Stages of Puberty – What is Normal and What is Not?

blog_92284195_0Puberty is an often-confusing time, both for the pubescent child and for their parents. Thanks to the hormonal influence of testosterone and estrogen, the changes that occur as a part of puberty can vary greatly for each individual child.  As pediatricians, we want to help provide you with trusted information so that you can recognize the changes and support your child through this very complex period of development.

“Normal” Puberty Experiences

As mentioned before, every child will have a unique experience during puberty, but here are a few standard expectations.

The average age for girls to begin puberty is around 10 and for boys, around 11 years old. Most children will experience changes over the course of 4 years, with most visible changes noticeable by ages 13 for girls and 14 for boys.

Puberty is most apparent through the physical sexual changes that take place.For girls, the first sign of puberty is the beginning of breast development. Next, pubic hair typically begins to grow, followed by growth of hair in the armpits. Menstruation is usually one of the later changes to occur (around 2-3 years after the onset of other physical changes). For boys, the first observable pubescent change is usually an increase in the size of the testicles. Enlargement of the penis usually comes next, followed by the development of pubic hair and growth of armpit hair. The next stage involves the voice becoming deeper and an increase in muscle size. The last step for boys is usually the development of facial hair.

There are also several other changes that typically occur during puberty. Along with the development of sexual characteristics will come the attainment of fertility. Many boys and girls will experience a “growth spurt” as they progress through the stages of puberty. About 17%-18% of adult height is usually attained during puberty. Changes in weight also occur in both girls and boys. Girls typically develop a larger proportion of fat, lending to a curvier appearance. Boys tend to gain weight as they gain muscle mass. Bone development also takes place during puberty. Studies have shown that boys and girls typically experience an increase in bone width first, and then bone mineral content, followed by the achievement of bone density. Finally, the maturation of the lungs and cardiovascular system during puberty is associated with an overall increase in strength and endurance, especially for boys.

Now these are typical changes for most children, but the process of puberty can often take place on different timelines and in different orders, yet still be considered “normal.” Body composition and/or body fat may play a role in regulating the onset and completion of puberty.

There are, however, a few reasons to see your doctor if something seems significantly out of range.

Puberty Concerns: Reasons to See Your Doctor

It is extremely important to support your child through a healthy development, so if you have any pressing concerns about pubescent changes, or the lack thereof, don’t hesitate to discuss those concerns with your doctor.

Common Problems During Puberty: Some medical conditions may become apparent or worsen during puberty. These can include acne, gynecomastia, anemia, scoliosis, vision changes, abnormal menstrual bleeding, and an increased risk for musculoskeletal injuries. While these can often be mild and unobtrusive, call your doctor to find out about treatment options if these symptoms or conditions become disturbing for your child.

Early Puberty: Medically referred to as precocious puberty, this involves children who begin puberty at a much earlier age than normal. A girl that begins to show breast or pubic hair development before the age of 8, or a boythat develops secondary sex characteristics before the age of 9 should be medically evaluated. Precocious puberty may be associated with psychological difficulties that may impact a child’s emotional development. Early puberty may also be linked to an underlying medical condition, especially for boys. Your doctor may want to check for abnormalities of the testes, thyroid gland or other hormone problems, genetic conditions, tumors or infections of the brain, and/or brain injuries.

Delayed Puberty: Puberty is usually considered to be delayed if there is no breast development for a girl by the age of 14, and no increase in testicular volume for a boy by the age of 15. There are several factors that can contribute to delayed puberty, including a high muscle mass-to-body fat ratio, genetic predispositions, malnutrition, the existence of chronic medical conditions such as cystic fibrosis or diabetes, problems with the thyroid or pituitary glands, or problems with the testes or ovaries.

Ultimately, you should exercise your best judgment and consult your doctor if you have any real concerns about your child’s health and development. The most important thing you can do is TALK TO YOUR CHILD and BE SUPPORTIVE as they go through this very volatile time in life.

As always, we are here to help if you have concerns. Please contact our office and we will be happy to assist you.