Deborah Howell (Host): Welcome to the Peds Pod by Le BonHeur Children's Hospital. I'm your host, Deborah Howell, bringing you another insightful episode, diving into the world of pediatric health. Today we're joined by Dr. Grace Nelson, an esteemed Endocrinologist from Le BonHeur Children's Hospital.

Dr. Nelson will be guiding us through the intricacies of puberty, discussing milestones, the range of what to expect, and how parents can navigate these transformative years in their child's life. Welcome, Dr. Nelson. 

Grace Nelson, MD: Thank you for having me.

Host: So glad to have you with us. So let's dive right in. Could you explain to us what exactly puberty is?

Grace Nelson, MD: Yes. So puberty in the most, scientific or sort of simplest of terms is the transition from immature individuals into reproductively mature individuals. So once you are finished with puberty, you are able to reproduce and make offspring. 

Host: At what age should parents typically expect their children to start experiencing puberty?  

Grace Nelson, MD: Between the ages of 8 to 13, we expect girls to start puberty. Boys, it's a little older, 9 to 14. And that, kind of helps, that's part of the reason why middle school boys tend to be a little shorter and the girls tend to be a little taller. 

Host: And what are some of the key milestones during puberty that parents should be aware of?

Grace Nelson, MD: So I think some of the key milestones would be like the very start of puberty. So for girls, that's going to be breast development. And so the need to start wearing a bra, especially under those t-shirts can be the very start of puberty. And so if that's happening in a girl less than eight, that would be early. But that would be kind of the beginning signs. For boys, the beginning sign is actually testicle enlargement. And so chances are that's not something parents are going to notice, but it's something that the pediatrician should be keeping tabs on, on annual visits. 

Host: Got it. Now, can you tell us about the physical changes that occur during puberty?  

Grace Nelson, MD: Yes, so with girls, like I said, the first thing that is going to start is breast development and then followed shortly by hair and like pubic hair. And so that's really hair in your pubic area and under your arms. I have some parents who, and that's true for boys and girls is, and then boys, it's the testicular enlargement and then the pubic hair.

I have parents that will get concerned about leg hair getting darker or back hair getting darker. Just body hair. All of us have different types of hair, different colors of hair. That's not related to puberty. That's just what your hair follicles look like.

Host: Okay, got it. That's natural and normal. In addition to physical changes, what psychological shifts might children experience during this time? 

Grace Nelson, MD: Potentially a lot of them. There's all those hormones, the estrogen and testosterone, they really do have effects on our brain and they're really important for our brain maturation. But those rapid changes in hormones can definitely make us feel emotions a lot stronger. And then combined with that age and getting more independence, they go hand in hand. And so there definitely can be some turmoil as teenagers or at least, almost teenagers are starting to really develop their independence and so that can be stressful for the parent-child relationship. 

Host: How common is it for children to experience delayed or early puberty? And should parents be concerned about that?

Grace Nelson, MD: So, it's funny because I did look this statistic up because it feels very common in our clinic. It is one of the most common things we see, as far as like endocrine things. That's one of the reasons kids get sent to see a pediatric endocrinologist. About 1 percent of the population will have early puberty and about 3 percent will have delayed puberty.

So it's not totally uncommon. It feels much more common in my office, though. And parents if your child, if they're a girl and they're having breast development before they turn eight, or if a boy is having testicular changes before nine, they should get evaluated.

There are sort of variations of normal and it does not necessarily mean that they're going to need medication or that they're going to rapidly advance through puberty or need anything in particular, but it should be evaluated. And I think talking to your primary doctor, early is very important, so that you can get evaluated.

Host: Let me drill down a little further on that. What are some of the signs indicating that a parent should consult with a pediatrician about their child's early or late onset of puberty? 

Grace Nelson, MD: It's really those changes. So breast tissue for girls, testicular changes for boys, but a lot of parents will also notice that hair, which is not exactly the same thing as true puberty. Some people develop that pubic hair in a slightly different timing, and it doesn't mean that they're developing other changes of puberty, but any of those signs, before the age of eight or nine should be evaluated and should be brought up to the pediatrician if they don't notice it themselves. Because it can be kind of nothing, if you will, just like a variation of normal, but we definitely want to look at it.

Host: Let's switch gears just a little bit. And I'm going to ask you, are there lifestyle changes that can ease the puberty transition for kids? 

Grace Nelson, MD: A very interesting question. I think physical activity is really important for a couple different reasons. Being physically active in sort of the right amount is going to be important, right? Because if you're too underweight and in some cases may even say too physically active, that can delay the onset of puberty.

But if you're very sedentary and are carrying too much weight, that, that may push you to earlier puberty, depending. And so the right amount of physical activity can be really important. But as far as like easing the transition of puberty and lifestyle changes, I mean, I think having kids as much of an enriched life beyond school and the right balance of extracurriculars and things so that kids feel supported and belonging, because during puberty you can just sort of lose that feeling of support and belonging as so many changes are happening.

Host: I'm telling you, girls sports just saved my life during those days.

Grace Nelson, MD: Right, right. Yeah, me too.

Host: The whole team thing is just so important. Or even an individual sport with good coaching can provide the same kind of outlet. So how can parents support their children emotionally during puberty?

Grace Nelson, MD: I think making sure to talk with your kids about expected changes and as a medical doctor, I spend more time talking about like the physical and physiological changes that are happening; but I think that does relate to the emotionality of it because making sure that kids feel comfortable coming to their parents for body changes or things that are happening, whether it's the acne that they're getting that is affecting like how they're feeling at their self confidence at school. I think there's lots of different books that are geared for the kids as well as the parents. And I think those can be some really good resources. I think making sure that kids have resources as well of leaving around books that are age appropriate and explaining like what's happening. Most of those books also talk about that they're going to feel different and, relating it back to the physical part. 

Host: And what role, if any, does diet play in the onset and progression of puberty?  

Grace Nelson, MD: If you're not getting enough calories, you're not going to get through puberty. And so that can be a reason for delayed puberty, not enough calories for kind of any reason really, or not enough absorbed calories in the case of like a GI disease. Obesity can increase the chance of early puberty in girls, especially, and so that can play a role in that aspect.

Host: Okay, and also girls who are athletes and just go, go, go all day long and just forget to eat along the way. That can be problematic.

Grace Nelson, MD: Exactly. Like, whether they're truly restricting or just they are so busy and burning so many calories and it's just hard to get enough in.

Host: That's right. Now, let's discuss any myths about puberty that you'd like to debunk.  

Grace Nelson, MD: I don't know if this is a myth, but I definitely have lots of parents that come to me and are panicked that their daughter has breast tissue, because they're concerned her period is going to start like the next day. And from the start of breast tissue till the onset of periods is typically is about two years, give or take a few months.

I mean, it may be like 18 months, it may be two and a half or three years. But it's not immediate, and I think, people get really worried the moment they see any change, that's it. For boys, I don't have that same kind of like parents don't come in with the same kind of concern, per se. But I think the other thing is the knowing that girls have their growth spurt in the first bit of puberty and boys have it in the second bit of puberty may help with some of the concerns about the growth patterns during puberty that people can also get worried about. 

Host: I have just a couple more for you, Dr. Nelson. First, how do endocrinologists like yourself address mental health concerns related to puberty?  

Grace Nelson, MD: That's a great question and a really important one. I think we try to talk very openly with our patients about what they're seeing and experiencing and if we're seeing a young kid going through early puberty, we still try to really talk to them about what they're feeling and how they're feeling, to address them where they're at. If we need to refer them to a therapist of any kind for other reasons, we always are tuned into that. And then we have, lots of resources. When we need to treat them for early puberty or late puberty, lots of those medications and things, there's lots of resources that come with them as far as understanding the process. And then just screening if we need to for depression and anxiety and getting them to the right people.

Host: You mentioned some books. Are there any resources you'd recommend for parents wanting to learn more about puberty?  

Grace Nelson, MD: Yeah, so I think my best list of resources at this point are the Pediatric Endocrine Society. There's a link on there that's for patients and parents and they have things about normal puberty, early, late. The AAP website also has a wonderful called healthychildren.org that talks about what to expect during puberty.

And the CDC has some really good positive parenting tips for young teens that, kind of goes into that puberty and parenting interactions has some really good.

Host: Okay, great. Anything else you'd like to add to our conversation?

Grace Nelson, MD: The only thing is just, if you have questions about your kid's development and growth, talk to your pediatrician. They're a wonderful resource. They've been watching your child grow and they can really be the first line to reach out to us if they're worried there's a concern and we can go from there.

Host: Sure. Sounds good. Well, for our listeners, remember that understanding these changes can not only ease the transition for your child, but also strengthen your relationship through these transformative years. It's been fascinating.

Grace Nelson, MD: Thank you so much for having me. This has been fun.

Host: Thank you, Dr. Nelson, for sharing your expertise and insights into the sometimes bewildering experience of puberty. It's been fascinating. For our listeners, remember that understanding these changes can not only ease the transition for your child, but also strengthen your relationship through these transformative years. Don't forget to visit Le BonHeur Children's Hospital's website for more resources and information.

Until next time, this has been Deborah Howell on the Peds Pod, where we care for kids.