Puberty can be a challenging time for both parents and children. Puberty is a normal phase of childhood but parents are often unprepared for the changes that occur. In addition, many parents are uncomfortable talking about puberty and may also be worried about what is or is not normal. 

Rebecca Malik, MD, Family Physician at NorthShore, has worked with children and teens extensively, formerly in an adolescent sexual health center and currently seeing many children and teens in her practice. Also, she is anticipating this phase in her own children who are now six and eight and thus has a keen personal interest.  Recently, she sat down with us to answer questions and share her insights:

When should I expect my child to enter puberty?
Although there is a wide range of normal ages, girls typically begin the process of puberty at ages 10-11 and boys at ages 11–12. Girls usually complete puberty by ages 15–17 while boys usually complete puberty by ages 16–17.

What body changes should I expect in my child?

Girls: 

• Breast development is typically the first physical sign of puberty in girls.
• Pubic hair is often the second noticeable change in puberty usually within a few months of breast development. 
• Menstruation typically occurs about two years after breast development.  Girls on average will start their periods around 12.5 years of age in the United States. A high proportion of girls will have irregularity in the menstrual cycle for months. If your daughter has not begun menstruation by age 16 bring her in for a well child check-up. 

How do I talk to my daughter about her period?
Make her first period less daunting by talking about it before it starts. Let her know:

1. A period is normal and nothing to be afraid of.
2. The time it starts can vary and that is normal.
3. To be prepared as it may come without warning.
4. How to use feminine products.
5. How to manage cramps.
6. She can talk to you about her period.

Boys:

• Testicular and penis growth is the first sign of puberty in boys.
• Pubic hair often appears on a boy shortly after the genitalia begin to grow. 
• Body and facial hair follow the appearance of pubic hair, other areas may also develop hair including the underarm, face and around the nipples and anus. Arm, leg, chest, abdominal and back hair become heavier more gradually. 
• A boy’s voice changes when the voice box, or larynx, grows, causing the voice to drop and deepen. It usually precedes the development of significant facial hair by several months to years.
• Muscle development is part of the later stage of puberty and can include the development of some breast tissue in about 60% of boys which is called gynecomastia. Reassure your son that this is normal and will resolve within one to two years.

How do I talk to my son about erections?
Your teenage son might feel embarrassment or shame but involuntary erections are normal. Let him know: 

1. Erections are a normal part of growing up and developing.
2. Involuntary erections happen to every boy as his body develops.
3. Erections while sleeping are normal. 
4. Eventually involuntary erections will occur less frequently. 

Are body odor and acne common in boys and girls?
The composition of perspiration changes will result in a more "adult" body odor. You might need to have a discussion about deodorant and anti-perspirant options, as you will likely notice the odor before your son or daughter does. There is also increased secretion of oil from the skin which may cause acne. Acne varies greatly in its severity but it is important to see your healthcare provider before there is a chance of scarring and damage.

My child has become moody. Is this normal?
Moodiness is very common during puberty. You may see dramatic changes in your child’s personality. Your child may be less willing to spend time with you, may be less interested in talking to you and may develop new interests. Though moodiness is to be expected, some mood changes can signal possible depression. Symptoms of depression include: changes in sleep pattern, loss of appetite, loss of interest in things that they used to enjoy, low energy, frequent crying, withdrawing from friends and family, irritability and anger, talking about feeling worthless or hopeless and/or a noticeable drop in grades. If you notice any of these signs, bring your child to see his or her healthcare provider right away. 

How and when should I start talking to my child about sex?
Sex can be an uncomfortable topic for both kids and parents to discuss. Nevertheless it’s important that your child is prepared with all the information necessary to prevent unwanted pregnancy and sexually transmitted disease. So, talk to your child about sex early and often! Parents, you are the most influential people in your child's life and you should be his or her source for reliable information when it comes to sex. It’s important that the conversations begin before your child starts to experience any bodily changes. While it might feel embarrassing or awkward to discuss these sensitive topics, your child likely will be relieved to have you take the lead. 

Initiate the discussion by providing your child with a book or pamphlet from a trusted source to read on their own. Make sure you are available afterwards to answer questions. Try to use proper anatomic terminology whenever possible. Using specific names for each part will make it much easier to identify medical issues later in life. Some parents worry that scientific terms are too complicated for their children, but I’ve found that these terms actually simplify things in the long run. Children can then easily explain future symptoms to you in a clear, understandable way. Each time you talk, provide more detail, depending on your child’s maturity level and interest in the topic. If you feel unable, ask your healthcare provider for advice or bring your child in for a well child visit to provide an opportunity to discuss puberty one-on-one. This can be a chance for your child to ask the questions they may not be comfortable asking you.  

Should I be worried if my teenager is masturbating?
During puberty as hormone levels increase, interest in sex increases. Masturbation is a common, very normal way for boys and girls to explore their own sexuality and changing bodies. It’s not harmful to your child. It is important to respect your child’s privacy, but, again, be sure your child knows that you are always available to answer any questions.