Amanda Wilde (Host): This is Children's Health Checkup, where we answer parents most common questions about raising healthy and happy kids. Puberty is a time of consequential change, as a child's body transitions to an adult body. One of the most significant events of puberty is the onset of menstruation. On this episode, we talk about preparing your child for their period with Dr.

Mei Lau, Adolescent Medicine Specialist at Children's Health and Associate Professor at UT Southwestern. I'm Amanda Wild and welcome to the podcast, Dr. Lau.

Dr May Lau: Thank you for inviting me.

Amanda Wilde (Host): the age at which a child starts her period has been getting earlier and earlier, hasn't it? I mean when do most girls get their first period?

Dr May Lau: So what I usually tell parents is the average age of when someone starts their period, it's around 12, 12 and a half years. and, there was a recent study that showed that over time from the 1950s to The average age of menarche decreased from 12. 2 years to 11. 9 years. very minor, and I don't think parents need to worry about it.

Amanda Wilde (Host): Yeah, I kind of thought of this as a trending thing over a few years that maybe environmental factors were involved. What does cause an early or late first period?

Dr May Lau: So, possible causes for an early period include A stressful family environment, such as, you know, being in foster care or living with a stiff parent. But that does not mean it is always a cause. Other causes for an early menarche. are diet. So those with a higher, weight can lead to menarche.

And those who eat more sugar sweetened beverages, for example, may also start their period earlier.

Amanda Wilde (Host): And should that be a cause for concern?

Dr May Lau: Well, it really depends on family genetics and when someone started development. So in my clinic, I do see some adolescents who have started periods, late nine years old or started periods at 10. However, if they're otherwise healthy and developing normally, it is not a big worry.

Amanda Wilde (Host): And what about the other side, kids who have their period later than what is average?

Dr May Lau: So pediatricians normally don't get concerned, unless. An adolescent not started their period by 15 years old. Then we need to think about, is there a cause for that? So, does someone have an endocrine problem that we can cause in a double A period? Other causes of people not starting their periods by 15 years old could be a chronic illness.

Sometimes, an adolescent is an athlete and they're involved in a lot of different sports and so that could be a cause of someone not starting their period at 15 years old. A poor nutritional status. Someone who has, anatomical reason for someone not to have their period can also be a reason.

And sometimes it's just family genetics, where everybody in the family just starts their period a little bit later than what is normally expected.

Amanda Wilde (Host): So while that can be very individual, are there general signs that a child is about to start her first period?

Dr May Lau: Yes. So, what I tell parents is, once their child starts developing breasts, It takes about two to three years before periods will start. That's approximately. some youths will start their period in one and a half years. Some people will start their period in about three and a half years. But generally, after breast development, menses start about two to three years later.

Another sign could be pubic hair development, because that usually occurs after breast development. And. Periods start usually about one to two years after pubic hair development. Another way for parents to have an idea whether or not their child is going to start their period, is there's a point in time where their child feels like they're growing faster than their age.

So really six months after that, their child may start their period. Other potential signs include the development of acne, sometimes mood swings, having a little bit of vaginal discharge, or even, some abdominal cramping.

Amanda Wilde (Host): With all of the signs you mentioned that. menstruation is probably coming on, and with 12 being the average age when a child begins to menstruate, when should parents begin talking to their child about periods?

Is there an appropriate age or stage of development to look for?

Dr May Lau: think it's important that parents talk to their child about how their bodies work. when they're young. And puberty conversations can really start around eight years old when some of those changes start to occur, such as body odor, pubic hair development or underarm hair development.

And it, you know, of course depends on the maturity level and understanding of the child. And these conversations are best at home because sometimes Youth will hear what their friends say at school and they may get confused or the information may not be correct. And I think it's important that parents, answer all their questions clearly, factually, and using proper words and correct terminology.

You know, we don't want parents using euphemisms or another word to describe a body part because that could lead to misunderstanding. And I think it's important that boys know how bodies work, and how girl's bodies work. Because it's important for them to understand that this is just a normal part of human development. 

Amanda Wilde (Host): What suggestions might you have as to what parents should say or do to prepare their child for their first period and

Dr May Lau: I think one of the most important things that a parent can do is actually reassure your child that periods are totally normal and that it's a normal part of human development and part of. their body maturing. Another thing that parents can do is actually have their child become familiar with the different period hygiene products such as menstrual pads, tampons, period underwear, and menstrual cups. In order to prepare them for their first period, some parents may want to purchase these menstrual kits, which do contain the menstrual pads, the panty liners, some period underwear, and these can be purchased online or at stores. However, parents can also create their own kit. using a small makeup or storage bag and then put in a mix of pads from different sizes and styles, some tampons, panty liners, period underwear if their child is interested in or regular underwear.

And one of the things parents should tell their child that, you know, no matter how prepared the parent is or the child is, The day that the first period occurs, it can still be a surprise.

Amanda Wilde (Host): very emotional?

Dr May Lau: It can be very emotional because I think some youth may feel like that they're dying when they actually see the red blood on their underwear. And, having maybe a trusted teacher or counselor or nurse that they can go to, to talk about it may also be helpful.

Amanda Wilde (Host): Yeah, it can be a shock. Of all the products you just mentioned. Are there ones you think are best when they start their period? Mm

Dr May Lau: some of the youth may want to use menstrual pads with wings Since these help the PAD stay in place for those really active teenagers. And there is the thought that thicker pads mean they're more absorbent, however with this advanced technology that we have, thin pads can absorb as much blood as thicker pads, and they're definitely more comfortable and less bulky.

There are some pads that are especially made for smaller teens, however most teens don't need these special teen pads. And If a youth decides to use tampons, they should really use the thin or regular tampons. many youth, when they start having their period, may not want to use tampons, and it may take a few years before they're comfortable.

However, if they're in a sport, that may encourage tampon use, such as swimming. I've had patients come into my office because they're runners and when they're running very fast, they've actually lost their menstrual pad on the track field. And so we've educated them on how to use tampons.

Amanda Wilde (Host): so those are all options, but I think you're saying start with the kind of least invasive techniques to get used to this whole change. you have your period and you're just beginning to have your period, And not just the first one, but the first several, how can you tell the difference between a normal versus an abnormal period?

Mm hmm.

Dr May Lau: So, when an adolescent starts having their period, periods can be slightly irregular, where they may skip a month or two. And that's actually normal within the first two to three years. But, a normal period are ones that occur every month. Changing a pad every 3 4 hours and lasts less than 8 days. Abnormal periods are periods that are infrequent, and usually when I think about infrequent periods or skipping periods, it's after that, second or third year.

However, if they haven't had a period in 3 months, then I start getting worried. Another sign of an abnormal period is someone who's having frequent periods, where they're actually having periods twice a month. Or, if they're changing a pad every hour, periods that are lasting more than one week, they're having accidents where they're bleeding so much, they're having accidents and bleeding on their clothes, or they may have blood clots that are bigger than a quarter, or actually needing to double up pads in order to soak up all the blood.

Those are signs. And in order to help determine are your periods normal or regular or abnormal. I recommend that my patients, my adolescent patients, keep track of their periods. Not the parents, but the teenagers themselves keep track of their periods, such as a calendar or an app if a child has a phone.

Amanda Wilde (Host): Once a child starts having periods, is it then recommended they should see their doctor at that point to be checked out, or only if the periods are abnormal?

Dr May Lau: During their checkup, pediatricians normally ask about their periods because if they're having abnormal period, then that's a sign they may need to be referred. However, if a parent has a concern about their period, I think it'd be worthwhile to go to talk to their pediatrician about their child's period so that the pediatrician can determine whether or not The period is normal or abnormal. I do want to also mention something about menstrual cramps. So, if menstrual cramps are debilitating, where an adolescent is bent over in pain, is actually missing school because of cramps, or it's interfering with their ability to participate in sports or activities, They definitely need to see a physician, a pediatrician, to see if there's anything abnormal or is there something that the pediatrician can provide to them with the cramps.

So things that parents can do are ibuprofen, they can take ibuprofen, they can use heating pads. Another thing that I think parents need to know is that for athletic adolescents, there's actually swimwear that, adolescents can wear when they're wearing their period.

So if they're not comfortable using a tampon, they can still participate in swimming by wearing period swimwear

Amanda Wilde (Host): For children who are gender diverse, such as non binary or transgender, are there any special considerations we should keep in mind when having conversations with those kids?

Dr May Lau: So many of these youth actually dread any of the body changes and especially their first period. So Periods can be really distressing for these youth. So parents may want to talk to their pediatrician or if their adolescent is seeing a mental health specialist, talk to them about it so they can determine how to support the adolescent. 

Amanda Wilde (Host): What are some other tips you have to help parents support their child who is entering the phase of puberty?

Dr May Lau: A couple other things I do want to add. If their adolescent wants to use tampons, adolescents may need to be educated about how to use them. So if a parent does not know how to use a tampon, they can always see their pediatrician. In our office, we actually provide tampon teaching to our adolescents so that they feel comfortable using tampons. Adolescents should not wear tampons for more than eight hours or overnight since that may increase the risk of toxic shock syndrome, which is a bacterial infection

And so, if an adolescent is going to use a tampon, they should use the lowest absorbency tampon to reduce that risk. So, menstrual hygiene products can be expensive. There is an organization called Period Access Dallas. where free menstrual products can be obtained at libraries, community, and recreation centers. There are also many books that can teach youth about periods, and their parents can obtain these books from the library.

They can also get recommendations from their pediatrician.

Amanda Wilde (Host): This conversation has been so enlightening because of the specific details and actual actions and resources. parents can take. So, thank you so much, Dr. Lau, for giving us the facts about menstruation and how we can best support our kids through the process.

Dr May Lau: Thank you again for inviting me.

Amanda Wilde (Host: For more information on how to discuss puberty with kids, visit Childrens. com slash

AYA.

Amanda Wilde (Host): Thank you for listening to Children's Health Checkup. if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels.