| Tweens + Teens | Child Health + Development | Behavior + Discipline

Ways to help your kids cope with puberty

Puberty and sex are often an uncomfortable topic for parents and children -- even for Bridgett Blackburn, MS, a parent educator at Bellevue Community College who also co-teaches puberty preparation courses at Overlake Hospital in Bellevue.

Blackburn, the mother of 12- and 14-year-old boys, notes that she can talk about sex, penises and vaginas to hundreds of people regularly. Yet, when it came to talking to her own kids, she was still nervous. "The more you practice talking to each other about sex, the easier it gets," she adds.

Kids ages 11-14 experience dramatic changes, but most of them just want to know, "Am I normal?"

Cora Bruener, MD, MPH, head of adolescent medicine at Children's Hospital and Regional Medical Center in Seattle, who also teaches a class on puberty at her son's school, breaks down the physical changes for this age group:

Boys and girls

  • Skin: increased oiliness and pimples and blackheads on the face, chest and back.
  • Body odor.
  • Increase in muscle size, particularly for boys.
  • Wisdom teeth are growing and most molars are coming in. Many kids get braces and need to work on dental hygiene.
  • They have to gain weight before they grow taller. These are the years when someone looks a little pudgy or really skinny because growth is not linear; it is more like a roller coaster. Clothes often don't fit right and parents should never tease or criticize kids about weight changes.
  • Underarm and pubic hair grows.
  • Both genders get more testosterone and estrogen, which leads to emotional changes such as anger or crying (although boys get more testosterone and girls get more estrogen).


  • Breast development and tenderness. Normal for one side to get a little bigger than the other.
  • The labia, ovaries and uterus enlarge.
  • Menstruation begins at around 12.7 years of age, usually two years after getting breast buds, and is often irregular for the first year.
  • Red flags for girls include: facial hair, menstrual cycles that don't even out to about every 28 days after a year, and continuous bleeding.


  • The larynx gets bigger, deepening the voice.
  • Facial hair may occur now.
  • Penis gets longer, testicles get bigger and skin around the testicles gets thinner, so the testicles hang down more.
  • Wet dreams and erections occur often. This is out of the kids' control and it is important to validate the normalcy of this. Erections can occur for a wide variety of reasons, including temperature changes, and are not limited to sexual excitement.
  • It is normal in boys to have some breast development.

Kids do go through these changes about the same age as their parents did, Bruener says, so it is helpful for parents to tell their children when they started shaving or when they began menstruating. During a child's annual physical exam, parents should be prepared that children usually begin seeing the doctor alone for the first part of the exam at around 12 or 13 years of age.

"One of the number-one questions girls ask is, 'What if I start my period at school?'" says Blackburn, who recommends parents and kids come up with a plan since most schools do not have full-time nurses available. Possible options include carrying a sanitary pad in a purse, calling a parent on a cell phone or talking to a female teacher or secretary, plus making sure ahead of time that there is a napkin dispenser in the bathroom or office.

While physical changes get most of the attention, emotional changes must also be addressed. Studies show that girls' self-esteem tends to drop during puberty. "If you watch young adolescent girls, their shoulders all slump for one reason: to hide their breast development. It is a hugely embarrassing thing," says Blackburn, who notes that most female physical changes are outwardly visible and girls often receive comments from peers regarding their bodies.

Many of the male changes include gaining muscle tissue and a larger penis, "so the boys are feeling like Superman at the same time that women are becoming more vulnerable," Blackburn says.

The "thin is in" mentality is causing girls to go to great lengths to be the desired size 0. As a result, group throw-up sessions have become popular in middle school bathrooms.

Parents need to talk to their kids earlier about issues such as oral sex, which is occurring more commonly in middle school, typically with the girl performing the oral sex and the boy receiving. Many turn to oral sex before they would consider intercourse, because it is promoted among peers as safe, and not really sex.

"We haven't done enough to explain to kids that oral sex is a level of intimacy way beyond kissing," Blackburn explains. "It is sex and you can transmit STDs that way. Because of that, kids are engaging in that activity without really understanding the emotional or physical ramifications of it."

Blackburn recommends using open-ended questions to start a dialogue with kids. Asking about their friends is a good way to start. She also says that talking while driving in the car eases the comfort level if the kids are in the backseat where you are not looking at each other. Sharing stories from your adolescence helps children know you have been there.

For kids, the two biggest buffers against the turbulence caused by their changing bodies are finding a comfortable social group and having an adult role model in addition to the parent, Blackburn says. Help your child find "a sense of risk and a sense of belonging in a place or in a group," she adds. "The risk is important because if they don't find it in healthy ways, they will find it in unhealthy ways. It could be theater, horseback riding, sports or debate club. You look at your child's interests and help them find groups to pursue interests they have."

Jolene Gensheimer is a freelance writer, mother of two and a former high school teacher.

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