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Currently, there are more 600 million girls ages 10-24 worldwide, with the population growing fastest in developing countries. During adolescence, health and social behaviors are established for life; the decisions a girl makes during this period and the situations she faces will have long-term consequences for her sexual and reproductive health and a range of other outcomes.

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The lives of these girls are complex, affected by their gender, race, ethnicity, class, differing abilities and sexual orientation.

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What Is It? Teenage girls encounter many physical, emotional and personal changes, which are sometimes confusing, but all normal parts of growing up into women. Puberty - How Your Body Changes Your body is changing; your moods may be unpredictable and sometimes hard to explain. Don't worry. These changes are normal.

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Many parents assume that teen boys are less complicated than girls. Girls have periods, can get pregnant, and have messy emotions and friendship drama. Boys, on the other hand, have relatively smooth sailing through adolescence.

Of course, this isn't really true. Puberty is a confusing and often stressful (and exciting!) time for everyone. But because we have these assumptions that boys don't need as much guidance, discussions around teen boys' health can get jaded.

Let's change that. In honor of Men's Health Month, here are 7 conversations to have with your teen son.

Of course, not every teen boy has a penis. Some of these conversations may not be appropriate for trans boys, and some may be suited for trans girls. Frame these conversations in ways that are appropriate to your child's development and unique identity. If you have a child who is trans, know that puberty can be an especially stressful time for them. Make sure you understand how to support them.
1. Their Changing Body
Puberty means a lot of change, including spontaneous erections, wet dreams, and gynecomastia (when men's breast tissue swells). These changes can start occurring as young as 10 and as old as 14. Gynecomastia may make boys feel self-conscious, while spontaneous erections and wet dreams can be confusing and embarrassing if they don't understand what's going on. This is why it's important for parents to frame these changes as natural, and emphasize that there's no reason to be embarrassed about them. Make sure your teen understands that spontaneous erections and wet dreams may happen for a while, but will then go away.
2. Doing the Horizontal Monster Mash
Definitely avoid the above euphemism, but DON'T avoid talking about sex-in an honest and direct way. Remember that The Talk isn't just one conversation-it's many. In addition to the mechanics of sex and reproduction, teens need to learn about consent, safety, communication, and emotions. Make sure your teen understands that it's normal to be interested in sex, but that that doesn't mean they're ready to have it. How you talk about having a healthy sexuality impacts not only how they see themselves, but how they treat others. In the right context, sex is a normal and healthy part of life. You can help them figure out what that context is.
3. The Triple S (Safe Shaving Skills)
People with testicles start shaving their face as early as 12-13 years old, and as late as 16-17 years old. The first time they shave, they shouldn't do it alone. Make sure your teen understands the importance of using shaving cream and a brand new, clean razor. This can help them avoid ingrown hairs, which black and Latinx folk (or anyone with especially wiry hair) are particularly prone to.

It's also completely normal if your teen wants to shave places other than their face, such as their legs, arms, or pubic area (aka manscaping). While there aren't any health consequences to shaving, it IS important for your teen to understand that shaving these other areas is different than shaving their face. With manscaping, there's a greater risk of getting ingrown hairs, which can lead to infections. Teens should talk to their medical provider or someone who has experience shaving these areas before they try it themselves. Wanting to shave areas other than their face does NOT mean that they are gay or less "manly."
4. Know Your Junk
Talk to your teen about the importance of becoming familiar with what their testicles feel like. This allows them to pick up on any changes that occur. They should pay attention to lumps, bumps and pains. If they notice any changes, they should talk to a health care provider as soon as possible.
5. Emotions are a Human Thing, Not a Girl Thing
During puberty, emotions can become more intense and complicated. Experiencing happiness, sadness, anger, and everything outside and in-between is completely normal. However, it's important your teen understands how to express their emotions in a healthy way. If teens don't understand how to healthily express their emotions, they may have risky sex when they're happy, get into fights when they're angry, or use drugs when they're sad. Help your teen frame their feelings and emotions, and talk about healthy emotional expression. For example, you can suggest a kickboxing class or drum lessons when they're angry, or journaling when they're sad.

Teen boys must also deal with stereotypes about acceptable "masculine" behavior. Emphasize that feeling and expressing emotion is normal and healthy.
6. Mental Health is as Important as Physical Health
Talk to your teen about the importance of mental health and the signs of depression and anxiety, which can show up as early as 11 years old. Make sure they understand that going to therapy doesn't mean they're "crazy," and that they can ask you (or another trusted adult) for support without judgment.

Substance use is closely tied to mental health. Talk to your teen about the health effects of drug use, and the legal consequences if they're ever caught with illegal substances. If your teen needs drugs for everyday activities like school work or falling asleep, they may be self-medicating.
7. You Don't Have to be Sick to See a Doctor
Everyone needs routine preventive care. Talk to your teen about the importance of regular medical appointments and engaging with their health. This is especially important for older teens who may be getting closer to living on their own and managing their own medical care. Yearly check-ups are an important way for people to engage with ways to stay healthy, like regular STI testing, exercise, and healthy eating. Even though they may not need shots or blood work, health care providers will check their cholesterol, blood pressure, and assess risk factors for a variety of diseases and conditions.

Of course, this is far from a comprehensive list. What important conversations would you add?
Dr. Michael Guyton is currently serving his second year as an Adolescent Medicine Fellow at MSAHC after earning his M.D. from the University of South Carolina. His areas of clinical interest include preventative screening tools for adolescents in the primary care setting, mental health services for LGBT youth, and health education with particular focus on college-aged youth. Michael is also a member of the Girlology/Guyology Team, providing age-appropriate health and sexuality education for grade- and high school-aged boys. The Mount Sinai Adolescent Health Center is located in New York City. It provides comprehensive, confidential, judgment free health care at no charge to over 10,000 young people every year. This column is not intended to provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, only general information for education purposes only.

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important conversations to have with teen son

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important conversations to have with teen

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talking to teens about healthy sexuality

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talking to teens about being sexually healthy

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talking to teen boys about sexual health

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Have These 7 Conversations With Your Teen Son for Men's Health Month

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Many parents assume that teen boys are less complicated than girls. Girls have periods, can get pregnant, and have messy emotions and friendship drama. Boys, on the other hand, have relatively smooth sailing through adolescence. Of course, this isn't really true. Puberty is a confusing and often stressful (and exciting!)

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On the way to becoming a man, a boy's body will go through a lot of changes, including your body growing bigger, your voice changing, and hair sprouting everywhere. Find out more.

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In my clinical experience, the biggest complaint I hear from parents of teenage boys is that they are angry.

Teenage girls get angry, too, of course, but they tend to be more amenable to processing emotions and talking them through, which at least gives parents a little more leverage in dealing with them. The testosterone surges that boys experience blunts fear and disinhibits impulses, making them more susceptible to dangerous behaviors that both invoke and result from anger.

Teenage boys need a lot of structure. Both parents need to know where he is and what he's doing at all times. Don't fall into the "You don't trust me," trap. The issue isn't trust but a realistic assessment of the dangerous world that adolescents must negotiate with limited pre-frontal cortex development. Before 18, a child does not have sufficient articulation in the judgment and regulatory areas of the brain to be able to see possible consequences of behavior under the stress of powerful impulses. It's a dangerous combination, even when substances are not at all involved - increased impulsivity with diminished regulatory capacity.

Compassionate parents focus on the long-term wellbeing of the child, rather than the momentary ego boost of feeling "trusted." The trick is getting them out of the defensive and into the improve mode of the brain. A good parental rejoinder to "You don't trust me," is, "I don't trust myself enough to know that you will be safe and well without knowing where you are and what you're doing. So what can you do so that you will have some freedom without me having to worry so much?"

In particular angry teenagers need to learn that:

They are part of a family and community which require some emotional investment - in small ways helping the family (chores) and occasional volunteer work in the community

Respect for other people's rights and property

Money is a resource that must be managed responsibly.

In general, boys do not auditory-process as well as girls, even when they're not angry. (They hear almost as well, but don't interpret the meaning of the spoken word as efficiently, not without other sensory modalities engaged.) If you want to give your son instructions or say anything important:

Make eye contact and try to touch him while you speak (two or three sensory modalities work better than one)

If detail is important, ask him to repeat what you said

Use short sentences and give him a chance to respond before going on (never lecture).

It's easy for boys to get into the habit of automatically tuning out familiar voices, a habit that will cause them serious problems in future close relationships.Habits are much easier to prevent than to alter.
Responsibility
The world is cruel to the irresponsible.

Kids are not naturally responsible -parents or painful circumstances must teach them. Responsibility can be learned by modeling - responsible parents enjoy a better chance of having responsible children - but it also must be taught deliberately. Children can learn responsibility relatively painlessly up to about 13. After that, the life lessons that teach responsibility - mostly in the form of social sanctions and punishments - become more painful. Teaching responsibility to children is one of the most compassionate things parents can do for them.

The key to teaching responsibility is to make sure that your children understand this crucial fact: Power, privilege, and responsibility go together. When responsibility is high, so are the other two. And when it is low, so are the other two.

Teenagers, especially boys, feel powerless a lot of the time. They need to learn that they have the power to affect what happens to them by behaving responsibly. And they need to know in advance exactly how much power and privilege they will lose for specific irresponsible behaviors. That is really the way of the world. When you behave irresponsibly, say speeding or cheating on your taxes, you know in advance what the penalty will be.

Finally, children learn emotion regulation principally by modeling, not by what parents tell them. Like all mammals, the juveniles learn by watching the adults. There is a same sex bias to modelling - the boys watch the men more closely and the girls watch the women more closely, but they watch both parents to learn how to regulate emotions. Anger is an attribution of blame. If parents are blamers, children, especially high testosterone boys, are more likely to have anger problems. (Testosterone doesn't cause anger but it amplifies it considerably.) It's crucial for parents to model responsibility in all that they do, including owning their own mistakes, especially those that relate to disputes with their children.

For more help, see Compassionate Parenting

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Children learn emotion regulation by modeling, not by what parents tell them. Anger is an attribution of blame. If parents are blamers, children, especially high testosterone boys, are more likely to have anger problems. (Testosterone doesn't cause anger but amplifies it considerably.)

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In adults, various parts of the brain work together to evaluate choices, make decisions and act accordingly in each situation. The teenage brain doesn't appear to work like this. For comparison's sake, think of the teenage brain as an entertainment center that hasn't been fully hooked up. There are loose wires, so that the speaker system isn't working with the DVD player, which in turn hasn't been formatted to work with the television yet. And to top it all off, the remote control hasn't even arrived!

The brain's remote control is the prefrontal cortex, a section of the brain that weighs outcomes, forms judgments and controls impulses and emotions. This section of the brain also helps people understand one another. If you were to walk into a sports bar full of Lakers fans wearing a Celtics jersey, your prefrontal cortex would immediately begin firing in warning; those teams are bitter enemies, and it might serve you to change your behavior (and your clothes). The prefrontal cortex communicates with the other sections of the brain through connections called synapses. These are like the wires of the entertainment system.

What scientists have found is that teenagers experience a wealth of growth in synapses during adolescence. But if you've ever hooked up an entertainment center, you know that more wires means more problems. You tend to keep the components you use the most, while getting rid of something superfluous, like an out-of-date laserdisc player. The brain works the same way, because it starts pruning away the synapses that it doesn't need in order to make the remaining ones much more efficient in communicating. In teenagers, it seems that this process starts in the back of the brain and moves forward, so that the prefrontal cortex, that vital center of control, is the last to be trimmed. As the connections are trimmed down, an insulating substance called myelin coats the synapses to protect them.

As such, the prefrontal cortex is a little immature in teenagers as compared to adults; it may not fully develop until your mid-20s [source: Kotulak]. And if you don't have a remote control to call the shots in the brain, using the other brain structures can become more difficult. Imaging studies have shown that most of the mental energy that teenagers use in making decisions is located in the back of the brain, whereas adults do most of their processing in the frontal lobe [source: Wallis]. When teenagers do use the frontal lobe, it seems they overdo it, calling upon much more of the brain to get the job done than adults would [source: Powell]. And because adults have already refined those communicating synapses, they can make decisions more quickly.

Adult brains are also better wired to notice errors in decision-making. While adults performed tasks that required the quick response of pushing buttons, their brains sent out a signal when a hasty mistake was made. Before 80 milliseconds had passed, adult brains had noticed the blunder, but teenage brains didn't notice any slip-up [source: Monastersky].

An area of the teenager's brain that is fairly well-developed early on, though, is the nucleus accumbens, or the area of the brain that seeks pleasure and reward. In imaging studies that compared brain activity when the subject received a small, medium or large reward, teenagers exhibited exaggerated responses to medium and large rewards compared to children and adults [source: Powell]. When presented with a small reward, the teenagers' brains hardly fired at all in comparison to adults and children.

So what does it mean to have an undeveloped prefrontal cortex in conjunction with a strong desire for reward? As it happens, this combination could explain a lot of stereotypical teenage behavior.

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Are teenage brains really different from adult brains?

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In adults, various parts of the brain work together to evaluate choices, make decisions and act accordingly in each situation. The teenage brain doesn't appear to work like this. For comparison's sake, think of the teenage brain as an entertainment center that hasn't been fully hooked up.

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TEEN LINE is a non-profit, community based organization that provides emotional support to youth. It is our mission to provide peer based education and support before problems become a crisis, using a national hotline, community outreach and online support.

NEW! Try the free TEEN TALK APP to vent, share and get support from a trained teen.
DOWNLOAD | READ MORE

Do you need help working something out? Do you want to talk to someone who understands, like another teen? We're here to help! Call (310) 855-HOPE or (800) TLC-TEEN (nationwide toll-free) from 6pm to 10pm PST.

Text "TEEN" to 839863 between 6:00pm-9:00pm PST to speak with one of our teens (Text STOP to opt out. Standard msg and data rates may apply - click here for terms and conditions).

TEEN LINE answers emails every evening. You can send us a question, and we will answer you as quickly as possible.

You can ask other teens questions on our message boards. Read through the disscusions and login or register to join the conversation.

Donate

Are you concerned about bullying, teen suicide, and depression? Donate to TEEN LINE to make a difference! Your support keeps outreach events in schools, the hotline open, and directly helps teens. TEEN LINE is a 501(c)(3) non-profit, donations are tax deductible.

see more ways to donate

Volunteer

TEEN LINE is more than just a hotline. Our teens and adult volunteers gain invaluable knowledge in helping others, they work in a team-orientated environment, attend outreach opportunities, and they make a difference: in some cases even a life-saving one.

how you can help

Outreach

Our Outreach program reaches over 38,000 people each year providing presentations on various topics pertinent to adolescence. Outreach services are tailored to fit any schedule or population. Schedule an outreach event today to help educate the community.

learn more about outreach

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TEEN LINE | Teens Helping Teens - Connect, talk, get help!

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TEEN LINE is a non-profit, community based organization that provides emotional support to youth. It is our mission to provide peer based education and support before problems become a crisis, using a national hotline, community outreach and online support. NEW! Try the free TEEN TALK APP to vent, share and get support from a trained teen.

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Social & Emotional Changes in Adolescence

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Social & Emotional Changes in Adolescence

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Adolescence is a time of big social and emotional development for your child. It helps to know what to expect and how to support your child through the changes.

Social changes and emotional changes: what to expect in adolescence

During adolescence, you'll notice changes in the way your child interacts with family, friends and peers. Every teen's social and emotional development is different. Your child's unique combination of genes, brain development, environment, experiences with family and friends, and community and culture shape development.

Social changes and emotional changes show that your child is forming an independent identity and learning to be an adult.

Social changes
You might notice that your teen is:

searching for identity: young people are busy working out who they are and where they fit in the world. This search can be influenced by gender, peer group, cultural background, media, school and family expectations

seeking more independence: this is likely to influence the decisions your child makes and the relationships your child has with family and friends

seeking more responsibility, both at home and at school

looking for new experiences: the nature of teenage brain development means that teenagers are likely to seek out new experiences and engage in more risk-taking behaviour. But they're still developing control over their impulses

thinking more about "right" and "wrong": your child will start developing a stronger individual set of values and morals. Teenagers also learn that they're responsible for their own actions, decisions and consequences. They question more things. Your words and actions shape your child's sense of ''right'' and "wrong"

influenced more by friends, especially when it comes to behaviour, sense of self and self-esteem

starting to develop and explore a sexual identity: your child might start to have romantic relationships or go on "dates". These are not necessarily intimate relationships. For some young people, intimate or sexual relationships don't occur until later on in life

communicating in different ways: the internet, cell phones and social media can significantly influence how your child communicates with friends and learns about the world.

Emotional changes
You might notice that your teen:

shows strong feelings and intense emotions at different times. Moods might seem unpredictable. These emotional ups and downs can lead to increased conflict. Your child's brain is still learning how to control and express emotions in a grown-up way

is more sensitive to your emotions: young people get better at reading and processing other people's emotions as they get older. While they're developing these skills, they can sometimes misread facial expressions or body language

is more self-conscious, especially about physical appearance and changes. Teenage self-esteem is often affected by appearance - or by how teenagers think they look. As they develop, teens might compare their bodies with those of friends and peers

goes through a "invincible" stage of thinking and acting as if nothing bad could happen to him. Your child's decision-making skills are still developing, and your child is still learning about the consequences of actions.

Changes in relationships
You might notice that your teen:

wants to spend less time with family and more time with friends

has more arguments with you: some conflict between parents and children during the teenage years is normal as teens seek more independence. It actually shows that your child is maturing. Conflict tends to peak in early adolescence. If you feel like you're arguing with your child all the time, it might help to know that this isn't likely to affect your long term relationship with your child

sees things differently from you: this isn't because your child wants to upset you. It's because your child is beginning to think more abstractly and to question different points of view. At the same time, some teens find it hard to understand the effects of their behaviour and comments on other people. These skills will develop with time.

Supporting social and emotional development

Here are some ideas to help you support your teen's social and emotional development.

Be a role model for forming and maintaining positive relationships with your friends, children, partner and colleagues. Your child will learn from observing relationships where there is respect, empathy and positive ways of resolving conflict.

Get to know your child's friends, and make them welcome in your home. This will help you keep in touch with your child's social relationships. It also shows that you recognize how important your child's friends are to your child's sense of self.

Listen to your child's feelings. If your child wants to talk, stop and give your child your full attention. If you're in the middle of something, make a specific time when you can listen.

Be explicit and open about your feelings. In particular, tell your child how you feel when your child behaves in different ways. Be a role model for positive ways of dealing with difficult emotions and moods.

Talk with your child about relationships, sex and sexuality. Look for "teachable moments" - those everyday times when you can easily bring up these issues. Focus on the non-physical. Teenagers are often self-conscious and anxious about their bodies and appearance. So reinforce the positive aspects of your child's social and emotional development.

Staying connected with your teen can be an important part of supporting your child's social and emotional development.

Children with special needs

It's normal for parents to worry that their child with disability won't make friends easily or be accepted into a peer group. It helps to remember that the rate of social and emotional development varies widely for young people.

Teens who miss a lot of school because of a physical or mental illness, or who have a visible physical disability, might find it harder to make and keep friendships. This doesn't mean that friendships won't happen. There might be other ways for your child to form friendships, such as joining community groups and online networks. Give your child lots of love and support at home. Boost confidence and self-esteem by focusing on your child's strengths and interests.

Tip: Your child's relationships with family and peers will undergo dramatic changes and shifts. Strong relationships with both family and friends are vital for healthy social and emotional development. Parents tend to influence a young person's long-term decisions, such as career choices, values and morals. Friends are more likely to influence short-term choices, such as appearance and interests.

© Raising Children Network Limited, reproduced with permission.
Resources & Links:
HealthLink BC: Growth and Development, Ages 11 to 14
HealthLink BC: Emotional and Social Development, Ages 15 to 18
HealthLink BC: Growth and Development, Ages 15 to 18
HealthLink BC: Emotional and Social Development, Ages 11 to 14

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Social and Emotional Changes in Adolescence

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Adolescence is a time of big social and emotional development for your child. It helps to know what to expect and how to support your child through the changes. During adolescence, you'll notice changes in the way your child interacts with family, friends and peers. Every teen's social and emotional development is different.

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The teenage years are accompanied by changes in the body. Perhaps the most profound changes are linked to sexual maturation. It is during the teen years that the body grows into a sexually mature entity, and there are many distinct physical characteristics that develop as a result of this growth. Additional physical changes include rapid growth in height and weight, as well as continued developments in the physical make-up of the brain (1).
Sexual development
The changes associated with sexual maturation are among the most exciting and the most confusing for teens. Because of the hormones that are released sometime between the ages of 8 and 13, the body feels different - and soon begins to look different as well. While the period of sexual development (puberty) usually begins between the ages of 8 and 13 (2), it is not unusual for the changes to develop over a period of years. Most bodies, however, are developed by the age of 16, although everyone's rate of development is different.

Substantial differences between girls and boys appear during the teen years. While both boys and girls grow pubic and underarm hair, and get acne due to increased skin oils, just about everything else that happens during teenage physical development differs according to gender (2).

Teen girls developments are often very visible, and a source of anxiety as well as anticipation:

Breast development

Hips become rounded

Female reproductive system components (uterus, vagina, labia, clitoris) increase in size

Menstruation begins

Teen boys also experience profound changes that affect their bodies, and often self-image:

Facial hair growth

Increased size of penis and testicles

Sperm production

Enlarged Adam's apple

Voice changes

Increased height and weight
The teen years are the time in which height and weight increase at a rapid rate. Added height is, on average, 3.5 inches for girls and 4.1 inches for boys (1). Additionally, boys put on muscle weight while girls put on weight due to body fat. This can cause anxiety in many girls, who feel pressure to be thin. However, a certain amount of body fat, about 16% to 23% (3) is healthy for teenage girls. These changes can result in clumsiness, as different parts of the body grow at different rates, making it difficult to cope with the changing lengths of arms and legs (1). More sleep is also usually needed so that growth proceeds at a good rate, and so that the body receives the rest it needs. 9 1/2 hours of sleep each night is recommended (1).
Physical make-up of the brain
A teenager's brain is still developing. It is not until the early 20s that the brain reaches its full development. Neuron connections are still forming during the teen years, and this can lead to emotional and mental lapses in judgment. Additionally, the developing brain contributes to impulsivity (1). Learning to control impulses, emotions and judgment is part of a teen's physical brain development.
Helping teens through physical changes
Proper nutrition and exercise can help teens feel better about themselves and about their changing bodies. It is important to fuel the body's physical changes with good foods and to encourage its healthy development with physical activity. Healthy sleeping habits should be encouraged. Additionally, it is important to help teens properly understand the sexual changes in their bodies. Honesty and education are important aspects of helping them understand teenage bodies in order to make healthy sexual decisions. Emotional support, that does not compare teens to their peers, is also important (1). Everyone develops at a different pace, and each teen should be aware that his or her pace is normal and appropriate for his or her own body.
Sources:

1. ext.vt.edu/pubs/family/350-850/350-850.html

2. kidshealth.org/parent/growth/growth/growth_13_to_18.html

3. girlshealth.gov/nutrition/bmi_calc.cfm

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The teenage years are accompanied by changes in the body. Perhaps the most profound changes are linked to sexual maturation. It is during the teen years that the body grows into a sexually mature entity, and there are many distinct physical characteristics that develop as a result of this growth.

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Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment.

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Insight Into the Teenage Brain: Adriana Galván at TEDxYouth@Caltech

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Physical Growth & Development During Adolescence

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Many physical changes are happening during the teen years, including rapid gains in height and weight, hormonal influences, the development of secondary sex characteristics and continued brain development.

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Puberty is made up of a clear sequence of stages, affecting the skeletal, muscular, reproductive, and nearly all other bodily systems. Physical changes during puberty tend to be more gradual and steady. This is comforting to many parents who feel childhood passes much too quickly.

Changes in Body Composition & Height

Most children have a slimmer appearance during middle childhood than they did during the preschool years. This is due to shifts in the accumulation and location of body fat. As a child's entire body size increases, the amount of body fat stays relatively stable, giving her a thinner look. Also during this stage of life, a child's legs are longer in proportion to the body than they were before. On average, the steady growth of middle childhood results in an increase in height of a little over 2 inches a year in both boys and girls. Weight gain averages about 6.5 pounds a year.

A number of factors, including how close the child is to puberty, will determine when and how much a child grows. In general, there tends to be a period of a slightly increased growth rate between ages 6 and 8. This may be accompanied with the appearance of a small amount of pubic hair, armpit hair, mild acne, and/or body odor.

The Influence of Heredity

Perhaps more than any other factor, your child's growth and ultimate height will be influenced by heredity. While there are exceptions, tall parents usually have tall children, and short parents usually have short children. Those are the realities of genetics.

Concerns About Growth

If your child seems unusually short or tall relative to his friends the same age, talk with your pediatrician. A true growth disorder can sometimes be treated by administering growth hormones; however, this therapy is reserved for young children whose own glands cannot produce this hormone. Doctors do not recommend this treatment for healthy boys and girls who may want (or whose parents may want them) to grow to be 6 feet tall instead of 5 feet 8. See When a Child is Unusually Short or Tall.

Growth Spurts

Just as height can vary from child to child, so can the timing of a child's growth. Despite the averages mentioned above, children have a tendency to grow in spurts. Thus, they may grow faster at times and slower at others. Some children grow as much as three times faster during a particular season of the year, compared with their "slow" seasons. These individual variations in timing-along with hereditary factors-are largely responsible for the wide variations in size among children the same age. Height differences among children in a typical elementary school classroom can range from 4 to 5 inches.

Although boys and girls are generally of similar height during middle childhood, that changes with the beginning of puberty. Particularly in junior high school, girls are often taller than their male classmates, but within a year or two, boys catch up and usually surpass their female classmates. About 25 percent of human growth in height occurs during puberty.

Nutrition's Influence on Physical Development

A number of other factors-so-called environmental influences-can affect physical development as well. Nutrition is important to normal growth processes. Parents should make an effort to ensure their child consumes a well-balanced diet. A child's need for calories rises during times of rapid growth, gradually increasing as she moves through middle childhood into puberty. However, if the calories consumed exceed those expended, a child may develop a weight problem. See Energy In: Recommended Food & Drink Amounts for Children.

A Word about Picky Eaters

Some parents worry that their child is not eating enough. Even with what seems to be relatively low food intake, however, children can grow at normal rates.

If your school-age child is a picky eater, do not worry that this frustrating behavior is impairing her growth. These fluctuating eating habits may be due to normal, slow-growth periods or simply uniquely personal, unpredictable preferences or distastes for certain foods.

In general, children outgrow these food preferences without any harm to their physical well-being. As long as a child is gaining weight appropriately (4 to 7 pounds per year) and is eating a healthy variety of foods, his nutritional needs are being met.

The Importance of Regular Exercise

Children also need to exercise regularly to ensure normal physical development. Those who spend their free time watching TV, playing video games, or engaging in other stationary activities rather than playing outdoors may have impaired bone growth. When physical activity is increased, bones are denser and stronger. However, there is no evidence that a very strenuous exercise program will help your child grow faster or bigger. Running marathons, for example, will not stimulate physical growth. See Energy Out: Daily Physical Activity Recommendations .

Pre-Puberty Changes

A number of other changes occur during middle childhood:

Children become stronger as their muscle mass increases.

Motor skills-in both strength and coordination-improve.

A school-age child's hair may become a little darker.

The texture and appearance of a child's skin gradually changes, becoming more like that of an adult.

First Signs of Puberty

Puberty often begins earlier than parents think:

Girls

Breast budding in girls starts around age ten, with some girls starting as early as eight and others not starting until thirteen.

Girls should be checked by their pediatrician if they begin puberty before age eight.

The peak growth period (in height, weight, muscle mass, and the like) in girls occurs about one year after puberty has begun.

Menstruation usually starts about 18 months to two years after the onset of puberty. On average, the first menses occur just before girls turn thirteen.

If a girl shows no signs of puberty by age 13, consult with your pediatrician.

See Physical Development in Girls: What to Expect.

Boys

Boys enter puberty about one year later than girls. The first sign is enlargement of the testes and a thinning and reddening of the scrotum, which happens at an average age of eleven but may occur anytime between nine to fourteen years.

Boys should be checked by their pediatrician if they begin puberty before age nine.

For boys, the peak growth period occurs about two years after the beginning of puberty.

If a boy shows no signs of puberty by age 14, consult with your pediatrician.

See Physical Development in Boys: What to Expect.

How to Discuss These Changes with Your Child

Your child needs to understand the physical changes that will occur in her body during puberty. There are many opportunities during this time of life for you to talk to your child about what she's experiencing. You should emphasize that these changes are part of the natural process of growing into adulthood, stimulated by hormones (chemicals that are produced within the body).

Keep track of your child's bodily changes, while fully respecting privacy. As the age ranges above indicate, there are wide variations of "normal" in the time when puberty begins. Remind your child that while her friends will grow at different rates, they will eventually catch up with one another.

Additional Information:

Section on Endocrinology (Copyright © 2014 American Academy of Pediatrics)

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