Growth & Development: 12-21 Years

Developmental Milestones in Teens

Puberty for Girls

The age that your daughter enters puberty depends on several factors including her general health, nutritional status and family history.

You can predict the order of the changes associated with puberty, but you cannot predict the timing. Girls usually tend to develop breast buds before their pubic and axillary hair. About two years later, menstrual periods begin. A growth spurt begins before breast budding and ends before periods begin.

Puberty for Boys

You can also predict the order of the changes associated with puberty, but you cannot predict the timing. Boys usually begin puberty with enlargement of the testicles and scrotum. Pubic hair begins to grow. At the same time, boys may begin to ejaculate. The penis becomes longer and thicker. At the same time, hair grows on the face and underarms and the voice deepens. A growth spurt begins at the same time pubic hair appears and usually lasts between 24 to 36 months.

It is important to be informed about testicular cancer and testicular self-exams. Follow these instructions and healthy habits.

When Do Girls and Boys Start Puberty​?

When Puberty Comes Too Early

Call your doctor for an appointment for the following:

Girls: Before age 7-8: Breast development or pubic hair Before age 10: Menstrual periods

Boys: Before age 9: Enlargement of the testicles and scrotum or pubic hair

When Puberty Comes Too Late

Call your doctor for an appointment for the following:

Girls: At age 13: No signs of breast enlargement At age 16: No menstrual periods

Boys: At age 14: No testicular enlargement

Teens and Sleep

Weekend morning sleep-ins are your teen’s way of making up for missed sleep. Teens need at least nine to 10 hours of sleep per night. If your teenager sleeps more than one hour past his or her typical wake time, this is evidence of chronic sleep deprivation.

Chronic daytime sleepiness, poor grades in morning classes or drowsiness when driving are signs that your teen might need a more consistent sleep routine every day of the week.

Safety

Be sure your teen knows what to do if involved in a motor vehicle accident. Stress the importance of remaining at the scene. Write out simple directions on a 3 x 5 card (including insurance information) and place it in the glove compartment of the car, along with auto-registration.

Teen Mental Health

Signs of Substance Abuse in Teens

If your teen has a substance abuse problem, get him or her into therapy immediately. Deal with the situation as you would an illness, accepting the problem and putting your energy into supporting your child’s recovery.

Although almost any one of these signs can appear in a normal, nondrug-using teen, if you see several of these signs together, your child may have a substance abuse problem.

Call your doctor to find out how to get help if your child: spends too much time alone; stops talking or argues frequently with family members; drastically changes style of dress or hair; ignores homework and their grades are dropping; drops old friends; has new friends who are less familiar and less friendly to adults; has frequent or unexplained injuries; sleeps poorly or complains of tiredness; develops irregular eating habits; has bloodshot eyes, very large or small pupils; has frequent “colds” or nosebleeds; has unusual odors on clothing; seems “jumpy” or hyperactive; has mood swings including irritability, depression, hostility, or paranoia; keeps drug paraphernalia; attempts to or runs away from home; or steals money or valuables from your home.

Remember, children need love most when they are the most unlovable.

Signs of Depression in Teens

If your teen shows signs of serious depression, get help for him or her immediately. Deal with the situation as you would an illness, accepting the problem and putting the energy into supporting your child’s recovery.

Teens are often moody and cannot seem to hear anything you say. While you will learn to ignore some behaviors, other behaviors are signs of a serious problem and must not be ignored.

The following are warning signs of severe depression. Call your doctor and ask for help if your child: constantly complains of stomachaches, headaches or tiredness; sleeps too much or too little; loses or gains weight very quickly; neglects appearance; increases risky behaviors – drugs, alcohol, unsafe sex, and drinking and driving; loses interest in school and friends – falling grades, dropping out of activities, cutting classes and withdrawing from friends and family; seems suddenly cheerful after a long period of depression; makes statements like “I feel dead inside”; seems preoccupied with death in choice of music and clothing and talks frequently about friends who have died; or gives away prized possessions, writes a will, or makes other “final” arrangements.

Call a suicide crisis hotline, local emergency department, 911, or your child’s doctor if your child: complains of feeling hopeless; makes comments like, “I’d be better off dead;” or has a specific plan for committing suicide. Take suicide seriously.

Risk Factors for Suicide

Suicide is the third leading cause of death in the teen years. For every teen suicide, there are 200 suicide attempts. Risk factors may include:

• Previous suicide attempts
• Family history of suicide
• Friends who have committed suicide
• Access to a gun
• History of mood, conduct, or psychotic disorders
• Problems with impulse control
• Concerns about sexual identity, homosexuality
• History of physical or sexual abuse
• Depression

Source: Bright Futures, 2nd edition

The Signs of Suicide (SOS) Program trains people how to ACT if a friend or child is severely depressed and possibly suicidal. ACT stands for Acknowledge, Care and Treatment (for teenagers, the “T” stands for “Tell a responsible adult”). Call 1.800.573.4433 to locate the closest training site.

Top 10 Facts You Should Know about Adolescence

1. Adolescence is the developmental stage between childhood and adulthood. It is more than physical growth and sexual maturation (puberty or biological development). Adolescence includes dramatic and important changes in thought processes of the brain (intellectual or cognitive development) and changes in the way the teen thinks of himself or herself and relates to others (psychosocial or social/emotional development).
   
2. The age that puberty begins and ends – and how fast the process goes – can vary for different individuals and still be considered normal. For example, puberty in one girl can start as early as age 8 and proceed to menstrual periods by the time she is 10; while another girl starts breast development at age 11 and does not start menstruating until she is 14.
   
3. It is normal for development to proceed steadily for a while and then stop for a few months. This can be especially troubling when a short male grows quickly for a few months and then stops just when his hopes are up.
   
4. The three areas of development (physical/sexual, intellectual, and social/emotional) do not necessarily progress at the same rate. This can be troubling for a girl whose sexual development occurs early, making her appear “grown up,” but her social/emotional development is still that of a child; or for a teenage boy who has his growth spurt early, making everyone expect him to act his “height age” – not his chronological age.
   
5. There are three stages of adolescence. Early adolescence – the middle-school years: 11-14. Middle adolescence – the high-school years: 15-17. Late adolescence – the age of maturity: 18-21. Each stage is associated with specific characteristics.
   
6. There are four main developmental goals for adolescence: to become independent of family; to form close, personal relationships; to become comfortable with their body and self-image; and to develop an individual identity, realistic life goals, the life skills to “get on” in the world and settle on personal, moral, religious, and sexual values. These four goals are accomplished stepwise as the child goes through the three stages of adolescence – early, middle, and late.
   
7. Early adolescence (11-14) is the time most of the dramatic physical changes of puberty occur. Early work on developmental goals begins in this stage.
   1. Independence: not as willing to do things with family; moody.
   2. Friends: form close friendships with teens of the same sex, usually one best friend.
   3. Body/self-image: worried about being normal, attractive; preoccupied with concerns about sexual maturation, including wet dreams and masturbation.
   4. Individual identity: feel watched; daydream; plan for the future although not necessarily realistic plans; begin to test limits; think about sex, which may lead to masturbation or wet dreams; lack impulse control; exaggerate personal problems out of proportion.
      
8. Middle adolescence (15-17) is the time of intense emotions and intense relationships with peers. Independence: argue with parents more than any other stage; turn to friends – not parents – for support.
   1. Friends: want to fit in with a chosen peer group, including clothing, values, music; dating and sexual experimentation begin; may get involved in clubs, gangs, and other groups.
   2. Body/self-image: more comfortable with physical changes; physical attractiveness is important.
   3. Individual identity: consider the feelings of others; capable of more difficult thought processes; more realistic plans for the future; magical thinking about being able to take risks and not be harmed.
      
9. Late adolescence (18-21) is the last step to adulthood. It can be a depressing time if the goals for early and middle adolescence were not successfully reached. Independence: become closer to family again; more likely to accept advice.
   1. Friends: less dependent on group activities; more time spent in a meaningful relationship with one partner.
   2. Body/self-image: OK with body.
   3. Individual identity: develop practical, realistic career goals; able to compromise; settle on personal, moral, religious, and sexual values.
      
10. The 21-year-old who is socially and emotionally independent of parents while still remains close to them, who is comfortable with himself/herself as an adult, and who is capable of meaningful relationships has successfully completed the passage from childhood to adulthood.

Topics to Discuss with Your Pediatrician by Age

At your child's yearly well child visits, discuss the following topics:

11-14 Years Old

• TV and computer limits
• Time management
• Family time
• Team sports
• Sexuality issues, sex identification, abstinence, protected sex, sexually-transmitted diseases (STDs)
• Substance abuse, alcohol, tobacco

15-17 Years Old

• Stress
• Feelings
• Challenges
• School/work
• Life plans
• Safe driving
• New skills like lifesaving, peer mentoring
• Sexuality issues, STDs, abstinence
• Substance abuse, alcohol, tobacco