components to keep and which to change.
Though growing up in a complex and challenging world, teens often have positive attitudes and engage in positive behaviors. Instead of simply trying to stop a negative behavior, we as parents and supporters of a teenaged child, we should address and enhance positive influences, giving the positive more attention and getting out teens involved in the change. We need to build and reinforce out teens' positive behaviors, instead of only targeting problems, with a holistic view rather than focusing exclusively on a single aspect of a teen's life. Programs and strategies need to develop activities that engage teens and are age appropriate. They must create a social and physical infrastructure to sustain the initiatives. Goals should be challenging but obtainable.
Additional information is available from the American Academy of Pediatrics, Department of Publications, P.O. Box 927, Elk Grove Village, IL 60007; website www.aap.org.
MEDICATION
If there is a problem with cramps during menstrual periods, a mild non-prescription pain medicine may be used.
OTHER HELPFUL SUGGESTIONS
Adolescent girls should be encouraged to eat well, maintain normal weight, and to develop a routine exercise program (taking into consideration the peer pressure and the multiple, difficult changes going on during this time).
MoonDragon's ObGyn Information: Anorexia
NOTIFY YOUR HEALTH CARE PRACTITIONER IF...
You have concerns about your daughter's physical or sexual development.
Any unusual vaginal bleeding or discharge occurs, or there is excessive pain during menstruation.
Your daughter develops any psychological or behavioral problems.
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