Parenting Through Puberty

I know when my oldest let me know about the changes, I wasn’t ready.  I had prepared my child with what to expect, gotten her some nice books about it that we read together. But, when the time arrived, I thought, “already?”

The changes of puberty are different for every child, but there are some points that help know what’s ahead, just around the corner.

Physical Changes

 

For girls, the changes of puberty start between 8 and 13 years old.  Usually the first sign is breast development.  It commonly takes about two years to get from there to the first menses, or period.  Along the way, development of pubertal hair and a growth spurt usually ensue as well.  When girls start menses, it can be irregular in the first year, but it tends to become more regular with time.

For boys, the changes of puberty start between 9 and 14 years of age.  This starts with genitals enlarging, followed by pubertal hair.  Then they will develop increased muscle mass and voice changes, with the start of these averaging at 13 ½ years old. The peak height for boys is usually reached by 17 years old, 2 years past that for girls.

Both girls and boys will have other changes as well, including hair growth, acne, and body odor.  If you have questions or concerns about whether your child’s patterns are normal, it’s important to ask your healthcare provider.

Emotional Changes

 

Along with the physical changes, there are many emotional changes with puberty as well. Adolescent youth begin to become more independent and less interested in having the attention of their parents.  Some will lose their temper more easily and have more mood swings.  It’s important to keep the conversation open with these changes, both physical and emotional.  Being positively and proactively involved in your child life, even when it’s not invited, helps them know you support them when they need it.

Puberty is Starting Earlier

 

Despite the normal ranges of puberty described above, the onset of puberty has gotten earlier over the years. The cause is unclear, but we know several factors can lead to an earlier start.  Trends from lifestyle factors include an earlier start for girls with more sugar intake (independent of weight), also an earlier start for girls with obesity.  There are differences in the start of puberty with different racial background as well, with puberty often occurring earlier in African-American children.


Booklist

 

Some books that may help open the conversation with you and your child include “The Care and Keeping of You: A Body Book for Girls” by Valerie Lee Schafer and “Guy Stuff: the Body Book” by Dr. Cara Natterson.  These are appropriate for kids 8 years old and up according to Common Sense Media, a website with recommendations on books and movies for kids that are age appropriate.


Are My Child’s Changes Normal?

 

If your girl starts showing signs of puberty before 8 years old or your boy before 9, it’s worth bringing up with your provider to discuss further.  Similarly, if your girl has not started these changes by the time she reaches 13 or your boy by 14, that’s a good reason to discuss as well. Your annual well-child visits are a great opportunity for providers to evaluate these development milestones and make sure things are on track. Please make sure to keep up-to-date on these important visits.

Entering into the next stage can be an intimidating phase for parents and kids alike, but it’s all about being there for your child in an open and honest way.

By Dr. Deborah Wiser, Chief Medical Officer

Autism, what is it?

Autism spectrum disorder (ASD) is a complex developmental disability; signs typically appear during early childhood and affect a person’s ability to communicate, and interact with others. Your Pediatrician can start to recognize these symptoms between 1-2 years old and should be testing for concerns. ASD is defined by a certain set of behaviors and there is a wide spectrum as to how it impacts each child’s life.

There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes.

Many of the early signs of Autism deal with difficulties with social interaction. 

The range and severity of symptoms can vary widely. Common symptoms include:

  • difficulty with communication
  • difficulty with social interactions
  • obsessive interests
  • repetitive behaviors
  • difficulty making eye contact
  • poor motor skills’ and sensory sensitivities (overly sensitive to the feel of clothing or texture of foods).

A person with ASD may follow many of these behaviors or just a few, or many others as well. The diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity and how they impact that child life and learning.

Autism is treatable.

Children do not “outgrow” autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. For more information on developmental milestones, visit the CDC’s “Know the Signs. Act Early” site.

  • Lack of or delay in spoken language
  • Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
  • Little or no eye contact
  • Lack of interest in peer relationships
  • Lack of spontaneous or make-believe play
  • Persistent fixation on parts of objects

Early recognition, as well as behavioral, educational, and family therapies may reduce symptoms and support development and learning.

Too sick for school?

Flu season is officially here! Over the next few months, many parents of ill children will be faced with the decision whether or not to send their child to school. The most important thing for parents to consider when making this decision is if the child will be able to learn and participate in school activities. We also don’t want to unnecessarily expose other children to illness causing germs. However, we all want to minimize missed school and work days for both students and their parents. Below are a few guidelines that can help parents make this often tricky call.

Fever

A fever is body’s way of fighting off infection and is the most common reason parents keep their children home from school. The definition of a fever is a temperature of 100.4 or higher, though some schools and daycare centers will have their own rules. The general rule of thumb is to keep your child home until they have been fever free for 24 hours.

Upper respiratory Infections

Most children will have several different cold viruses each winter. A child with typical cold symptoms including a runny nose, sore throat, and cough can usually participate in school without any restrictions. Coughs may linger for several weeks after the other symptoms have resolved. It is important to go over the importance of coughing or sneezing into an elbow or a tissue and proper hand washing techniques with your sick child to limit the spread of these germs.

It may be necessary to keep a child home if they have more severe symptoms, such as extreme fatigue, loss of appetite, or anything else that will keep them from learning and participating at school. If a child has influenza (the “flu”), they should be kept home from school until their symptoms have resolved. The flu is similar to a cold but is accompanied by high fevers and body aches. We recommend an annual influenza vaccine to help lower the risk of this illness.

If your child has an ear, sinus, or strep throat infection it is recommended that they stay home from school until at least 24 hours after antibiotic treatment has been started. Conjunctivitis (also known as “pink eye”) can be caused by allergies or a virus, but when it’s caused by bacteria it is very contagious and needs antibiotic treatment before the child returns to school.

Vomiting and Diarrhea

Children with vomiting and diarrhea should also be kept home until their symptoms have resolved. If there are no other symptoms, older children with mild diarrhea that are able to use the toilet and wash their hands on their own may go to school if they don’t have any other symptoms.

Skin

Most childhood rashes are caused by viruses and most are not cause for concern. Certain rashes, such as chicken pox are more severe and highly contagious. If a rash is accompanied by a fever, the child should not attend school. If you are unsure what is causing a child’s rash, it’s a good idea for them be seen by their healthcare provider to find out what the rash is and any precautions that should be taken.

Lice is another common reason for children to miss school. In the past, many schools had a “no nits” policy. Experts now agree that these absences are unnecessary and children can return to school as soon as they have had one lice treatment.
Illnesses are a normal part childhood. We can’t keep our children home for every sniffle and sneeze, but we do want to minimize the spread of germs and make sure that our children go to school ready to learn. If you have any questions about whether or not to send your child to school, talk to your child’s healthcare provider.

Autumn Barbero, Pediatric Nurse Practitioner

Football Season is Here!!! Let’s Play…

Spokane Football

Fall sports have started and it’s time to get those kids in for their annual Well-child exams/sports physicals (please call their doctors office today if this hasn’t happened yet). We want to make sure all kids and adolescents are healthy enough to play sports and that they continue to stay healthy throughout the school year.

Injuries can happen to any child at any time and a concussion can happen in just about all sports. Statistically, girls are at a higher risk of suffering concussions in their chosen sports than boys are; however, concussions can impact any student athlete. Striving for scholarships, championships, and social acceptance drives kids to make a choice about continuing to play when injured, despite their lack of readiness. It is your job as a parent, and our job as your child’s Doctor, to convince our kids that if they have not recovered 100% from a head injury then they are not ready to jump back into the game. Going back early places them at increased risk for severe bodily injury, permanent brain injury, or, in rare cases, even death. If your child has had a head injury and is having any symptoms at all, please get them in to their doctor for an assessment.

Concussion is a clinical diagnosis and you do not have to be KNOCKED OUT to have a concussion…this only happens 10% of the time. The most common symptoms to develop after injury to the head are headaches, dizziness, nausea or vomiting, disorientation, confusion, and loss of coordination. Severe symptoms can result in changes to your child’s personality, grades or academic effort, and their friendships.

There are 4 R’s for concussion to consider:

  1. Recognition- You have to recognize that a concussion has occurred.
  2. Remove- You need to remove that athlete from the risk of repeat injury.
  3. Recovery- Athletes need time to be symptom free before going back to activity.
  4. Return- To cognitive activity as well as return to play.

Diagnosis after injury should be done by your child’s primary care provider so they can follow up during and after the recovery period. There are many tools and tests people use to diagnose a concussion, but the symptoms should be followed closely by a medical provider to help prevent re-injury as well as to educate the athlete about risks of a second concussion. This typically results in worse symptoms, much longer recovery times and potential removal from the activity entirely. Missing a week for 100% recovery is certainly better than missing the entire season due to repeat injury.

With a single concussion, 85% of high school athletes have full symptom recovery within 2-3 weeks. When an athlete is highly symptomatic they should take a couple of days (48 hours) off from school. Their doctor can help make a plan as to the speed of their return to school and sports based in the extent of the concussion and symptoms. Returning to light aerobic activity that does not put the athlete at risk for repeat injury can help maintain fitness and mental health during the recovery period. In the past, athletes were strongly advised to avoid all physical activity until recovery had reached 100%. But new evidence shows that physical activity can help with brain growth and repair while doing nothing may prolong the recovery time.

So when should your child stop their activity or be disqualified from sports?

Three concussions in a lifetime requires having a serious conversation about risks associated with repeat head injury. Things that should disqualify your child from continued activity are increasing length of or severity of symptoms, concussions caused by less trauma then the first or second, decreased time in between concussion or prolonged post-concussive symptoms.

Remembering to help your child place their overall health and wellness above their sports performance may just help keep them playing sports for years to come.