After infancy, puberty is the second fastest time of growth and development in a child’s life. It can be a confusing period of physical changes, emotional fluctuations and general upheaval as kids become aware of the transformation that is taking place in their bodies. For parents of daughters, it can be a time of anxiety, apprehension and dread about how and when to begin the conversation about a girl’s journey through puberty.
Well-Being spoke with physicians Alia Hussain, M.D., Pediatrician, Nneka Holder, M.D., Adolescent Medicine Specialist, and Michelle Taheri, M.D., OB/GYN, to get solid professional advice to help answer some of parents’ most pressing questions when it comes to preparing their little girls for the changes in store.
Q: What is the average age for a girl to begin the process of puberty?
A. “While every child is different, most girls will begin to see changes in their bodies at the age of 9 or 10. Depending on genetics, race, and body structure, some girls may begin the process of puberty as early as 7 or 8 years of age. The first sign of puberty is usually the presence of “breast buds,” small firm nodules that indicate the beginning of breast development. They may be slightly painful and uncomfortable at first, and some girls may feel self-conscious when they first appear.” Alia Hussain, M.D.
Q: What is a good time to begin a conversation about puberty and the changes to expect?
A. “Only you can find the right time to talk to your daughter about what she can expect as she starts the process of puberty. Look for a time that you both are relaxed, when there will be no interruptions. Since one of the first visual signs of puberty is breast development, it may be helpful to start the conversation about a bra. Shopping for the first bra can be something you share, opening the way for further discussions about growth of hair, preparing for the first period, and more. Some girls start the ‘marathon” of puberty earlier, some later, but it’s important that your daughter knows whenever it happens, it is normal for her.” Nneka Holder, M.D.
Q: What is the average age for a girl to have her first period?
A. In the U.S. the average age for a girl’s first period is 12.43 years. The age has decreased only slightly over the last half-century. Less than 10% of girls will start their period before age 11 and over 90% will reach this milestone by 14 years. “First periods are usually a shock, even when anticipated, but they should not be painful or excessive. They may not become regular for 18 – 24 months. If a girl’s periods are longer than 7 days, if they are excessive and painful, or if there is itching, burning or an unusual odor, that is not normal and she should be seen by a doctor.” Nneka Holder, M.D.
Q: What can parents do to help their daughters feel comfortable talking to them about the changes they are experiencing?
A. “It is essential to keep an open line of communication. Girls should feel comfortable coming to their parents and pediatricians with questions regarding the changes they are experiencing, both physical and emotional, during this sensitive time. It is very important that we tell girls they are not alone and that all girls go through the same changes but at their own biological pace.” Alia Hussain, M.D.
Q: What role can a girl’s physician play in encouraging conversation about puberty?
A. “I begin the discussion by first asking the parent if they have spoken to their daughter about expected changes in her body. It is important to begin this discussion before puberty so that the child is prepared. I usually start these discussions at around the 9-year well check visit or sooner if the child is already showing signs of puberty.” Alia Hussain, M.D.
Q: What is the recommended age for a girl to receive the HPV vaccine?
A. The Advisory Committee on Immunization Practices, which provides guidance to the Centers for Disease Control and Prevention, recommends that the vaccination for HPV4 and HPV2 be given to girls between the ages of 11 and 12 years old. While the decision to vaccinate is left to the discretion of parents, it has been proven highly effective in preventing cervical cancer.
Q: How can a pediatrician or OB/GYN help parents with the difficult task of preparing their tween and teen daughters for some of the dangers and responsibilities that come with puberty?
A. “A trusted physician can help facilitate the difficult conversation about sexuality, reproductive health and safety with a young patient. It is important for young people to be appropriately informed. With the permission of parents, an OB/GYN or other healthcare provider can offer a safe environment in which to dispel myths about topics such as sex, pregnancy prevention and sexually transmitted diseases.” Michelle Taheri, M.D.
Q: When is it appropriate for a girl to begin seeing an OB/GYN?
A. “A good time to establish care with an OB/GYN is between 13 and 15 years old. The primary goal of early reproductive health care is education and prevention. It also allows the patient to develop a relationship with her OB/GYN that is based on confidentiality and trust.”
“Generally, the initial visit with an OB/GYN would include a breast exam and external pelvic exam in order to assess appropriate development. This should take place after a discussion with the OB/GYN and with the consent of the patient. An internal pelvic exam may only be needed if there are specific concerns. Current recommendations state that cervical cancer screening begin at age 21 with a pap smear, which requires an internal pelvic exam.” Michelle Taheri, M.D.
Q: What are other ways parents can help their young daughters through this transition period?
A. “Most importantly, parents need to let their tweens and teens know that they’ll be there to provide support during this confusing and difficult time. In addition to the obvious changes, between the ages of 10 and 15 a girl may grow in height significantly. Their shoe size increases. Their vision may change. They may struggle with acne. And, they may experience mood changes. Helping daughters through these challenges can go a long way toward building trust and fostering communication.”
“Remember, while their bodies are growing at such a fast pace, teens need ample sleep – 8-10 hours a night; a healthy diet – rich in calcium and iron, avoiding caffeine; and regular physical activity. They also need to be encouraged to practice safety measures such as always using seatbelts, and wearing helmets during biking and contact sports, as well as observing internet safety – keeping what should be private, private and understanding anything they post, text or tweet now may haunt them from online forever.” Nneka Holder, M.D.
Nneka Holder, M.D., Pediatrics, Adolescent Medicine, is a graduate of Lincoln University, Lincoln University, PA; Harvard Medical School, Boston, MA and George Washington University, Washington, D.C. She completed her pediatric residency and adolescent medicine fellowship at Children’s National Medical Center, Washington, D.C. Dr. Holder is board-certified in Pediatrics and sub-boarded in Adolescent Medicine. She is part of the Adolescent Medicine team at Children’s of Mississippi.
Alia Hussain, M.D., Pediatrics, attended Medical School at King Edward Medical College, Lahore, Pakistan and completed her Residency and Chief Residency at Winthrop University Hospital, Mineola, NY. She is a member of the American Academy of Pediatrics. Her practice, Merit Health Medical Group, will be moving their offices to River Oaks Drive in Flowood.
Michelle Taheri, M.D., OB/GYN, graduated from the University of Mississippi Medical Center, School of Medicine. During her residency in Obstetrics and Gynecology at Louisiana State University Health Sciences Center, Dr. Taheri served for one year as Chief Resident. She is a member of the American College of Obstetrics and Gynecology. Dr. Taheri’s practice, Merit Health Medical Group is located in Canton.
dig deeper: Check out It’s Perfectly Normal by Robie H. Harris and Michael Emberley. For two decades, this universally acclaimed book has been a trusted and accessible resource for kids, parents, teachers, librarians, and anyone else who cares about the well-being of tweens and teens.