Search for tag: "puberty"

Boys in puberty. Most people think of teen boys eating them out of house and home, needing new clothes because they outgrow them every two weeks, and interesting smells. Well, there's more than that, and I'll help you navigate puberty in boys on today's Scope.

I've got a teenager at my house and one who is about to be a teenager. I can definitely say that all of those things that I just mentioned are absolutely true. But what exactly is going on in their bodies? There's going to be a lot of changes that they may come to you as parents to ask questions about. Puberty in boys can start as early as 9 but really hits between 11 and 14 and lasts for 3 to 4 years. Boys can continue to grow until they are 18 or even 20.

The first thing your boy will notice is that his private area will be changing. His testicles will get bigger, his penis will grow, and he will get pubic hair. Then comes hair under the arms and on his body, and that's usually when the body odor starts too. And you'll need to make sure to get your son some deodorant and you'll probably also need to stress the importance of hygiene.

Voice changes are next. Often boys get pretty embarrassed about how their voice cracks as it gets deeper. At our house, we pretty much just laugh about it because my boys know it's normal and it's happening to all their friends as well.

Their bodies will also start to bulk up, and their muscles will be getting bigger and stronger thanks to testosterone. Testosterone is also what triggers some mood changes in boys, especially the anger issues. So be prepared.

This is also when romances start to blossom so be sure you have the talk with your boys about your family's view on sex, birth control, and protection against sexually transmitted diseases.

Something else that testosterone causes is acne. Acne is not caused by not washing your face or by what you eat but by changing hormones. There is a lot of treatments for acne, including many that are over the counter.

Like I said, boys can continue to grow until they are 18 years old. They will usually have a growth spurt of about four to six inches towards the end of puberty. That's also when more body and facial hair shows up and boys need to learn about shaving beards and mustaches.

What about some of the more uncomfortable things that you may need to talk to your teen boy about? Well, boys start getting erections more, and sometimes they happen at embarrassing times like in the hall at school. They also start having nocturnal emissions, otherwise known as wet dreams. This is when they have erections and ejaculations during their sleep. It's normal. They have no control over it, and it can happen up to a few times per week.

Remember, puberty happens to all of us who make it to adulthood. While things change from each generation to generation, some things are constant, like the changes that happen to a boy's body as they go from being a little kid to being a man. It's a tricky time for kids, and if you or your child have any questions about what's going on in their bodies, be sure to ask your child's pediatrician for help.

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

Dr. Jones: "Help! My daughter is 10 and she's developing breasts. Is this too soon? I'm not ready for this." This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health Care and this is puberty on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Many years ago, a dear friend of mine called me with a worried question. Her 10-year-old, flat-chested daughter had developed a small, tender bump under one nipple. "Is it cancer?" she asked. I replied, "Oh, no. It's something much more frightening. It's puberty." But what is puberty? How old are girls when it usually happens? And is it occurring earlier in the US?

Well, puberty is when the sleeping gonads, ovaries, and testicles of boys and girls wake up to begin the coordinated development of sexual tissues. In girls, it begins with breast development called thelarche, followed closely by pubic hair called pubarche. And about two years after the beginning of breast development in the normal pubertal process, the first menstrual period starts, menarche. This waking up of the sleeping gonads is preceded by a year or two by the maturing of the adrenal glands called adrenarche. All of our lovely developing arches, I'm waiting for an arche to name the start of the development of the mature brain.

Anyway, all of these arches, menarche is the easiest to reliably record and remember. Most women, or their mothers, don't know or recognize the first beginning of breast buds. But the first period is more memorable and there are many reasons why a culture may want to record the age of menarche in its girls. Not the least of which is their potential fertility and marriageability.

The average age of menarche in the early 1800s was about 17, as reported in Norwegian records. There was a steady and significant decline in the age of menarche over the past 200 years in European records. Although one researcher in the US noted about 1900 that girls with "greater culture and education" had earlier menarche by about a year, it was probably better nutrition that contributed to the earlier menarche. "Cultured white girls" had earlier menarche than Irish immigrant girls or African-American girls. And that's probably not the culture that made a difference, but the nutrition.

Contributing to earlier menarche is early childhood nutrition and pre-pubertal nutrition. So, is the age of menarche still falling? And the answer is yes, all over the world, but not so quickly. The National Health and Nutrition Examination Survey, NHANES, found that the average age of menarche in the US dropped about one year from girls born in 1920 to women born in 1980. African-American girls had the biggest drop from 13.6 years to 12.2 years. Non-Hispanic white girls had a decline from 13.3 years to 12.5 years. And Hispanic girls were about in the middle. In Japan, Japanese girls had their change of menarche drop from 13.8 in girls born in the '30s to 12.2 for girls born in the '80s.

But, you know, 13, 12 is not such a big deal, but to think of it a different way, the percent of US girls who've had their first period by age 10 was zero for girls born in the '20s and is 2% to 3% for girls born in 1980.

So why is this happening? Is it good nutrition, our fruits, veggies, and protein? Or is it bad nutrition? Well, body weight is a contributing factor to the age of menarche and we know that kids are taller now than they were 80 years ago. The most recent changes in the past 30 years have not been so much taller kids, but fatter kids. The likelihood of reaching menarche in girls now is most likely associated and most highly associated with pre-pubertal adiposity, or fatness. Although, some people even question this.

So sweet drinks in cans and boxes are associated with earlier periods. A few separate studies have debated whether it's the sodas, caffeinated, sugared, or artificially sweetened, and whether they're associated with early menarche. And there are some debates as to whether it's the caffeine, the sugar, or the artificial sweeteners, but one big study suggests that sweet drinks in cans do make puberty earlier. We do know that kids that consume artificially sweetened sodas are more likely to be overweight. But is it the overweight kids are more likely to drink artificially sweet drinks?

Or is it the bisphenol A that lines the soda cans? Well, BPA is a plastic with some estrogen-like activity that's been a concern for all of us. One study, though, looked at BPA levels in the urine of kids and recorded that the menarche, when controlling for race and fatness, didn't seem to be different based on their BPA levels. But there is still a concern about the artificial chemicals in the environment in the lotions and potions we put on our kids that may have some effect on their puberty.

So how does this all matter? Well, first, as the age of menarche goes down, the number of kids who have menarche before 10 goes up. Developing breasts at seven and periods at nine is hard for girls that we still consider as little kids. We also know that earlier exposure to estrogens is a small factor in the risk of breast cancer. When could early puberty be a medical problem? Well, if your daughter develops breasts before the age of seven, you should talk to her pediatrician.

Now, is there anything we can do about it? If pre-pubertal adiposity, fatness, is the number one risk factor for earlier breast development and periods, we should take care with what our kids eat and drink and keep them active. We should have a say about what food is available at their schools, such as sodas and juices and high-calorie snacks in the machines. We should try to decrease screen time and increase outdoor time. And, most importantly, because we cannot control everything, we need to be ready to have the talk and support our girls as girls as they make this transition. And thanks for joining us on The Scope.

Announcer: Thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get the latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Gellner: Puberty is one of those awkward times for teens and parents. So how does one talk to their daughter about a certain monthly change that's going to start around now? I've got some advice for that. I'm Dr. Cindy Gellner on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kid Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Many parents of girls get very apprehensive around the time of puberty. They start pulling out books like "Are you there, God? It's me, Margaret" and secretly stashing feminine protection products for that big day when a girl has their first period.

It can be a challenge to talk to girls about the changes in their body. But if you are honest and open about what is going on, they will be more comfortable with this milestone. Let them know that puberty is the time when a girl's body grows into a woman's body. The physical changes are necessary for a girl to have babies. Puberty may begin as early eight years old or as late as 14 years old. For girls, the start of puberty is officially marked by the first period, which usually happens anywhere from two to two and half years after breast development occurs. The average for a girl's first period to start is 12 years old. Some girls start to get their periods as early as eight or as late as 16. If your child gets their period before age eight or after age 16, you need to talk to your child's pediatrician about that.

Once puberty has begun, the hormones from the brain signal the ovaries to start developing numerous eggs that have been present since birth. After puberty, an egg fully develops and is released from the ovary about once a month. After the period stops, the monthly cycle starts again. And the entire menstrual cycle takes 22 to 35 days. Periods come at the end of this monthly hormonal menstrual cycle and lasts about three to seven days.

There is a whole host of products out there specifically designed for teens to help with protection. A variety of pads and tampons to help absorb the blood that comes out. And though it seems like a lot of blood, it's usually only about two to five tablespoons over the entire period for most girls. Some girls can have heavy periods. Some can have lighter. For the first year or two, a girl's periods are usually irregular. That means they can happen anywhere from twice a month to three times a year. During this time, the body's hormones are not yet fine-tuned so the ovaries may not release an egg once every month.

Periods start coming on a regular schedule once the body starts releasing eggs. Ovulation usually begins one to two years after your daughter's periods start, but it can happen with the first period. Most girl's menstrual cycles become fairly regular as their hormone levels mature and synchronize. If your child has been having periods for less than two years and their physical exam is normal, irregular periods may be part of their normal development. Some women will continue to have irregular cycles as their normal pattern. It's always good for girls to carry an extra tampon or pad in case her period starts unexpectedly.

Some girls have lower abdominal pain and cramping during ovulation or during their period. The pain can be mild or severe. If this happens before a period starts, usually in the middle of the menstrual cycle, the pain is caused by ovulation and usually lasts a short time. It is called mittelschmerz and it feels like a stabbing pain on one side. It's nothing to worry about. Cramps most often happen during a period. They are caused by the hormones that cause the shedding of the lining of the uterus. Some girls have pain for only a day or others, it may last your entire period. Taking ibuprofen or naproxen usually helps.

Remember, your child needs you during this time of transition. Don't make her feel more awkward than she already does. Remind her of the beautiful woman she is becoming.

Announcer: TheScopeRadio.com is University of Utah Health Science's radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: Puberty's over, but you still have acne. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is, Am I Normal? On, The Scope.

Interviewer: I'm here today with Dr. Kirtly Parker Jones, she's the expert on all things woman. Dr. Jones, I have one question that's on my mind. I feel like it's on the mind of a lot of other women. My teenage years are over, I'm supposed to be done with acne, but I still have them. First of all, why is acne happening, and is it a normal thing?

Dr. Jones: It's important for the listener to understand, I'm not a dermatologist. I am a reproductive endocrinologist, so I am a ladies hormone doctor. Acne is related to hormones. So what happens is that your skin makes oils, and the little hair follicles that you have on your face make oils. But when you go through puberty, both men and women start making more male hormones which actually start to make more oils in the skin. Female hormones are also made at the same time, but the oils of the skin then can get infected a little or build up, and that's how you get acne.

So when you're young, and a young male or a young female, your hormones are high, right? Every mother knows that, every teen knows that. And not everyone gets acne, but people who are predisposed to this who have certain kinds of genes, or who have certain kinds of bacteria in their skin, can get acne. Acne's very common in adolescence. So you say, okay fine, your hormones are kind of wacky the first couple years of your periods, but then they settle down and you think "Why do I still have acne?"

Well certainly there are some people who have acne all their life, and those people should see a dermatologist if it's severe acne with big bumps that are very painful and get infected, because there's medication that can calm down your skin. Many young women know, that when they go on the pill for contraception and actually can go on the pill just for their skin, that many of the new pills can calm down the male hormones, and it can significantly improve their skin.

However for women to continue to have significant acne after the first rocking and rolling years of adolescence, they may actually have a hormone problem. Particularly women who also have irregular periods. So there is a condition called polycystic ovary syndrome, about 1 in 20 women have this. It's associated with irregular periods. Eggs that kind of get stuck in development in the ovaries and so they don't grow and ovulate, so their periods are irregular, and these little eggs, these little follicles that make the eggs make male hormones. So women with this condition often have irregular periods and persistent acne. So this may carry on, and it's worthwhile talking to your clinician about it, because in fact, there are things that can make your face better. So that's the good news.

Interviewer: If it's related to hormones, do I have to see a dermatologist then?

Dr. Jones: I think if it's something which isn't the most severe kind of what we call cystic acne, that's going to take a medication that only dermatologists prescribe. It's not uncommon, particularly during the early teenage years, when women have acne and they have irregular periods. For their moms to bring them in maybe for their very first visit to the gynecologist and say, "You know gosh she's got acne, and she has irregular periods and I had that when I was a teen and I went on pills and my face just cleared up beautifully." I say "Great. If it's the right thing for your daughter, we can do that now." So that's an appropriate choice.

Interviewer: So what I'm hearing is, your hormones are kind of out of whack during your teenage years and that's the main reason why young girls and guys get acne. But then what happens when you grow older say in your 20s or 30s, even into your 40s and 50s and you still have acne, is it still because of your hormones?

Dr. Jones: Well it's still hormones in the sense that it's still hormones that are active in your face. However, everybody makes hormones during the reproductive years and men continue to make hormones all their life. So the question is, if you have continued to may have acne after adolescence, then it's worth seeing a dermatologist or and a gynecologist, who can sometimes work together to come up with the right hormone package for you, and the right anti-acne package for you. So here's, here's the other thing. So just as hormones are a little bit wacky at the beginning of reproductive life, they get that way at the end too. And about 10% of women going through menopause get acne again.

Interviewer: Wait you get acne during menopause, is this a Dr. Kirtly Jones problem, or is this still a dermatologist problem?

Dr. Jones: So if you get acne after, when you're going through menopause, it's probably both, in a sense that for certainly menopause women are at the age when they want the dermatologist to look at their skin so they can get a skin check. But a skin check by dermatologists is often just an excuse for someone to say, "Oh I have acne, my skin's not great, but can you look at these wrinkles right here, what can I do about that?" '

In fact, the transition into the perimenopause can cause acne again, because women's hormones are a little disrupted. Again, women may actually stop making as many ovulations, they may make a little bit more male hormones. The other important thing is the dermatologist can separate what is acne from what's rosacea.

Interviewer: Okay.

Dr. Jones: So there's another condition of the skin common in women of menopausal years that can look like acne in that it's red and it's bumpy.

Interviewer: It's not.

Dr. Jones: But it's not. You don't treat it the same way. Now, for women who are going through menopause who get acne, the good news is, as they get older, the ovaries stop working entirely and in general it gets better. The other news is that some women who go on hormone replacement therapy, estrogen and progesterone or estrogen alone if they don't have a uterus, they often notice that their skin gets a little bit better because they're balancing things out a little bit.

So, A, your dermatologist can help differentiate what's acne from what's rosacea, a bumpy condition where your skin gets quite red, and it gets a lot redder when you have hot flashes. That's no fun. And they can make that difference and they can help guide you in terms of what might be the best therapy. And ladies, I've never seen a 70-year-old with acne so good news from that.

Announcer: TheScopeRadio.com is university of Utah Health Science Radio, if you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: Am I normal? Today we are talking with Dr. Kirtly Jones, the expert on all things woman. The situation is, I have one breast that's bigger than the other. Am I... is that weird?

Dr. Kirtly Parker Jones: Well, it turns out that no woman is completely symmetrical. Even women who have had their breasts enhanced will not be completely symmetrical, just because the nature of who they were before they had the add-ons.

So there are two breast buds, they start growing at the very beginning of puberty. Sometimes one grows faster than the other for reasons we don't particularly understand. Occasionally, there are women, and this is quite rare, where one breast bud won't develop at all. That is not normal.

Interviewer: Okay.

Dr. Kirtly Parker Jones: But being within 20 percent of volume, meaning one breast can easily be 20 percent smaller than the other. Now is this worrisome? One breast may hang a little lower, not that any young woman's breasts hang, of course, but if one breast seems to be a little lower than the other, that's also normal. It's important for adolescents to know that breast development isn't completed until about five years after the period, so no interventions should be taken for "correcting" a disparity in breast size or augmenting breast size until women are at least 17 to 18, because at that point their breasts are relatively developed. Disparity in breast size is common. Fifteen to 20 percent difference in size is common.

Interviewer: How common?

Dr. Kirtly Parker Jones: Ninety percent of women have at least that much.

Interviewer: Oh, okay, so really high.

Dr. Kirtly Parker Jones: A very high percent of women have 10 to 15 percent disparity in breast size. They may only notice it when they are in their bra and notice that the bras, which are designed to be symmetrical...

Interviewer: Of course.

Dr. Kirtly Parker Jones: ...may feel a little differently, one versus the other. Or the cleavage may be pushed over toward the middle a little bit more than one side or the other.

Now what about breast size? What's normal for breast size? Well every woman who walks down the street can tell that the range of normal from A cup to DD cup is all within the range of normal. Now what makes large breasts different than small breasts isn't the amount of breast tissue, isn't the amount of tissue that is able to lactate or produce milk during pregnancy, its how much fat is in the breast. So some women develop and deposit fat in their breast more than others.

It is not common to find a very slender woman, with no hips and big breasts, because we tend to put fat in our breasts and our hips somewhat equally. But very slender women may not have that much breast development either. Breast development is also different based on race. So Asian women will have smaller breasts than Caucasian women. The range of normal from A size cups to DD size cups, that's a very large range, and they are all within the range of normal.

Fashion comes and goes. During the 20s, with those really straight shifts, those really straight dresses that we all saw on Downtown Abby, no DD cups were going into those. Now we all know that Dowager Duchess, who had quite large breasts, and the kinds of dresses that she wore. But the beautiful young women were all A cups and flat as can be, and women also bound their chests so that they could be a little flatter in those really straight dresses.

Interviewer: Okay, so I have a question, and I'm going to ask this for all the ladies out there that have this question. Is there any way I can naturally change the size of my breast? Or do I have to go get them fixed?

Dr. Kirtly Parker Jones: Well, the best way to naturally, and there's a little chuckling in the room, the best way to make your breasts be a little bit larger is to be pregnant, however...

Interviewer: That's not an option.

Dr. Kirtly Parker Jones: Yes, pregnancy and breastfeeding makes your breasts larger. After breastfeeding, though, many women find that their breasts are actually smaller than they were before they were pregnant. Now you can always gain a lot of weight, and hopefully if you have a tendency to gain weight by putting fat in your breasts, your breasts might be getting larger, but at the expense of your hips and your thighs and your belly. I don't think that's worth it.

Interviewer: That doesn't sound like a good idea.

Dr. Kirtly Parker Jones: So although there have been many breast augmentation vitamins or exercises, in fact, exercises just increase the size of your pectoral muscles, which lie underneath your breasts. And women have a difficult time getting huge pecks. So getting pecks that are really big to put your boobs on is not going to be all that delicate. I would say that larger breast size for women who are small breasted, consider it fashionable, spend more time watching Downtown Abby. Spend more time running, in which case you will certainly appreciate your breast size or take up a little archery.

The term "Amazon," which is not just a very large distribution company, refers to a tribe of women who were a mezos, without Scota breast, and they took off the breast that was in front of their arrow so they could be better huntresses, so Amazon was a single breasted group of women hunters who took of a breast so they could hunt better. So for all of you small breasted women, well this is mythological of course—so all you small breasted women, spend some time in Downtown Abby, run a little bit more and you'll appreciate your breast size, or think about taking up archery.

Interviewer: My mom says it's actually nice when you have the smaller breast because when you grow older, your breasts aren't going to sag.

Dr. Kirtly Parker Jones: Absolutely, so that's another thing to... count your little breast blessings all you small breasted women, because you have quite a few breast blessings. And those of you large breast women, count your breast blessings too. It's better to count your blessings than to add or subtract from what you were given. Unless you were well outside the range of normal. So our cup size that are fashionable or desirable depends on your ethnicity, your race, the culture of the times, but between A and DD, ladies, you're all normal.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 15, 2018
originally published: June 19, 2014

Announcer: Medical news and research from University of Utah physicians and specialists you could use for a happier and healthier life, you're listening to the Scope.

Interviewer: Does this sound familiar, you ask you kid how was your day? They go, Fine, what did you learn in school? Nothing. How can you relate to your kids, it seems there's a certain point where you're no longer the center of the universe, they're not answering your questions. I'm here with Dr. Matt Woolly, Clinical Psychologist and Assistant Professor of Psychiatry at the University of Utah. Relating to kids that just don't want to talk to you, is there anything that can be done?

Dr. Woolly: This is something that parents bring up to me all the time. You have your cute little guys and gals, and they come home from school, elementary school, tell you all about their day, and then they hit about fifth or sixth grade, they get into that prepubescent time and they kind of start shutting down, they don't share much. The fine and the good and those [inaudible 00:50].

Interviewer: Why is that? What's going on there?

Dr. Woolly: Well some of it's just biological, emotional, they're changing, they're dealing with...

Interviewer: So it's just normal?

Dr. Woolly: Yeah, it's very much normal.

Interviewer: Okay.

Dr.Woolly: It's to be expected, there are some kids that make it all through you know, adolescence, and they're still a chatterbox, and they maintain that relationship with parents, that's unusual though.

Interviewer: Okay.

Mr. Woolly: This is a time where up until puberty is a time where the child has seen mom and dad, and the structure of the home as the most important thing on earth to them. Quite literally, a switch flips in their brain as they get into puberty, and they start to see the world in a more abstract way, and all of a sudden things outside the family including friends start to become very, very important to them. And getting that feedback and that acceptance from friends, and exploring ideas outside of the family are developmentally normal and appropriate, right?

Interviewer: Okay.

Dr. Woolly: Then by the time the late teens, early 20's roll around there's this kind of rejoining where you can now, mom and dad are not as dumb as I used to think they were, and I see the value in that relationship, but I've also developed this other sense of who I am, and so that's maybe something that relates, or doesn't relate at all to the family, but I'm okay with that. And so they blend both and you have this young adult self identity.

Interviewer: So is it important during that kind of period where they lose identity with the family to even maintain it?

Dr. Woolly: Absolutely.

Interviewer: So it is important.

Dr. Woolly: Yeah.

Interviewer: You should.

Dr. Woolly: Yeah..

Interviewer: Even though it's natural, you need to try to fight it a little bit.

Dr. Woolly: Well, you need to know how to deal with it. I don't know that we want to fight it, we want to accept the fact that that's important. We all went through it, and if you didn't go through it you're either; A in denial or B; one of those unusual cases that I was just talking about. But we all found other things to be really important, whether it was sports, or art, or music, friends became very important, wanting to spend time with friends was much more enticing then going to a movie with mom and dad when you're 13, and just hanging out was a big deal. So parents want to know, how do I relate to my child? Often time we try the same old things we did when they were younger, we just keep asking. You know, we just keep pushing it.

Interviewer: And that's annoying.

Dr. Woolly: It is annoying, and often we get a pretty heavy push back from them, or...

Interviewer: And a sigh.

Dr. Woolly: And a sigh, and you don't get me and all that kind of moody stuff. And so we can kind of get stuck in this no-man's land. So what I recommend is entertainment, so the idea is that children are going through an immense amount of development trying to understand who they are, and they're kind of up and down emotionally, and they want to feel good about themselves at that age. That's why when you're a kid you might start to identify with being a rock-star and you get a guitar, and you learn to play it, or being an athlete or being an academic person learning all there is to know about science, or whatever it happens to be. But the idea is content, what are they interested in? And as a parent do you know what your child's interested in? If your child is really into a particular form of entertainment before you start to worry too much about do, I need to limit that entertainment, which you know, you may. But ask them, "Tell me about that", use open ended questions. So for example, kind of back to the movie aspect; if you're child saw a movie, you took them to it, or they saw it with their friends, you might say, "Tell me about that movie, what did you like about it?" Get them talking about it, ask them who their favorite characters were, and then you, if you don't know who that character is you might need to go hit the internet and do a little research. Well, what is it about that character maybe that my child likes? You can even ask them, they often won't know though, that's the interesting thing, they'll just relate to and identify with particular characters, because of the qualities that those characters in the books, movies, or video games have. And that can tell you a little bit about where you're child's at.
Now, some of it may seem kind of generic, but the more you do this, this isn't a one-time activity, this is called being involved, so you're going to do this on all of those different levels, and by doing it, it gives you a little bit of a window, an insight into maybe what they are thinking about, what they're feeling about themselves, what they're struggling with. And it gives you a little bit of a platform to then maybe be present in their life, because even though the children are pulling away during those years, it doesn't mean they devalue completely what parents have to offer, it's just they're not needed every day like they wanted and needed it when they were younger. If you start to use this, you get this consistent window and insight, it also might help you know if you're concerned, if they're a withdrawn teenager, if they're kind of down and depressed. This gives you an avenue to talk to them about the characters and the themes in the stories that they like. And that might help you make decisions about whether your child needs some professional input, or if your child just is going through a difficult time, or just exploring identities about who they are. Are they focused on being the hero? Are they focused on being the loyal friend?
I had a conversation once with a kid who had just seen this movie, he wanted to know if I had ever seen it before, it was called "Star Wars, A New Hope." You know this is a kid, I think he was about 13, 12 maybe 12 turning 13, I said," So what did you like about it?" And he went and talked about how cool it was, and so I asked him, "If you, you know, what was your favorite character? If you had to say what your favorite character was" he said "Obi Wan, Kenobi" I was really surprised, and I said "Really? Tell me more about that, why are you so excited about, or why do you identify with Obi Wan Kenobi?" And he couldn't give me a great answer, but he kind of stammered a little bit about how Obi Wan knew everything, and Obi Wan was helpful, and Obi Wan could guide Luke. The interesting thing here about this boy is that he's also somebody who's a little bit without a guide in his life. And so it was interesting to me, it provided some insight to me as a therapist well what do I need to be doing, what sorts of themes are important to him? I made the mistake of assuming that like most boys his age he'd want to be Luke Skywalker.

Interviewer: Yeah.

Dr. Woolly: He probably wouldn't turn that down if it was offered to him, but the character he most identified with was the wise old sage.

Interviewer: So what did you take away from that, how did that change how you related to this?

Dr. Woolly: Well, to be honest it allowed me to have that little bit of insight into his psyche, and what was going on for him emotionally.

Interviewer: So is he saying he misses that, is that what he's saying do you think?

Dr. Woolly: Well see, that's the funny thing, we assume like, the kids can describe things like adults. We have to respect the fact that they have to project some of their unconscious needs, drives and desires out onto things like powerful things in their environment like characters. That's a simple way that a parent, what I did in the session is exactly what a parent could do at home.

Interviewer: So it sounds kind of brilliant on a couple of levels. First of all you're probably not going to get anywhere if you're directly asking a child how are you feeling, what are you thinking? And so you do it indirectly, through these characters, and you also play a little bit of detective by picking out what kind of content they're consuming, what they're relating to, and then that gives you insight, because they would never tell you if you asked them, they probably couldn't.

Dr. Woolly: They wouldn't and they most likely couldn't. This is an opportunity to understand and relate to your children, and perhaps provide them some guidance when needed.

Announcer: We're your daily dose of science, conversation, medicine. This is the " Scope", University of Utah Health Sciences radio.

Dr. Jones: About 50 years ago, my parents must have known what was in the wind when I burst out in tears every time my father said the word puberty. I'd been sneaking my Dad's razor to shave my legs, already had my training bra. And what was I in training for? I had a book on how babies were made, but I didn't really know what was going to happen then, and when.
This is Dr. Kirtly Jones from the Department Obstetrics and Gynecology at University of Utah Healthcare and today on The Scope we will start a little conversation on puberty.

Announcer: Medical news and research from University Utah physicians and specialists you can use for happier and healthier life. You're listening to The Scope.

Dr. Jones: Today we'll talk about girls and puberty. When does it usually happen, what are the first signs, what are the milestones, what should girls and their moms know, and why does puberty make our previously perfect children so weird?
Okay. One for science; although some folks think that puberty for girls begins with the first period, a young woman already had two or three years of changes in her body. Probably the first, well known to mothers and not known to doctors, is that a girl starts to smell a little differently. This may start from seven to eight years old, and is the sign that the adrenal gland is maturing. The adrenal gland starts to make small amounts of male hormones that could make boys and girls smell a little different. It isn't in the textbooks, but a mom's nose knows.
Two, breast buds; as early as seven or eight or as late as 13, girls develop tender little nickel-sized bumps under their nipples. Sometimes one side before the other; this is the beginning of breast development and it's a sign that the ovaries have started to wake up and make small amounts of estrogen. It's about two years before the first period.
Three, first periods are weird. They are not usually regular; they can be light, heavy, and unpredictable. They may have cramps; they may not. Usually, a girl gets regular, about once a month, in about a year. And if a girl hasn't become regular in about three years you should mention it to her pediatrician. No breast bumps by 14 or no period by 16 means you should talk with your doctor.
For weight gain, girls go from straight to curvy with fat deposits on their hips and breasts. This is sometimes welcome, and sometimes not. For complicated reasons at puberty, many girls stop being as active as they were, and this isn't a good thing. Keep your girls active in sports and in outside family activities. This is good for the whole family.
Number five, sleep; puberty resets the sleep pattern for kids to want to stay up later and get up later. This isn't just computers and TV; it happens in the Amazon. But teenagers need nine to 10 hours of sleep as they rewire their brain, and if kids stay up late on their computers and phones, the light from these devices suppresses melatonin and can suppress sleep. And if they have to get up early for school, they'll get distracted, irritable, and unfocused. Your kid needs sleep and you need to make sure they get it; TV, computers, phone lights off at 9:00. Good luck.
Cranky; aside from being sleep deprived, puberty rewires the brain and is making and changing its wiring, its neuron connections. More than any time since age two, risk taking, inability to judge risk, and all the things we associate with the mature brain just aren't happening. Here are some things parents can do.
First of all, you should know what to expect. If you don't know what to expect, you need to do a little reading. Get together with other mothers so that you might actually practice your patter. Just as I practiced my talk today before I talk to you about puberty, you should practice what you're going to say so you're comfortable with the words. And be prepared. For your daughter, you should have supplies in the home. These should be supplies that are appropriate for a young girl. Have them ready so that you can help your daughter when her first period comes. She'll have a little more privacy. She should know where the material is and you can help her.
And what about the weird business, the recognition that they aren't the people who they just were when they were eight, that reliable, mature, terrific eight-year-old? And they're not the people who are going to be at 25, that reliable, mature, terrific 25-year-old. This is a transition; you got through it when they were two to three, you'll get through it now. And remember, no matter how painful this is for you, it's more painful for your daughter. Hang in there; it'll get better. This is Dr. Kirtly Jones and thanks for joining us on The Scope.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope, the University of Utah Health Sciences Radio.