Growing Up

Preparing for the First Period

The start of menstruation is a major event in a girl’s life. Some girls greet those first drops of blood with joy or relief, while others feel confused and scared. Whatever the reaction, the arrival of the first period holds the same meaning for every girl: It’s proof that she’s becoming a woman.

On average, most girls start their periods when they’re 12 or 13 years old (although some begin earlier or later). But if you wait until your daughter gets her period to talk to her about menstruation, that’s too late.

So, how do you discuss menstruation and offer education, as well as guidance and support, before the big day arrives? Or, what do you tell your son? (Boys have questions, too.) Before you can discuss menstruation, it’s important to have a good understanding of how the process works.

About Menstruation

In the early 1900s, girls generally reached menarche (the medical term for the first period or the beginning of menstruation) at age 14 or 15. For a variety of reasons, including better nutrition, girls now usually start to menstruate between the ages of 10 and 16. But menstruation isn’t just about having a period. It’s a sign that a girl is physically capable of becoming pregnant.

During the menstrual cycle, hormones are released from different parts of the body to help control and prepare the body for pregnancy. That preparation begins when the ovaries (two oval-shaped organs that lie to the upper right and left of the uterus, or womb) produce the hormones estrogen and progesterone.

These hormones trigger certain changes in the endometrium (the lining of the uterus). Then, other hormones from the pituitary gland stimulate the maturing and release of the egg, or ovum, from the ovary.

The release of the egg is called ovulation, and it happens in the middle of the cycle — usually day 14 of a 28-day cycle, for example. From the ovary, the egg moves into one of the fallopian tubes (the two tubes that lead from the ovaries to the uterus).

If the egg is fertilized by sperm, the fertilized egg will take about 2 to 4 days to travel down the fallopian tube. It will then attach to the thick, blood-rich lining of the uterus. If it’s not fertilized, the egg begins to fall apart, the estrogen and progesterone levels drop, and the uterine lining breaks down and is shed — this bleeding is what’s known as a period.

Cycles and More

A menstrual cycle lasts from the first day of one period to the first day of the next. The typical cycle of an adult female is 28 days, although some are as short as 22 days and others are as long as 45. Periods usually last about 5 days, although that can vary, too. During a period, a woman passes about 2–4 tablespoons (30–59 milliliters) of menstrual fluid.

For the first few years after menstruation begins, cycles are often irregular. They may be shorter (3 weeks) or longer (6 weeks), or a young woman may have only three or four periods a year. The absence of periods is called amenorrhea. A girl should see her doctor if she hasn’t started menstruating by age 15, or 3 years after her first signs of puberty appeared.

So, how will you know when your daughter might start menstruating? You’ll probably be able to see physical changes that signal she’s getting close to starting. Breast development is usually the first sign that a girl has entered puberty. It’s usually followed by the growth of some pubic hair.

About a year after breast development begins, most girls enter into a phase of rapid growth. They’ll get taller and curvier, and their feet will grow. Then, about a year after the growth spurt begins and about 2 and a half years after breast development starts, the first period arrives.

Talking About It

It’s probably best to avoid “The Talk” about menstruation. Instead, try to spread it out into lots of smaller conversations — education about how the human body works should be continuous. Otherwise, too much importance is placed on a single discussion and the information can be overwhelming. Kids reaching puberty should already know what’s going to happen to their bodies.

Even toddlers begin asking questions about their bodies, and parents should answer them honestly. But how specific you are with the details should depend on your child’s maturity and ability to understand.

Throughout childhood, kids ask many questions and each is an opportunity for parents to advance their kids’ knowledge. Doing so not only gives kids the information they need when they ask for it, but also lets them know that their parents are available for and comfortable with these discussions.

But you shouldn’t necessarily wait for their questions to talk about puberty and menstruation. Ideally, by the time they’re close to puberty, both girls and boys should have full knowledge of the changes that will take place in their bodies. Why? Kids really want to learn about most things from their parents. And you can be sure that they’ll also hear their friends discuss these changes.

By providing kids with good information, parents will know that they’re well-informed and able to sort out any misinformation. Kids can often make certain aspects of puberty — menstruation, especially — sound bad and scary; and if that’s the only information kids, then that’s what they’ll believe.

It’s also important for parents to paint the process of menstruation in a positive light. If a mother refers to her period as “the curse,” her daughter might get a negative impression of the whole experience. Instead, mothers can explain that monthly periods are a natural and wonderful part of being a woman. After all, without them, women couldn’t become mothers.

Explaining that everyone is different is also key. For example, your daughter may be concerned that her body is changing more quickly — or more slowly — than her friends’ bodies.

Girls also need to be familiar with feminine-hygiene supplies (sanitary pads and tampons) and they should know that sometimes periods may cause cramps when the muscles of the uterus contract.

Another reason kids need to know about menstruation at an early age is that sexually active girls can get pregnant even before they start menstruating. Sometimes ovulation (the release of an egg from an ovary) can happen just before a girl is about to have her first period. This means that she can be fertile and become pregnant even though she hasn’t yet menstruated.

Common Questions About Periods

Kids — both girls and boys — often have lots of questions about menstruation, such as:

• How come only girls have periods? Explain that boys change in different ways during puberty, like the deepening of their voices and the growth of facial hair. Getting her period means a girl can have a baby. Periods happen because of changes in the uterus — a body part that girls have but boys do not.
• Do girls have their periods for the rest of their lives? No, a woman stops having her period usually between the ages of 45 and 51, which means she will no longer be able to become pregnant (at least, not without the help of some fancy reproductive technology!).
• How long does a period last and how much blood is there? It varies for each girl, but some have their period for 3 days and others have it for a week. Periods can be light, moderate, or heavy, and there can be a total of 2–4 tablespoons (30–59 milliliters) of blood. And this can vary from period to period in the same girl.
• Are pads or tampons better? In choosing between the two, what matters is a girl’s physical and emotional comfort. A tampon can be uncomfortable in the years right after menstruation starts, when the pelvis and vagina are still growing. Usually, girls are more comfortable using pads at first, but they may want to start using tampons when they get older (although they don’t need to wait to use tampons until a certain age). Their friends may have started using them, and the freedom tampons can give may be appealing. Each box of tampons includes instructions, so be sure to read them with your daughter.

  Although the first few times using a tampon can be frustrating, explain to your daughter that it will soon be easy with a little practice. Because the muscles of the vagina can become tense when a girl is nervous, it can be difficult to insert a tampon at first. It’s important to relax as much as possible. It’s a good idea to start with a slim tampon with an applicator because they can be easier to insert. It can also help to first try a tampon on a day with heavier flow, so that it is easier to put in.

• Do girls have to stop playing sports or swimming while they have their periods? Girls should understand they can do everything they normally would do — as long as they’re comfortable. For example, girls may choose to wear a tampon so they can continue to swim while menstruating.
• What’s toxic shock syndrome (TSS)? TSS is a rare but serious bacterial infection that can be associated with tampon use. Fortunately, TSS that is associated with menstruation can almost always be prevented by changing tampons regularly and by using the smallest absorbancy needed (for example, “slender regular” instead of “super plus”). A reasonable precaution is to change tampons every 4 hours or more frequently if the blood flow is heavy.
• Do girls always have cramps with their periods? Concern about cramps is a big issue for some girls. While most girls eventually have some cramps, many do not for the first year or two of getting their periods. It’s important to tell girls that cramps usually only last a few days. Sometimes, a hot water bottle or a hot bath can help ease discomfort. Some find that deep breathing and exercising help, too. If cramps become too uncomfortable, your daughter might want to take an over-the-counter (OTC) medicine like ibuprofen (such as Advil or Motrin).

  Having cramps for a day or two each month is common, but signs of dysmenorrhea — severely painful menstruation that interferes with a girl’s ability to attend school or study or sleep — or other menstrual problems should be discussed with your doctor.

• What’s PMS? Premenstrual syndrome (PMS) includes physical and emotional changes (mood swings and irritability, tension, bloating, and breast tenderness) that can occur during the time right before some girls get their periods. But girls usually don’t develop symptoms associated with PMS until several years after menstruation starts — if ever. While not all girls experience PMS, for those who do, plenty of rest, exercise, and eating a balanced diet may help.
• Do girls need to douche or use deodorant spray when they have their periods? No. In fact, douching can increase a girl’s possibility of infection by disrupting the normal balance of bacteria in the vagina.

Tips for Talking

Just as parents might be slightly embarrassed to talk with their children about menstruation, kids and teens may find it difficult to let mom and dad know their questions or concerns. If talking about menstruation is awkward for you, here are some ways to make discussions a little easier and more open:

• Look for good books and videos or DVDs that can help foster a more comfortable and educational conversation.
• Speak to your family doctor about ways to talk about menstruation and puberty.
• Brush up on the facts of menstruation and have information readily available for your child to look at or read.
• If there’s a question that you don’t know the answer to, let your child know you will find out the information.
• Coordinate your conversations with the health lessons and sex education your child receives in school. Ask your child’s teacher about his or her plans and for any advice.
• To break the ice, try asking your child some questions that will help you both ease into discussions. Ask what kind of questions he or she has while you walk down the feminine-hygiene products aisle at your grocery store or while you watch a commercial for pain relievers advertised to alleviate symptoms of PMS.
• If you hear your child mention something related to getting a period, spur a conversation by asking where the information came from. Questions can be a great way to set the record straight on any misconceptions kids might have.
• Before you take your preteen daughter for a routine checkup, let her know that the doctor may ask if she’s gotten her period yet. You can then ask if she has any concerns or questions about getting her first period.

It’s important to tell kids the truth about menstruation in an age-appropriate way and to be comfortable with the accuracy of that information. Don’t be put off by their questions — they’re probably the same questions you had at that age, and now you can answer them.

Start “The Talk” Early

Today, kids are exposed to so much information about sex and relationships on TV and the Internet that by the time they approach puberty, they may be familiar with some advanced ideas. And yet, talking about the issues of puberty remains an important job for parents because not all of a child’s information comes from reliable sources.

Don’t wait for your child to come to you with questions about his or her changing body — that day may never arrive, especially if your child doesn’t know it’s OK talk to you about this sensitive topic.

Ideally, as a parent, you’ve already started talking to your kids about the changes our bodies go through as we grow. Since the toddler years, kids have questions and most of your discussions probably come about as the result of your child’s inquiries.

It’s important to answer these questions about puberty honestly and openly — but don’t always wait for your child to initiate a discussion. By the time kids are 8 years old, they should know what physical and emotional changes are associated with puberty. That may seem young, but consider this: some girls are wearing training bras by then and some boys’ voices begin to change just a few years later.

The Timing With Boys and Girls

With girls, it’s vital that parents talk about menstruation before their daughters actually get their periods. If they are unaware of what’s happening, girls can be frightened by the sight and location of the blood.

Most girls get their first period when they’re 12 or 13 years old, which is about 2 or 2½ years after they begin puberty. But some get their periods as early as age 9, while others get it as late as age 16.

On average, boys begin going through puberty a little later than girls, usually around age 10 or 11. But they may begin to develop sexually or have their first ejaculation without looking older.

Just as it helps adults to know what to expect with changes such as moving to a new home or working for a new company, kids should know about puberty ahead of time.

Many kids receive some sex education at school. Often, though, the lessons are segregated, and the girls hear primarily about menstruation and training bras while the boys hear about erections and changing voices. It’s important that girls learn about the changes boys go through and boys learn about those affecting girls, so check with teachers about their lesson plans so you know what gaps need to be filled. It’s a good idea to review the lessons with your child, since kids often still have questions about certain topics.

What to Say

When talking to kids about puberty, it’s important to be reassuring. Puberty brings about so many changes that it’s easy for kids to feel insecure and alone.

Often, kids entering puberty feel insecure about their appearance, but it can help them to know that everyone goes through these changes, many of them awkward. They also should know that the timing of these changes can vary greatly. Acne, mood changes, growth spurts, and hormonal changes — it’s all part of growing up and everyone goes through it, but not always at the same pace.

Girls may begin puberty as early as second or third grade, and it can be upsetting if your daughter is the first one to get a training bra, for example. She may feel alone and awkward or like all eyes are on her in the school locker room.

With boys, changes include the cracking and then deepening of the voice, and the growth of facial hair. And just as with girls, if your son is an early bloomer, he may feel awkward or like he’s the subject of stares from his classmates.

Kids should know the following about puberty:

• Girls become more rounded, especially in the hips and legs.
• Girls’ breasts begin to swell and then grow, sometimes one faster than the other
• Girls and boys get pubic hair and underarm hair, and their leg hair becomes thicker and darker.
• Both girls and boys often get acne and start to sweat more.
• Both girls and boys have a growth spurt.
• Boys’ penises and testicles grow larger.
• Boys’ voices change and become deeper.
• Boys grow facial hair and their muscles get bigger.
• Boys sometimes have wet dreams, which means they ejaculate in their sleep.
• When a girl begins menstruating, once a month, her uterine lining fills with blood in preparation for a fertilized egg. If the egg isn’t fertilized, she will have a period. If it is fertilized, she will become pregnant.
• A girl’s period may last 3 days to a week, and she can use sanitary napkins (pads) or tampons to absorb the blood.

Common Questions

Not surprisingly, kids usually have lots of questions as they learn about puberty. It’s important to make sure you give your child the time and opportunity to ask questions — and answer them as honestly and thoroughly as possible.

Some of the most common questions are:

Other Tips for Talking

Let your child know that you’re available any time to talk. But it’s also important to initiate conversations, too. As a parent, it’s your job to try to discuss puberty — and the feelings associated with those changes — as openly as possible. While you might feel embarrassed or awkward discussing these sensitive topics, your child probably will be relieved to have you take the lead once in a while.

This can be easier if you’re confident that you know the subject matter. So before you answer your child’s questions, make sure your own questions have been answered. If you’re not entirely comfortable having a conversation about puberty, practice what you want to say first. Let your child know that it may be a little uncomfortable to discuss, but it’s an important talk to have.

If there are questions or concerns about puberty and development that you can’t answer, ask your child’s doctor for advice.

Teething, the emergence of the first teeth through a baby’s gums, can be a frustrating time for little ones and their parents. But knowing what to expect during teething and how to make the process a little less painful can help you manage.

The Teething Process

While teething can begin as early as 3 months, most likely you’ll see the first tooth start pushing through your baby’s gum line when your little one is between 4 and 7 months old.

The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. They’re usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.

Next to break through are the first molars (the back teeth used for grinding food), then finally the eyeteeth (the pointy teeth in the upper jaw). Most kids have all 20 of their primary teeth by their third birthday. (If your child’s teeth come in much slower than this, speak to your doctor.)

In some rare cases, kids are born with one or two teeth or have a tooth emerge within the first few weeks of life. Unless the teeth interfere with feeding or are loose enough to pose a choking risk, this is usually not a cause for concern.

As kids begin teething, they might drool more and want to chew on things. For some babies, teething is painless. Others may have brief periods of irritability, while some may seem cranky for weeks, with crying spells and disrupted sleeping and eating patterns. Teething can be uncomfortable, but if your baby seems very fussy, talk to your doctor.

Although tender and swollen gums could cause your baby’s temperature to be a little higher than normal, teething doesn’t usually cause high fever or diarrhea. If your baby does develop a fever during the teething phase, something else is probably causing the fever and you should contact your doctor.

Easing Teething

Here are some tips to keep in mind when your baby is teething:

• Wipe your baby’s face often with a cloth to remove the drool and prevent rashes from developing.
• Rub your baby’s gums with a clean finger.
• Give your baby something to chew on. Make sure it’s big enough that it can’t be swallowed or choked on and that it can’t break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething aid. Be sure to take it out of the freezer before it becomes rock hard — you don’t want to bruise those already swollen gums — and be sure to wash it after each use.

  Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, chill it in the refrigerator, but NOT the freezer. Also, never boil to sterilize it — extreme changes in temperature could cause the plastic to get damaged and leak chemicals.

• Never tie a teething ring around a baby’s neck or any other body part — it could get caught on something and strangle the baby.
• If your baby seems irritable, ask your doctor if it is OK to give a dose of acetaminophen or ibuprofen (for babies older than 6 months) to ease discomfort. Never place an aspirin against the tooth, and don’t rub alcohol on your baby’s gums.
• Teething biscuits and frozen or cold food are only OK for kids who are already eating solid foods. Don’t use them if your child has not yet started solids. And make sure to watch your baby to make sure that no pieces break off or pose a choking hazard.
• Avoid teething gels and tablets because they may not be safe for babies.

Baby Teeth Hygiene

The care and cleaning of your baby’s teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay makes them fall out more quickly, leaving gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.

Daily dental care should begin even before your baby’s first tooth emerges. Wipe your baby’s gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!).

As soon as the first tooth appears, brush it with water and fluoridated toothpaste, using only a tiny amount.

It’s OK to use a little more toothpaste once a child is old enough to spit it out — usually around age 3. Choose one with fluoride and use only a pea-sized amount or less in younger kids. Don’t let your child swallow the toothpaste or eat it out of the tube because an overdose of fluoride can be harmful to kids.

By the time all your baby’s teeth are in, try to brush them at least twice a day and especially after meals. It’s also important to get kids used to flossing early on. A good time to start flossing is when two teeth start to touch. Talk to your dentist for advice on flossing those tiny teeth. You also can get toddlers interested in the routine by letting them watch and imitate you as you brush and floss.

Another important tip for preventing tooth decay: Don’t let your baby fall asleep with a bottle. The milk or juice can pool in a baby’s mouth and cause tooth decay and plaque.

The American Dental Association (ADA) recommends that kids see a dentist by age 1, or within 6 months after the first tooth appears, to spot any potential problems and advise parents about preventive care.

Your daughter is asking about getting her first bra, and your son comes home from soccer practice smelling like he’s been digging on a road crew all day. What’s going on?

Welcome to puberty, the time when kids sprout up, fill out, and maybe even mouth off.

Puberty was awkward enough when you were the one going through it. So how can you help your child through all the changes?

Stages of Puberty

Sure, most of us know the telltale signs of puberty — hair growth in new places, menstruation, body odor, lower voice in boys, breast growth in girls, etc. But we may not fully comprehend the science behind all of these changes. Here’s a quick look at how it works.

Usually after a girl’s 8th birthday or after a boy turns 9 or 10, puberty begins when an area of the brain called the hypothalamus starts to release gonadotropin-releasing hormone (GnRH). When GnRH travels to the pituitary gland (a small gland under the brain that produces hormones that control other glands throughout the body), it releases two more puberty hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

What happens next depends on gender:

• Boys: Hormones travel through the bloodstream to the testes (testicles) and give the signal to begin production of sperm and the hormone testosterone.
• Girls: Hormones go to the ovaries (the two oval-shaped organs that lie to the right and left of the uterus) and trigger the maturation and release of eggs and the production of the hormone estrogen, which matures a female’s body and prepares her for pregnancy.

At about the same time, the adrenal glands of both boys and girls begin to produce a group of hormones called adrenal androgens. These hormones stimulate the growth of pubic and underarm hair in both sexes.

For a Boy

The physical changes of puberty for a boy usually start with enlargement of the testicles and sprouting of pubic hair, followed by a growth spurt between ages 10 and 16 — on average 1 to 2 years later than when girls start. His arms, legs, hands, and feet also grow faster than the rest of his body. His body shape will begin to change as his shoulders broaden and he gains weight and muscle.

A boy may become concerned if he notices tenderness or swelling under his nipples. This temporary development of breast tissue is called gynecomastia and it happens to about 50% of boys during puberty. But it usually disappears within 6 months or so.

And that first crack in the voice is a sign that his voice is changing and will become deeper.

Dark, coarse, curly hair will also sprout just above his penis and on his scrotum, and later under his arms and in the beard area. His penis and testes will get larger, and erections, which a boy begins experiencing as an infant, will become more frequent. Ejaculation — the release of sperm-containing semen — will also occur.

Many boys become concerned about their penis size. A boy may need reassurance, particularly if he tends to be a later developer and he compares himself with boys who are further along in puberty. If a boy is circumcised, he may also have questions about the skin that covers the tip of an uncircumcised penis.

For a Girl

Puberty generally starts earlier for girls, some time between 8 and 13 years of age. For most girls, the first evidence of puberty is breast development, but it can be the growth of pubic hair. As her breasts start to grow, a girl will initially have small, firm, tender lumps (called buds) under one or both nipples; the breast tissue will get larger and become less firm in texture over the next year or two. Dark, coarse, curly hair will appear on her labia (the folds of skin surrounding the vagina), and later, similar hair will begin growing under her arms.

The first signs of puberty are followed 1 or 2 years later by a noticeable growth spurt. Her body will begin to build up fat, particularly in the breasts and around her hips and thighs, as she takes on the contours of a woman. Her arms, legs, hands, and feet will also get bigger.

The culminating event will be the arrival of menarche, her first period (menstruation). Depending on the age at which they begin their pubertal development, girls may get their first period between the ages of 9 and 16.

Common Puberty Concerns

The physical changes kids experience as they move toward adulthood often are accompanied by emotional consequences.

Some girls are excited about their budding breasts and new training bras; others may worry that all eyes are focused on their breasts. Some boys love the sight of themselves all lathered up with shaving cream; others may be uncomfortable with the attention they get for a few new shoots of hair.

Pimples are common for most teens. Acne is caused by glands in the skin that produce a natural oil called sebum. Puberty hormones make the glands produce extra sebum, which can clog the pores. Washing gently with water and mild soap can get rid of excess sebum and help reduce breakouts.

Over-the-counter and prescription medications are available for more severe cases of acne. Your family doctor can recommend a dermatologist (a doctor who specializes in treating the skin) if basic skin care and OTC medications don’t keep acne under control.

Kids who once associated bath time with play need to learn to wash regularly and to apply deodorant or antiperspirant. A teen who’s learning to shave will need to learn how to keep a razor clean, to throw a disposable one away before it becomes dull and ineffective, and to not share it with others.

Boys, capable of having erections since infancy, can now experience ejaculation. Usually, this first happens between the ages of 11 and 15, either spontaneously in connection with sexual fantasies, during masturbation, or as a nocturnal emission (also called a wet dream). If he doesn’t know about wet dreams before he has one, a boy may think he has urinated accidentally or that something has gone wrong with his body.

As kids mature physically and emotionally, they become increasingly curious about their sexuality and their own bodies. Although infants and young kids do touch their own genitals from time to time because they like the way it feels, masturbation is more common in older kids, from the preadolescent and teen years and beyond.

As far as the myths and beliefs about masturbation: No, it won’t cause kids to grow hair on their hands, become infertile, go blind, or develop new emotional problems. A small number of kids and teens with already existing emotional problems may become preoccupied with masturbation — just as they may become overly occupied with other behaviors or thoughts. Constant or obsessive masturbation may be a sign of anxiety or other emotional problem.

But, other than that, masturbation is generally considered by doctors to be a common form of normal sexual self-exploration. Although some preteens and teens may choose to masturbate, others may not.

Because masturbation is often considered a private topic, many kids might feel too embarrassed to talk about it because they’re concerned that their parents will be angry or disappointed with them. Some kids may prefer to talk to older siblings, friends, or their doctors rather than a parent. If you are concerned or have questions about masturbation, consult your doctor.

Talking to Kids About Puberty

Boys and girls can see these changes happening to each other — in some cases, they can smell them. It’s important to talk to your child about how bodies change — sooner, rather than later.

Be prepared to talk to a girl about the expected events of puberty, including menstruation, when you see the first signs of breast development, or earlier if she seems ready or has questions. A boy should know about normal penile development, erections, and nocturnal emissions before age 12 — sooner, if he’s an early developer. And it’s also important to talk to your child about what’s happening to members of the opposite sex.

It’s best not to have “The Talk” as one grand summit but rather as a series of talks, ideally beginning when your child is young and starting to ask questions about body parts. Each time you talk, offer more and more detail, depending upon your child’s maturity level and interest in the topic.

And, if your child has a question, answer it honestly. If you feel uncomfortable, need answers to questions, or are uncertain about how to have these talks with your child, ask your doctor for advice.

Yesterday, your son sounded like he’s always sounded — like a boy. But today, you heard that first crack in his voice. He’s started puberty and several things about him are changing. Along with obvious changes in physical appearance, his voice will start sounding a whole lot different. For a while, he might have difficulty controlling it and he’ll make all sorts of odd noises when speaking.

The Changing Larynx

It’s the larynx (or voice box) that’s causing all that noise. As the body goes through puberty, the larynx grows larger and thicker. It happens in both boys and girls, but the change is more evident in boys. Girls’ voices only deepen by a couple of tones and the change is barely noticeable. Boys’ voices, however, start to get significantly deeper.

The Science Behind the Squeaking

The larynx, which is located in the throat, plays the major role in creating the sound of the voice. Two muscles, or vocal cords, are stretched across the larynx and they’re kind of like rubber bands.

When a person speaks, air rushes from the lungs and makes the vocal cords vibrate, which in turn produces the sound of the voice. The pitch of the sound produced is controlled by how tightly the vocal cord muscles contract as the air from the lungs hits them. If you’ve ever plucked a small, thin rubber band, you’ve heard the high-pitched twang it makes when it’s stretched. A thicker rubber band makes a deeper, lower-pitched twang. It’s the same process with vocal cords.

Before a boy reaches puberty, his larynx is pretty small and his vocal cords are kind of small and thin. That’s why his voice is higher than an adult’s. But as he goes through puberty, the larynx gets bigger and the vocal cords lengthen and thicken, so his voice gets deeper. Along with the larynx, the vocal cords grow significantly longer and become thicker. In addition, the facial bones begin to grow. Cavities in the sinuses, the nose, and the back of the throat grow bigger, creating more space in the face — which gives the voice more room to resonate.

As a boy’s body adjusts to this changing equipment, his voice may “crack” or “break.” This process lasts only a few months. Once the larynx is finished growing, your son’s voice won’t make those unpredictable sounds.

A Normal Stage of Growth

Those croaks and squeaks in a boy’s voice are just a part of this normal and natural stage of growth. As a boy gets used to these big changes, his voice can be difficult to handle and it may take a lot of effort to keep it under control. Just as he’s getting used to the big changes in his body, he has to adapt to the sound of what he’s saying.

As puberty continues, his body adjusts to the new size of the larynx, and the croaks and squeaks begin to taper off. After that, the new, deeper voice becomes much more stable and easier to control.

Along with other obvious changes in the way your son looks, there’s a significant change in the throat area. When his larynx grows bigger, it tilts to a different angle inside the neck and part of it sticks out at the front of the throat. This is the “Adam’s apple.” In girls, the larynx also grows bigger but not as much as a boy’s does, which is why girls don’t have prominent Adam’s apples.

Everyone’s timetable is different, so some boys’ voices might start to change earlier and some might start a little later. A boy’s voice typically begins to change between ages 11 and 14½, usually just after the major growth spurt. Some boys’ voices might change gradually, whereas others’ might change quickly.

If your son is concerned, stressed, or embarrassed about the sound of his voice, let him know that it’s only temporary and that everyone goes through it to some extent. After a few months, he’ll likely have a resonant, deep, and full voice just like an adult!

You may have noticed that your toddler’s growth has slowed a bit since the first year of life. Babies grow at what seems like lightning pace, but toddlers grow at a much slower rate.

While it might look as if little has changed on the outside, your toddler is making strides each day in language development, learning, balance, and coordination.

Doctors use certain milestones to tell if a toddler is developing as expected. There’s a wide range of what’s considered normal, so some children gain skills earlier or later than others. Toddlers who were born prematurely reach milestones later. Always talk with your doctor about your child’s progress.

Here are some things your toddler might be doing:

Communication and Language Skills

• says 10 to 20 words
• understands one-step commands (“Pick up the toy.”)
• can point to some body parts (“Where is your nose?”)

Movement and Physical Development

• runs
• walks up stairs with hand held
• throws a ball
• takes off some clothes
• scribbles with a crayon

Social and Emotional Development

• begins to engage in pretend play
• laughs in response to others
• shows affection
• asserts himself or herself verbally or through angry tantrums

Cognitive Skills (Thinking and Learning)

• knows the name of favorite toys
• names objects or actions in a picture book
• imitates household tasks, such as cooking
• can match pairs of objects

When to Talk to Your Doctor

Every child develops at his or her own pace, but certain signs could indicate a delay in development. Talk to your doctor if your child:

• doesn’t walk
• doesn’t make eye contact or gesture to items of interest
• speaks fewer than five words
• doesn’t understand simple requests

Also, if you ever notice that your child has lost skills he or she once had or shows weakness on one side of the body, tell your doctor.

What Is Growth?

From the moment parents greet their newborn, they watch the baby’s progress eagerly, anticipating every inch of growth and each new developmental milestone along the way. But how can they tell if their child is growing properly?

Physical growth refers to the increases in height and weight and other body changes that happen as a child matures. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

What’s Normal?

The first year of life is a time of amazing change during which babies, on average, grow 10 inches (25 centimeters) in length and triple their birth weights.

Given all the growth that happens then, new parents might be surprised when their child doesn’t continue to grow so fast after the first year. But no child continues the rate of growth experienced during infancy. After age 1, a baby’s growth in length slows quite a bit. By age 2, growth in height usually continues at a fairly steady rate of about 2½ inches (6 centimeters) per year until adolescence.

No child grows at a perfectly steady rate throughout this period of childhood, though. Weeks or months of slightly slower growth alternate with mini “growth spurts” in most children. Kids actually tend to grow a bit faster in the spring than during other times of the year!

A major growth spurt happens at the time of puberty, usually between 8 to 13 years of age in girls and 10 to 15 years in boys. Puberty lasts about 2 to 5 years. This growth spurt is associated with sexual development, which includes the appearance of pubic and underarm hair, the growth and development of sex organs, and in girls, the start of menstruation.

By the time girls reach age 15 and boys reach age 16 or 17, the growth associated with puberty will have ended for most and they will have reached physical maturity.

At the Doctor’s Office

Beginning in infancy, kids will visit a doctor for regular checkups. During these, the doctor will record height and weight as they compare with that of other kids the same age on a growth chart. This valuable tool can help the doctor determine whether a child is growing at an appropriate rate or whether there might be problems.

What Parents Can Do

You can do a few things to help ensure that your child grows and develops normally. Critical to kids’ overall health and wellness are:

• Enough rest: Sleep patterns vary by age and individual child, but most kids need an average of 10 to 12 hours of sleep per night. Sleep gives growing bodies the rest they need to continue growing properly.
• Good nutrition: A balanced diet full of essential vitamins and minerals will help kids reach their full growth potential.
• Regular exercise: Because obesity is a problem for many kids, parents should make sure that their kids exercise regularly. Bicycling, hiking, in-line skating, sports, or any enjoyable activity that will motivate kids to get moving will promote good health and fitness and help them maintain a healthy weight.

Talking to Kids About Growth

Kids differ in growth and development during childhood — just like adults, some kids are taller or shorter. Generally, girls hit puberty earlier than boys, although some girls might lag behind their peers in breast development or getting their first period. All of this is usually normal.

Try to avoid comparing growth among siblings or other children. Drawing attention to height, for example, will only make kids feel self-conscious about their size. Encourage your kids to accept their own growth and development. Explain that some kids grow and develop at different rates — and late bloomers usually catch up eventually.

Kids have many questions about growth, from why their teeth fall out to difficult or potentially embarrassing topics like breast development or sweating. Answer questions honestly and even initiate conversations about growth to help kids understand the many changes they’re facing. This will help them accept the changes positively.

If you’re uncomfortable discussing these topics, your kids may think that this means there’s something shameful about the changes they go through and might be less likely to bring their concerns to you.

Kids who are short often face teasing by peers and may need help coping. You can help by supporting your child’s self-esteem. For example, although it might be difficult for a small boy to make the football team, focusing on alternatives, such as soccer or tennis, may make him feel better about himself and what he can do. A small teen might have concerns about dating, driving, and participating in sports. It’s important to try to understand your child’s feelings and to keep the lines of communication open.

Another way to boost your child’s mood is to encourage activities that don’t focus on height or weight. Special skills and individual qualities, such as musical talent or a love of literature, are things to be proud of, too.

If You Think There’s a Problem

Some parents worry about their child’s growth and development. So it can be reassuring to know that most kids who are short or delayed in development are healthy and normal. For example, shorter parents tend to have shorter children and not all kids develop at the same rate.

If you have concerns, the first step is to talk with your doctor, who can examine your child, ask questions about your family history and, if necessary, order tests to see if there’s a medical condition affecting growth. The doctor may monitor your child’s growth more often on a growth chart or refer your child to a pediatric endocrinologist (a doctor specializing in growth disorders) for further evaluation.

Your baby cries every evening for hours at a time, and the crying has worn you down to the point where you feel like joining in. What could be upsetting your child?

Newborns cry and get fussy sometimes. During the first 3 months of life, they cry more than any other time. But when a baby who is otherwise healthy has several periods a week of fussiness, high-pitched crying, and difficulty being comforted, it’s a sign of a condition called colic.

Colic is defined as crying for more than 3 hours a day, for more than 3 days a week, for at least 3 weeks. But doctors may diagnose a baby as having colic before that point. Colic usually doesn’t point to any health problems and eventually goes away on its own.

About Colic

It’s estimated that up to 40% of all infants have colic. It usually starts between the 3rd and 6th week after birth and ends by the time the baby is 3 to 4 months old. If the baby is still crying excessively after that, another health problem may be to blame.

Here are some key facts about colic:

• Colicky babies have a healthy sucking reflex and a good appetite and are otherwise healthy and growing well. Call your doctor if your baby isn’t feeding well, isn’t gaining weight, or doesn’t have a strong sucking reflex.
• Colicky babies may spit up from time to time just as non-colicky babies do. But if your baby is actually vomiting and/or losing weight, call the doctor. (Vomiting is a forceful throwing up of stomach contents through the mouth, whereas spitting up is an easy flow of stomach contents out of the mouth.) Vomiting repeatedly is not a sign of colic.
• Colicky babies typically have normal stools (poop). If your baby has diarrhea or blood in the stool, call your doctor.

What Causes Colic?

Doctors aren’t sure what causes colic. Cow’s milk intolerance has been suggested as a possible culprit, but doctors now believe that this is rarely the case. Breastfed babies get colic too; in these cases, dietary changes by the mother may help the colic to ease. Some breastfeeding women find that getting rid of caffeine in their diet helps, while others see improvements when they eliminate dairy, soy, egg, or wheat products.

Some colicky babies also have gas, but it’s not clear if the gas causes colic or if the babies develop gas as a result of swallowing too much air while crying.

Some theories suggest that colic happens when food moves too quickly through a baby’s digestive system or is incompletely digested. Other theories are that colic is due to a baby’s temperament, that some babies just take a little bit longer to get adjusted to the world, or that some have undiagnosed gastroesophageal reflux (GER). Other research suggests that colic may be an early form of migraine headache. It’s also been found that infants of mothers who smoke are more likely to have colic.

Treating Colic

No single treatment has been proven to make colic go away. But there are ways to make life easier for both you and your colicky baby.

First, if your baby is not hungry, don’t try to continue the feeding. Instead, try to console your little one — you won’t be “spoiling” the baby with your attention. You can also:

• Walk with your baby or sit in a rocking chair, trying various positions.
• Try burping your baby more often during feedings.
• Place your baby across your lap on his or her belly and rub your baby’s back.
• Put your baby in a swing or vibrating seat. The motion may have a soothing effect.
• Put your baby in an infant car seat in the back of the car and go for a ride. The vibration and movement of the car are often calming.
• Play music — some babies respond to sound as well as movement.
• Place your baby in the same room as a running clothes dryer, white noise machine, or vacuum — some infants find the constant low noise soothing.
• Some babies need decreased stimulation. Babies 2 months and younger may do well swaddled in a darkened room.

Caring for a colicky baby can be extremely frustrating, so be sure to take care of yourself, too. Don’t blame yourself or your baby for the constant crying — colic is nobody’s fault. Try to relax, and remember that your baby will eventually outgrow this phase.

In the meantime, if you need a break from your baby’s crying, take one. Friends and relatives are often happy to watch your baby when you need some time to yourself. If no one is immediately available, it’s OK to put the baby down in the crib and take a break before making another attempt at soothing your little one. If at any time you feel like you might hurt yourself or the baby, put the baby down in the crib and call for help immediately. Never shake a baby.

If your baby has a temperature of 100.4°F (38°C) or higher, is crying for more than 2 hours at a time, is inconsolable, isn’t feeding well, has diarrhea or persistent vomiting, or is less awake or alert than usual, call your doctor right away. Also call your doctor if you’re unsure whether your baby’s crying is colic or a symptom of another illness.