We all remember the changes — and awkwardness — of puberty. But helping your child navigate puberty is a whole different matter.

For answers, we turned to Boston Children’s Primary Care Alliance physician Caitlyn Hark, MD, at Framingham Pediatrics, and Frances Grimstad, MD, a pediatric and adolescent gynecologist in the Division of Gynecology at Boston Children’s Hospital. Here’s their advice for helping your child through puberty.

What is puberty?

During puberty, a child’s body transitions into adulthood. Dr. Grimstad explains it as a time when children’s bodies undergo physical changes in response to hormones produced by their gonads (ovaries or testes).

Puberty can start at different ages and advance at different rates. Boys often begin between the ages of 9 and 14, about two years later than girls.

They can also experience emotional changes — sometimes at a different pace than the physical changes. That’s why Dr. Hark describes puberty as “an exciting but sometimes nerve-wracking time.”

Your child’s height and body shape can change rapidly. Other physical changes include:

• hair growth on the arms, legs, face, armpits, and around the genitals
• acne
• vocal changes
• testicle and penis growth
• unpredictable erections
• menstruation
• breast development

Reassuring your child about puberty

Children and teens are surrounded by peers who are also going through puberty. They naturally compare themselves to others. Physical changes, or lack thereof, can draw unwanted attention. Let your child know early and often that you’re available to talk about these changes. “It shouldn’t be a one-time conversation,” Dr. Hark says.

Reassure them that what they’re experiencing is normal. Consider sharing your own experience with puberty. “Puberty’s timing is often similar among family members. Parents can use their own experiences to talk about being behind or ahead of their peers and what that felt like,” Dr. Hark says.

“Try to encourage them to feel empowered by their new bodies, too,” Dr. Hark adds. These changes in their bodies signal growing independence and the beginnings of adulthood. “Consider discussing the changes they are experiencing in the context of their future goals or aspirations. The changes they are going through are kind of like a superpower.”

“Puberty is also a time where many begin to explore their identities,” explains Dr. Grimstad. This can include exploring gender, gender expression, and sexual orientation. “Supporting your teen in their identity exploration is just as important as supporting them in their body changes.”

If you sense your child is too embarrassed to ask you something, schedule an appointment with their pediatrician. In each visit, Dr. Hark and Dr. Grimstad both remind their puberty-age patients that no topic is off-limits.

Talking to your child about menstruation

Menstruation usually starts “two to three years after breast buds develop,” according to Dr. Hark.

Parents can start the conversation about menstruation when their child is 9 or 10. “It’s around that age that your child might start hearing about friends who got theirs,” Dr. Hark says. “Start when they’re younger if you have a family history of early periods. That way, they won’t be scared or caught off-guard.”

“If no one in the household is of menstruating age, it’s great to keep a starting box of pads on hand for when the first day comes,” adds Dr. Grimstad.

Be prepared to discuss:

• what a period is: a response to hormonal changes
• the purpose of periods: to continually prepare the uterus for pregnancy
• hygiene options: pads, tampons, cups, menstrual discs, period underwear

Let them know it’s normal to have an irregular period for a few years. They should alert you if:

• they haven’t had their first period by age 15
• their period soaks through a pad or tampon every two to three hours
• their period lasts longer than seven days
• heating pads or over-the-counter medications don’t reduce pain
• their period comes more frequently than every four weeks
• their period suddenly becomes irregular

It’s important to leave the door open with your teen to discuss their period and let them know they can share their concerns with you. “Everyone has different period goals, as well as different levels of tolerance for bleeding or period-related symptoms such as cramps,” explains Dr. Grimstad.

“Period goals also could include altering the amount of blood, duration, and frequency of bleeding, or managing period-related symptoms like cramping pains, acne, mood swings, or gender dysphoria with menses,” says Grimstad.

“What might seem like a normal period for one person may be difficult for another. Our goals as clinicians should be not only to identify what is atypical or concerning for all periods,” Dr. Grimstad says, “but also to help patients in managing their own period goals, such as making them lighter or less painful.”

When to ask for help

You may have already experienced your child’s mood swings. That’s to be expected; hormonal changes can affect their mental and emotional well-being. But not all behavioral changes should be left to work themselves out.

Call their pediatrician if you notice:

• changes in appetite leading to significant weight loss or gain
• dramatic changes in their sleep habits
• loss of interest in previously enjoyed activities
• difficulties in school or with their relationships
• self-isolation
• frequent sadness
• signs of bullying or cyberbullying

“For serious concerns, their pediatrician may recommend a referral to a therapist or other behavioral specialist,” Dr. Hark says. “Some serious concerns may include disclosure or history of trauma, thoughts or actions of self-harm, or engaging in other dangerous or risky behaviors.” 

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Boston Children’s Primary Care Alliance providers can support you and your child through puberty. Find a pediatrician near you. For those in the Greater Boston area, Dr. Hark is accepting new patients.

Learn more about how the Division of Gynecology and The Center for Young Women’s Health at Boston Children’s Hospital provide gynecologic, sexual, and reproductive care while helping patients better understand their own health and development.