​Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm your host, Caitlin Whyte. And today we are discussing staying physically and mentally healthy during puberty with pediatrician Dr. Kristen Lagor.

Well, to kick off our conversation today, Doctor, can you please define puberty?

Kristen Lagor, MD: Sure. So puberty is defined as sexual maturation and it has both a physical and an emotional component to development. It happens actually at slightly different ages in girls and boys. So girls start a little bit earlier, somewhere between the age of 8 and 13, and boys start a little bit later, somewhere between the age of 10 and 14, and it usually lasts about 4 years in total.

Host: And how can we take care of our physical health during puberty? How can we help those young people around us?

Kristen Lagor, MD: So there's actually a lot of different components to physical health during puberty, and some of them are common with physical health that we would have at any age. But we'll kind of run through some of those components. I'm going to touch on probably four or five things that I would say are important during puberty.

Of course, the number one thing I would say is nutrition. So these kids might be growing four or even five inches in a year, for a couple of those years during puberty, whereas earlier in childhood, they may pick up only two inches a year. So because of that rapid growth, their bones are expanding and they have an important need for calcium and vitamin D.

So it's really important that they're getting calcium and vitamin D daily. They also have an increased calorie need, so it's really important that they're eating good, protein rich meals and snacks, and trying to stay away from too much of the extra sugar and carbs that are just spiking their energy high and dropping it way down; things that we should all be doing anyway. Water intake is really important. During adolescence, it's really common for them to develop that, lightheadedness when they stand too quickly and things like that. We see that all the time in our teenagers and the first thing we tell them is, you know, did you refill your water bottle during the school day?

And most of them didn't even make it through one water bottle. So that's an easy thing that they can do to really help their physical health. So, calcium, protein, hydration. Those are the biggest parts of their nutrition.

There are several other important things to stay physically healthy. Sleep, which is important for all of us. You know, the National Institute of Health recommends that, that school-aged kids get 9-12 hours, but teenagers can get by on 8-10 hours, but they really do need those hours of sleep. One of the problems really comes in because, of course, teenagers like to stay up later, they like to wake up later. But then high school rolls around and they've got to get out of bed at 6:30 to make it to school on time. So they're not getting those hours that they need, so it's really important to try to have a regular bedtime during the school year so that they're getting enough sleep so that they can function during the school day.

Another important component to physical health would be exercise. You know, we're all trying to get those five, six days a week of exercise in and teenagers are no different. They need that same physical movement that everybody does. It can be a little tricky to schedule that into their day. So one of the suggestions I usually have for my patients is pick a sport, pick a dance team or an activity that seems interesting to you and join just a recreational group and that will schedule it into your day. You'll be able to spend time with peers and friends. And it's a lot easier than trying to get motivated to get off the couch and go outside and jog five miles. So that's something that I think is really important, getting that regular exercise in.

Of course, if we're talking about puberty and body changes, we're talking about these kids starting to get acne and body odor, and hygiene is a really important factor in their physical health too. So regular showers, washing their face, using deodorant, and for girls becoming familiar with menstrual products and what they may need when they do start getting their menstrual cycle.

One more thing that I can mention for physical health would be safety. As a pediatrician, we talk about safety all day long. In teenagers, it's no different. So some of the things that will come up would be, using seatbelts regularly. They're going to be getting a lot more rides with friends to practices and games and different things. So we want to make sure they're using their seatbelt regularly.

Also, they're going to be involved in some of these different sports and activities. We want to make sure they're wearing their helmets when they're riding their bikes, when they're playing hockey, when they're playing football. We want to make sure that those helmets are properly fitting to avoid things like serious head injuries, concussions, things like that.

Along the lines of safety, drugs and alcohol are going to come up. And so it's important that kids know what's out there, how it can affect their body, the dangers, how they can avoid it, and also to make sure that they know to never ride in a vehicle with somebody that has been under the influence of one of those substances. So those are some of the components of maintaining that physical health during puberty.

Host: Absolutely, well that is a really great list with some stuff that even I forgot myself, so thank you for those reminders. Now of course when we're talking about puberty, many will remember this is a mentally strenuous time for many. So what are some tips for staying mentally healthy during this time?

Kristen Lagor, MD: Of course, there's all sorts of hormonal changes, so, emotions can be running high and changing quite a bit during this time. And girls also starting puberty earlier than boys may be experiencing growth spurts before boys in their class. So you may have a four foot 10 kid in the same class with a six foot kid in sixth grade and both kids are totally normal.

But when they're right next to each other and comparing each other; and then you've got social media comparing them, it might make them start to question, “Hey, you know, what's wrong with me? Why didn't I grow yet? Or why did I grow six feet tall?” And so that can create some stress for both the kid that's gone through the changes earlier, and the kid who hasn't gone through the changes yet. And so, it's important to have open conversations with kids about their body, about how they're feeling about themselves, and what's normal, what's not normal. And having regular checkups with their pediatrician and talking to their parents about what they're experiencing are ways that we can kind of identify some of those emotions that they're feeling when there is that discrepancy between what one kid in sixth grade is experiencing, which is completely different than what the other one is.

I did touch on some of the proactive ways to kind of identify some of those things early, and that would be having that annual checkup with your pediatrician. Sometimes it's something that can slip through the cracks. We may forget about scheduling that annual checkup when nobody's asking us for a physical form or a sports form or things like that, but it's important to schedule a regular checkup so that their growth and development can be monitored.

And if they are outside of the normal range in terms of development or growth, the pediatrician can identify that early and help troubleshoot. It's also important for parents to have regular conversations with their kids about how they're feeling and if there is any hint of any mental health concern, seeking mental health help early.

I think most teens, and frankly most people, could probably benefit from a counselor at least at some point during their lives. And so getting that foot in the door early and just having that neutral trusted adult that they can talk freely to about how they're feeling, what their emotions are, I think is really important for teens and adolescents.

Host: Well, let's also talk about that screen time and the internet. How does that affect teen mental health?

Kristen Lagor, MD: Of course, there's no getting around screen time. It's a part of our daily lives, you know, everything we do, even schoolwork, the kids do all their classes on the tablets now. So, it's not going anywhere. In high school, a lot of the high schools will announce their clubs and meeting times on X or Instagram or even Snapchat.

So you can say, oh, we're going to stay totally away from screens, but reality is we're not. They're here to stay. So one of the things that the American Academy of Pediatrics touches on is when is an appropriate time to get a kid a smartphone. And they don't give a specific age. They talk more about maturity rather than a specific age.

And some of the things that parents can think about when they're making that big decision would be, how does my kid handle their responsibilities? For example, are they getting their homework done? Are they keeping their room clean? Are they responsible enough to handle something like a smartphone? Do they have the emotional maturity? Are they showing empathy for their friends, so they could handle things that came up with posts on the internet or things like that. Do they have an adult that's willing to supervise and monitor that screen time? And so these are just a few of the things that the American Academy of Pediatrics says parents should consider when they're deciding what age is the best one to introduce that smartphone.

Once the kid has it, then they need to have some guidelines on what's appropriate use, what are the parental controls in terms of websites they can go to, what social media are they allowed to join or access, and the time that they spend on it is probably the most important thing.

There's a lot of evidence out there that even an hour a day more can have negative impacts on a child's self-esteem. There have been studies that have shown that just that extra hour a day will increase rates of things like anxiety and depression and low self-esteem. So, it's an important thing to be aware of.

But like I said, there's no getting around using the screen because you've got to do it for homework and clubs and different things, but just kind of being aware of that and coming to some compromises on the time that they're using it and how they're using it.

Host: Absolutely, I mean that's something myself as a fully grown adult has to think about all the time as well, too.

Kristen Lagor, MD: Of course, it's easy to sit down there for a second and just, you know, oh, you're scrolling through something and before you know it, an hour's gone by.

Host: Exactly, exactly, oh my gosh. Well, you mentioned anxiety and depression in your last answer, and that brings me to my next question. What are some signs of anxiety and depression that parents can watch out for in their kids?

Kristen Lagor, MD: Sure. Well, there's the obvious things like crying for no reason or crying frequently, panic attacks, or expressing worries about things, but there's more subtle things that parents can look out for. Like, you know, were they a straight A student and now they're a B, C student or even an F student in terms of their grades?

Were they previously hanging out with their friends every weekend, and now they don't want to call or text or set up anything with their friends. Were they eating regular meals before, and now they're either overeating or undereating? Were they having good sleeping habits before and now they're either having trouble falling asleep or having trouble getting out of bed?

So changes in all these things, grades, eating habits, sleep, socialization, and interest in some of their favorite hobbies and activities, can be little clues that parents can look at that something might be going on that they need to figure out and kind of have a conversation about.

Host: Well, if parents are noticing some of those signs you mentioned, when should they seek out a doctor for extra help?

Kristen Lagor, MD: So it's a good idea anytime a parent notices that those things are changing in terms of their grades are dropping without a good explanation, they're suddenly not turning in their work, they are losing weight because they're not eating regular meals or they're gaining an excessive amount of weight because they're not eating nutritious meals.

Anytime they notice any change in their growth that seems out of the norm, they seem like their growth in terms of height and weight are not as expected, they should schedule with their pediatrician. If they see signs of puberty that are earlier or later than expected, they should seek out the pediatrician's guidance on that. If they notice subtle changes in mood that seem out of character, excessive anger or excessive conflict with family or friends, they should definitely schedule to talk this over with their pediatrician.

Anything that just seems out of character or out of the norm is probably a good clue to maybe schedule to at least have a conversation with the pediatrician, which is always a good starting point in terms of evaluation and whatever further management or treatment might be needed.

Host: And to close out our episode today, Doctor, what are some more resources we can give our parents listening right now?

Kristen Lagor, MD: There are a lot of good websites out there. Internet can be tricky, but there are also a lot of good resources at our fingertips. One put out by the American Academy of Pediatrics is HealthyChildren.org. And I love this site because they've got a lot of articles and a lot of common question and answer topics for parents. And they've got several surrounding puberty that would be a good resource.

There's a similarly good website called KidsHealth.org, and a couple of others would be the American Academy of Pediatrics, the National Institute of Child Health and Human Development, and finally, a local one for us would be BayCare Kids On Our Sleeves (BayCareKidsOnOurSleeves.org). And that is a campaign that BayCare has developed to showcase some community resources specific to West Central Florida and things that parents can access to help them with mental health resources in the area.

Host: A lot of great information for a tough time in our kids' lives. Thank you so much, Doctor. And that wraps up this episode of BayCare HealthChat.

Head on over to our website at BayCare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share it on your social media and be sure to check out all the other interesting podcasts in our library.

I'm Caitlin Whyte.