When people hear the word “puberty,” their first reaction may be to cringe or to laugh uneasily. Going through puberty makes many people feel awkward and uncomfortable, so it is understandable why they would not want to be reminded of that time in their lives.

However, it is important for parents to talk to their children about puberty (the time in their lives when their bodies change into adult form and they become sexually mature) so that their children know what to expect. Different children start puberty at different ages, and as their bodies change, they may have questions for their parents about what is happening. Parents need to make sure that they have accurate information about puberty so that they can better help their children through this challenging time in their lives.

In addition to talking to their children about puberty, parents also need to talk to their children about sex. Children receive messages about sex from a variety of sources (TV, the Internet, their friends, etc.) beginning at a very early age. These messages may not always be accurate or what parents want their children to know about sex. So, it is important for parents to communicate with their children about sex to help ensure that they do receive correct, healthy messages.

Puberty is the time in a child’s life when his or her body begins to develop into that of an adult and he or she becomes sexually mature, meaning they are now capable of reproduction. Puberty is a process that lasts for several years and causes many changes in a child’s body. In girls, puberty typically begins between ages 8 and 12, and in boys, puberty usually starts between ages 9 and 14. However, puberty can begin earlier or later than those age ranges in both boys and girls.

Puberty starts when the brain releases a hormone (or a chemical messenger) called gonadotropin-releasing hormone (Gn-RH). Gn-RH causes the pituitary gland (a small, bean-shaped gland at the base of the brain) to release two more hormones-luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In girls, LH and FSH cause the ovaries (the two reproductive organs that contain eggs) to produce another type of hormone called estrogen. In boys, LH and FSH cause the testicles (the two egg-shaped reproductive organs in the scrotum) to produce another type of hormone called testosterone. Estrogen and testosterone cause the physical changes of puberty.

These physical changes usually follow a similar pattern, but some children experience their physical changes in a different order. Typically, variations in the pattern of physical development do not indicate that there is any kind of problem. However, parents can check with their children’s doctors to be sure.

Boys and girls usually go through the following patterns of physical changes during puberty:

Physical Changes in Girls: In girls, the first sign of physical changes is usually the development of breasts. Then, hair grows in the pubic area followed by hair growth in the armpits. Throughout puberty, girls also experience a growth spurt when their bodies grow rapidly (maybe over four inches in a year). Girls’ bodies become curvier as well because their breasts get bigger and their hips become wider. Additionally, they may get acne as their hormones make their skin more oily and body odor as their hormones stimulate their sweat glands.

Girls also get their first period (menstruation) about two or two and a half years after they begin puberty. During the menstrual cycle, one of a girl’s ovaries releases an egg each month that makes its way toward her uterus (the hollow organ located in a female’s lower abdomen where a fetus develops). The lining of the girl’s uterus fills with blood and extra tissue over the course of the month that will nourish and protect a fetus if the egg becomes fertilized by a male’s sperm and the female becomes pregnant. If the egg is not fertilized, though, the uterus does not need that extra blood and tissue, and the blood leaves the female’s body through her vagina. This blood flow is a girl’s period, and it typically lasts between two and seven days.

Physical Changes in Boys: For boys, the first physical sign of puberty is usually larger testicles and a larger penis. Next, hair grows in the pubic area. Then, hair grows in the armpits. Boys may notice a small amount of breast tissue growth as well, but this is normal and typically goes away by the end of puberty. Boys’ voices also crack and eventually become deeper. Their bodies become more muscular, they experience growth spurts, and their shoulders widen. Finally, they start to grow facial hair and get acne and body odor.

Although there is a wide age range when children typically begin puberty, some children begin puberty even earlier than the younger end of that range (early puberty) and other children begin puberty even later than the older end of that range (delayed puberty).

• Early Puberty: Early puberty (also called precocious puberty) occurs when children begin to go through the physical changes of puberty before age 8 if they are girls or age 9 if they are boys. While these changes begin earlier than they ordinarily would, they still tend to follow the same patterns and timings as the changes that occur in a child who begins puberty during the average age range.

  Early puberty can run in families, and most of the time, doctors cannot identify a cause. This could be because it is just a variation of normal puberty in those cases. However, some medical conditions can cause early puberty. Although it is rare, the following medical conditions can cause children to begin physically developing earlier than is expected:

  • A tumor in the brain or spinal cord
  • An infection, such as meningitis (an infection of the membranes that cover the brain and spinal cord)
  • A brain defect, such as hydrocephalus (excess fluid buildup)
  • Radiation or injury to the brain or spinal cord
  • An obstruction of blood flow to the brain
  • Genetic diseases that cause hormone problems (e.g., McCune-Albright syndrome) or abnormal hormone production (e.g., congenital adrenal hyperplasia)
  • Problems (e.g., tumors) in the ovaries, testicles, or glands that cause the release of estrogen and testosterone into the body without the involvement of Gn-RH
  • Exposure to external sources of estrogen or testosterone (e.g., in creams or ointments)

• Delayed Puberty: When children have not yet gone through puberty and they are older than the normal age range when children begin puberty, they have delayed puberty. Children may also have delayed puberty if they have started developing but they have not finished developing after several years. For example, if girls have not started menstruating five years after they started developing breast tissue, they have delayed puberty. If boys’ testicles and penises have not fully developed five years after they started to grow, they have delayed puberty.

  Like early puberty, delayed puberty can run in families, and sometimes doctors cannot identify a cause. In these cases, the delay in puberty may just be a variation of normal puberty. When puberty does begin in these children, it usually progresses normally. However, there are also medical conditions and treatments for medical conditions that can cause delayed puberty.

  • Diabetes mellitus (a disease where the body does not properly produce or use the hormone insulin, which is necessary to turn food into energy)
  • Inflammatory bowel disease (diseases that cause chronic inflammation of the intestines)
  • Kidney disease
  • Cystic fibrosis (a disease that affects the glands that secrete mucus and sweat and can lead to other serious infections and problems digesting food)
  • Anemia (a condition where there are not enough healthy red blood cells to carry adequate levels of oxygen to the body’s tissues)
  • Radiation therapy or chemotherapy for cancer treatment
  • Excessive dieting or exercising
  • Chromosomal abnormalities (e.g., Turner’s syndrome, Klinefelter’s syndrome) and other genetic disorders
  • Infections (e.g., mumps)
  • A tumor that damages the pituitary gland or the brain

Diagnosing and Treating Early and Delayed Puberty

In order to make sure that there are no medical conditions causing early or delayed puberty, doctors will review a child’s medical histories. They will also perform physical exams and may run some additional tests. For example, they may run blood tests to measure hormone levels, take X-rays of children’s hands and wrists to determine how quickly children’s bones are growing, perform analyses to check for chromosomal abnormalities (in the case of delayed puberty), or use magnetic resonance imaging (MRI) to look at cross-sections of children’s brains for problems, such as tumors.

Treatment of early puberty and delayed puberty depends on their causes. In most cases, children with early or delayed puberty do not have any underlying medical conditions. Doctors can give children with early puberty medication to delay further physical development until they are older. Similarly, doctors can give children with delayed puberty supplemental sex hormones to start their development sooner. However, in many cases, doctors do not treat early or delayed puberty and just allow the children to develop at their own pace.

In cases where an underlying medical condition is causing the early or delayed puberty, doctors treat that medical condition. For example, if a child has a tumor, doctors may surgically remove the tumor. Or, if a child has an infection, doctors will give him or her medication to treat that infection.

Puberty can be an anxious and confusing time for children. Their bodies are changing, and they may not completely understand what is happening. They may feel clumsy and awkward as they adjust to their adult bodies. Also, they may feel self-conscious about their bodies if their friends are either developing faster or slower than they are. In addition to physical changes, children also experience emotional changes during puberty as their minds adjust to the new hormone levels. They may become upset more easily and may be embarrassed about their changing feelings regarding the opposite sex.

Parents can help their children through this challenging time by talking to them before they begin puberty. When talking to their children about puberty, parents should describe the changes that will happen to their children’s bodies. It is especially important to describe menstruation to girls before they experience it because girls may become alarmed if they discover blood and do not know why it is there. Parents should also describe the emotional changes that their children will go through, such as feelings of attraction to the opposite sex. If children are prepared for the changes that will happen to them, then they will be less surprised and confused about what they are experiencing. In addition to talking about the changes that their children will experience themselves, parents should also describe the changes that children of the opposite sex experience so that children are completely informed.

Parents need to make sure that they answer their children’s questions openly and honestly in age-appropriate ways. However, parents may need to initiate a discussion about puberty before their children feel comfortable talking to them about it. If parents are unsure about the answer to a question, they can talk to their family doctor about it or find the answer in a book or on a website, for example.

Finally, it is important for parents to reassure their children that the changes related to puberty are normal – everyone experiences them. This reassurance can help children feel less self-conscious. Even in the cases of early puberty and delayed puberty, most children experience a similar pattern of changes. If parents are concerned that something about their child’s development is not normal, they can visit their family doctor to have the issue checked out.

As parents think about their children going through puberty, they may ask themselves when they should talk to their children about sex. By the time that children reach puberty, they are already getting a lot of information about sex from sources including the media (TV, Internet, etc.) and their peers. Many of these messages may be incorrect or skewed. Instead of waiting to talk about sex until their children reach puberty, parents should introduce the topic as early as possible.

Also, instead of trying to teach their children about sex in one “talk,” it is a good idea for parents to teach children about sex over time. That way, children can receive age-appropriate information as they grow older and can have more of a chance to think about what their parents have told them to determine what they have questions about.

Starting an open, honest, continuing dialogue about sex when children are younger may help both parents and children feel more comfortable about the topic as well. When children are younger, it is easier for parents to give them age-appropriate books to read about sex as an introduction to the topic. Additionally, if parents start teaching about sex when children are young, their children will not feel like sex is a taboo subject that has been ignored in the family for years. If children feel that their parents are comfortable talking about sex, then they will be more likely to ask their parents questions. When children ask questions, it gives parents even more opportunities to teach their children what they want them to know about sex instead of what the media or their friends want them to know.