Podcast: Ready, Set, Here Comes Puberty

Leslie Lane: Welcome to Premier Health Now On-Air. If there's a young lady in your life, you'll want to stay with us, because we're talking about puberty, that roller-coaster ride to maturity that can begin as early as age eight in girls. We're so pleased to have two experienced health professionals who also happen to have daughters, so they know what it means to walk the talk. We're glad you're along. I'm your moderator, Leslie Lane. With me today are Dr. Anessa Alappatt, family practice physician with Fairborn Medical Center. Welcome to you.

Dr. Alappatt: Thank you, Leslie.

Leslie Lane: And Jalana Lazar, a certified nurse midwife with Life Stages Centers for Women. Thanks so much for joining us.

Jalana Lazar: Thanks for having me.

Leslie Lane: Puberty brings a lot of changes for a girl. Dr. Alappatt, can you walk us through this process of puberty for girls and what changes are in store?

Dr. Alappatt: Sure. I think that most women or girls remember the time when their bodies and minds started changing. You find that you're very emotional and you go from being angry or calm to crying and the mood swings can be daunting. But not only is your brain going all over the place, but so is your body. The little girl that was playing dolls suddenly is developing breasts and hair in places that may be uncomfortable. Then they go on to have a menstrual cycle. It is a time period where all these changes occur and a lot of times people might think that puberty's the onset of menses, but that's not the case. It usually starts with breast development. I have many patients who come in and say they ... "I'll have this painful knot under my nipple." That's actually the first stage of breast development. Usually, the first sign of puberty. Although, we might see some moodiness before that happens, the breast development is one of the first noticeable signs.

Leslie Lane: What works to talk with girls about what's coming?

Jalana Lazar: I sort of think that you want to have the talk about puberty not just be one talk, but a series of talks. You want to start talking to children when they're young just about how the ways in which their body is different from an adult body. Usually kids point that out for themselves. "Why do you look this way and I don't? Why do you have breasts and I don't?" That sort of opens up a conversation early on and then that allows you to continue having that conversation. Children generally just need short answers to their questions, but it helps set the stage for things like using proper anatomical terms for parts of your body and for normalizing the process so that it's not scary or intimidating. I think that's an important step.

Leslie Lane: When you say, "young," how young are you thinking?

Jalana Lazar: I mean, I think children start asking questions as early as three and four and it's appropriate to answer those questions correctly at three and four, making sure that kids understand that their body needs to be their body and a safe body and that no one should touch it except their doctor with permission, or their parents with permission, that kind of thing. It also seems like an important time to initiate talking about those differences so by the time a girl is eight or nine and is starting to develop breast buds, she sort of has had some anticipatory guidance about that.

Leslie Lane: What are some of the typical ways that you see kids responding to all of these changes?

Dr. Alappatt: It's very individualistic. It's based on I think the conversations that have been had, both by the parents and the children and siblings perhaps. They can play a role in how kids are challenged by the whole process. I think it varies and I think your approach as a parent or as a family can vary on that individual too. Some kids may take it pretty easily. Like, "Oh, my sister went through this. It wasn't any big deal." But if it's the only child and they have all brothers, they may be completely freaked out because their brothers didn't have the same issues. I think puberty from the beginning and as you go throughout is definitely an individual process and I think that each child needs to be catered to based on their emotional maturity, because some kids will go through menstrual cycles at 10 and others will go through their first menses at 15.

You're not going to have the same conversation with a 10 year old that you might have with a 15 year old. I think that's a difficult thing, because you can't say, "Oh, just say this." But I think just being open and honest and making sure that that conversation is something that you are able to have. Like, "I don't want to talk about that." And to be honest. You don't want to shut the kids down if they're asking questions. Now again, you're not necessarily going to have all the same sexual conversations that you are with a 10 year old that you are going to have with a 15 year old, but it's very important to be honest and open with those conversations.

Jalana Lazar: I think also kids often compare themselves to other kids in their school and so that will sometimes initiate some conversations. A lot of times children who are hitting puberty on either the early end or the late end, so kids who are starting to have physical changes as early as eight or nine might feel different than their classmates. It's important for you to be addressing some of that at home so that they don't find themselves the subject of teasing, or bullying if something's changing at school and they're not really comfortable with it. It's important, just like Dr. Alappatt said, to keep the conversation open and honest.

If there's something you don't know, to say, "I don't know, but we can look that up together." Or, "I don't know, but we can ask your doctor together." I think acknowledging that maybe you have some discomfort around it, but you can try to work through that together with your child is important. Similarly, normalizing that everybody goes through this at a different stage, so that if you are in a classroom you're going to see lots of different bodies going through lots of different changes, and boys and girls are going through those changes at such different rates and different times, so that also will sometimes stand out. Usually in eighth grade you have a whole bunch of short boys and tall girls and then that flips. That's natural. That's just what happens.

Leslie Lane: Is there a normal for when puberty begins, or how long it lasts, or what is this range?

Dr. Alappatt: Eight up until 17, so it's a huge range. I would say the average age is about four to five years by the time it first starts to the time it first finishes. Usually, breast buds start and then one and a half to two years after breast buds you have your menstrual cycle and then another two years after that your mostly developed. But again, you can be on the far end of that so that it stretches out to about five years or so. I mean, the total from beginning to end. It's a long process and some kids if they're on the late end are like, "When is this going to happen for me?" Then it can be very frightening for a younger child.

Leslie Lane: Is there an impact to body image that you've seen that girls respond differently to this?

Jalana Lazar: I think there's an awkwardness as your body is changing. This is probably true for boys as well, I just, I only see female patients. But I think there's a certain awkwardness. Your body is changing and maybe you feel like you don't fit in your body or you don't recognize your body. Adolescents do, especially that tween, start to get clumsy and sort of knock things over. It's just some ... Possibly the emotional changes also contribute and the moodiness to being a little bit all over the place in puberty. I do think that you see some awkwardness and some discomfort with your changes in your body and also that whole issue of comparing yourself to the media, and comparing yourself to others.

You're also going through this important transition where your parents, who are the ones that provide you most of your information, and your family who's the most important thing in your life, starts to recede slightly as you get some independence and you're starting to take a lot more cues from your friends and your classmates. As that transition happens, it begins this period where you also start comparing yourself to your peers more and that can contribute to some of the body image. But that's where that strong support at home, that positive reinforcement of body image and trying to normalize changes. Some girls are going to have bigger breasts. Some girls are going to have smaller breasts. Some girls are going to be taller, some are going to be shorter. Also helping girls adjust to them and make hygiene changes as needed.

Dr. Alappatt: I was just going to say that I just wanted to kind of reiterate the home support, because at this time in their lives they are looking outward towards friends and others to figure out what to do. It's just a natural tendency as they pull away from home, so you want to make sure that the information that they're getting about their bodies is from home and not necessarily from their friends. Because their friends are going to talk about it and they're going to say all kinds of things and you don't know where they're getting their information from, so it's important that you have multiple conversations to your children about what's going on. Even if it's uncomfortable, it's really important because who knows what they're hearing. Don't doubt that they are hearing things. It's just really important.

Jalana Lazar: I definitely would second that. That a lot of times parents think, "Well, my child isn't hearing this, or isn't paying attention, or isn't aware. She's still just playing on the swings." She's perfectly capable of both playing on the swings and also listening in to every conversation that's happening around her. That is important, because it's a good place for you to establish your values with your child around body image, and kindness, and support for your child during this time, because it is a difficult time.

Leslie Lane: Puberty also brings sexual maturity, interest in romance, testing boundaries. What's your counsel to parents about how to guide a young girl?

Dr. Alappatt: I believe that it's certainly natural for girls to be interested in boys and of course vice versa. I think as a family, you need to establish where your priorities are on that. I feel like girls are easily drawn into that and can put the boy/girl relationship as a priority and I find that they don't get the confidence from boys, because the boys don't have the maturity at that level to give what girls are looking for. It's important for girls to establish their own confidence in themselves, so offering other activities, like sports, or teams, or if you're into the arts, so that they aren't looking out towards boys to fulfill that lack or need that they're looking for in puberty.

Because as we've talked about, is that it is an awkward time and you're not sure what's going on and so it's really important to have something that they can go towards that gives them, "Oh, this is what I can do. I don't have to worry about necessarily those other things." Both personally and professionally, I think it's important for girls to establish their own self-esteem and self-competence during this time in their lives and to do that outside of, "Oh well, a boy I think is really important."

Jalana Lazar: I'd agree with that completely, especially because we live in such a media-driven culture where girls are constantly seeing images of themselves and highly sexualized images of women all over the place. It's easy to get the idea that the only thing that matters is how you look. When your body's changing into this thing that you can't control, right? That puberty's controlling itself, you can't really control that. It's really important to try and put your outlet into something that makes you feel strong and confident and helps you understand that your inside is the most important part of you.

Leslie Lane: Can moms today count on their daughters having a puberty experience similar to their own, or do you think the world has just changed too much and moms need to be thinking about this a little more broadly or differently?

Dr. Alappatt: I think they're a couple of ways to address that. I think from a physical standpoint, sometimes there's a lot of similarities. If your mom is big breasted, then you more likely have big breasts, or if you started your period early than there's a chance that your daughter will start her period early. From a physical standpoint, I think there can be a lot of similarities. Not always, but certainly that's a probability. Emotionally, it's still a roller-coaster. I think some of the biggest differences now are just the media in terms of the cellphones and the social networking. I think that's a huge difference from when we were growing up and so the self-image thing can be huge, even bigger than it used to be.

Because, I mean, selfies are nonstop, Instagram, Snapchat, Twitter. I mean, I could go on. I'm sure there's many I don't even know. The self-image is a bigger problem, so I think we're seeing a lot more emotional issues in teens then we used to. Anxiety, and depression, and I feel that a huge part of that is the whole social networking. If you have a young teen, or a teen at all, and they're on their phones all the time posting things and talking to people, then I would be very weary and keep monitors on that, because those things stay with you and kids can get into all kinds of trouble obviously with that. I think that's a huge change from when we were growing up.

Jalana Lazar: Yeah. I think it's so important to have a conversation with your kids. Some schools are doing a better job of this too, but to have that conversation at home is the most important, about how you want to use the internet in your home and in your family. Because a lot of times, especially around sexual issues, younger tweens, teens, will be using Google to find out the answers to the questions that ... The minute you type something into Google, you get all kinds of responses and it's hard to understand what is a good response and what is not. All kinds of things come up on YouTube and if you think your child has not seen it, the chances are they have if you haven't stuck really strong boundaries in place early on.

It is important to educate yourself about what is out there on the media, because there are good websites that can be resources, but you are their best resource to talk about what's happening in puberty and sexual issues moving forward. It is important to be aware of where they're getting their information and what kind of information they're sharing and try and keep them as safe as you can, while also being aware of the limits and trying to help them make the best choices.

Leslie Lane: What didn't we talk about that you really wish parents would remember about going through puberty with their daughters?

Dr. Alappatt: I would say that if there's a problem and you're struggling, whether it's physical, like their periods are heavy or extremely painful, that your child is missing a lot of school, or maybe your child is 15 and they haven't started their period yet and you're concerned, you should go to the doctor with your daughter and have a concern. Or if it's an emotional problem don't be like, "Oh, this is normal." If you're not comfortable and you're unsure, then seek a professional help. If you go see them and they say, "Oh, this is normal." Then you can go home and be reassured that that's okay. But if you're not sure, then don't you go on Google and look it up. Go seek professional advice.

Jalana Lazar: Exactly. I always warn all my patients away from the 3AM Google. It's the worst. Don't do any Googling at 3AM, especially. I think also acknowledging that it's a roller-coaster for your daughter and it's also a roller-coaster for you, because it's a new phase of your relationship together and that can be hard and emotional for you as well. I think that that's the key to getting through it is to realize that everything is not going to stay the same for you and your daughter and your relationship, but it could be a great time for you to strengthen things and really deepen your relationship.

Leslie Lane: I want to thank you both so much for sharing so many insights about what puberty means for girls, moms, families today. We're grateful to Dr. Anessa Alappatt, family practice physician with Fairborn Medical Center and Jalana Lazar, nurse midwife with Life Stages Centers for Women. We appreciate your spending time with us today. If you want to know more, visit premierhealth.com/healthnow. We'll be back and we hope you will. I'm Leslie Lane, thanks for joining us and watch for our next edition of Premier Health Now On-Air.