Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today to highlight changes in puberty is Dr. Chandrika Sridharamurthy. She's an instructor in Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center.

Dr. Sridharamurthy, thank you so much for joining us today. So, I'd like you to start by telling parents what's considered the start of puberty. What happens to the body when a child starts this whole period of their life?

Chandrika Sridharamurthy, MD: Yes, absolutely. Hi, Melanie. Thanks for having me today. This topic is an important one for parents and children. I think it's great that we're discussing the topic today because the more we talk about it in a safe manner and an educational manner, the easier it will be for parents to talk about it with their children and for kids to ask questions without any anxiety or concerns.

So when a child goes through puberty, there are many changes that occur, both physical and emotional/psychological changes. If we're focusing on the physical, the bodily aspects for girls, girls begin puberty around the ages of eight to 13. So, there's a big range. The earliest sign of puberty in most girls is the development of breast budding. So, that's like the bumps under the nipple. It's a common to have tenderness or soreness in that area. And that might be sort of the first sign that they come to you with as a parent or as the pediatrician.

Body hair is one of the other things that happens, right? So, coarser and darker hair begins to grow under the arms, on the legs, in the private areas. So, this is sort of the next step. In some girls actually, they can get that hair growth first, and then they can have the breast development. But most girls, the breast development starts first.

And then lastly, of course, is the beginning of menstruation. So, having your period, right? Most girls get their period within two to three years after the development of breast budding. And so, the average age for girls to get their first period in the US at least is around age 12.

And then, of course, boys go through changes as well, right? So, for boys, the changes are increase in size of their genitalia. There's the development of pubic hair, changing body shape. They'll have a growth spurt, so they'll get a lot taller and the changes in the voice, so a deeper voice, a less high pitched voice. These are kind of common changes.

So, there's a lot of changes in the body for both girls and boys. And, you know, when you're talking to your child about it as a parent, just emphasizing that it's normal, it's a normal part of growing up and it's different in all girls and all boys. It can be different in terms of timing. But you know, just let them know it's normal and expected.

Melanie Cole, MS: Well, thank you for saying that. And I remember with both my kids, it's a pretty exciting time. It's so interesting to watch the kids as they realize their developments and they notice their developments, which sometimes they don't notice so much about their bodies. But when we're talking about them noticing, one of the things I noticed with my son, personal hygiene, specifically my son, not so much my daughter, but we need to share this with our kids and we want to do it gently and not be harsh and be like, "Whoa, dude." So, how do we talk to them about the personal hygiene aspect of it as they're starting to grow hair and things are starting to change hormonally, and so are the smells?

Chandrika Sridharamurthy, MD: Yeah, absolutely. Great question, because we just talked about all the bodily changes and along with that comes some other interesting changes, especially the smells. And when we're talking about the smells, during puberty, sweat glands become more active than before. And they also secrete different chemicals in the sweat, so that's why it has that stronger smelling odor. And during this time, the child definitely notices, but of course people around them may notice as well, that odor under the arms and it can extend actually even to like the feet and the private areas where these smells are. So really, kind of encouraging your child to keep clean in the sense of bathing every day, that's going to make them feel cleaner as well. Using mild soap, warm water, that helps wash away the bacteria that contribute to those odors. And then, of course, just wearing clean clothes, that might help them, right? Laundered clothes every day, socks, underwear that are clean that can help kind of get rid of these smells.

If an adolescent is sweating a lot, they might find that certain materials work better to absorb the sweat. So, like, cotton is better, cotton underwear, cotton T-shirts, that kind of stuff. And then, other natural materials too, but cotton generally is the most common. And then, of course, if their underarms smell, we can encourage them to use deodorant. And then, antiperspirant is the other option, of course. It actually does decrease the amount of sweating, especially under the arms. So, that might be helpful.

And then, the other thing that happens of course with bodily changes is the body hair. And so, kids might come to their parents or their friends and, say, be uncomfortable about that. So, give them reassurance that it's normal, that they can have body hair in new places. And they may ask about shaving and getting rid of the body hair. And of course, that's not necessarily medically indicated or recommended, but allowing them the space to either do so in a safe way or if they feel comfortable leaving the hair where it is, that's fine too. So just as a parent, you can help them navigate these decisions.

Melanie Cole, MS: I remember the shaving discussions with both kids, with a boy and a girl, and that's kind of a sweet time. I think all of this is sweet in my opinion. Now, when do we first take our daughters to the gynecologist and what age do we start to discuss menstruation? Because that's something that can be scary for little girls to think about. And we know as adults it's something that you can't do nothing about, and it lasts until it doesn't. So, how do we talk to her about it, or do we let the gynecologist do that?

Chandrika Sridharamurthy, MD: Yeah. That's a great question. And as a pediatrician, it's actually a common question that I get in the office from parents of girls and pre teens and teens. As a pediatrician, I'm actually trained to discuss the bodily changes in puberty and perform like a general examination until adulthood. However, if there are special considerations, questions, concerns, for example, if a girl is having maybe delayed onset of puberty, you know, it's been a few years and it's delayed onset, or if she's having her periods, but it's irregular or heavy or painful or if she wants to talk about certain things like birth control, those are many of the reasons to actually start seeing a gynecologist and your pediatrician can refer you to one or you can certainly find one on your own as a parent for your child.

The American College of Obstetricians and Gynecologists recommends that girls first see a gynecologist between the ages of 13 and 15. And one of the questions I get is what kind of exam will they do? Are they going to do a pelvic exam during this visit? And that is not the case. Most gynecologists in the beginning, of course, will just do a regular health exam and talk to a girl about her development.

When it comes to talking about periods, I think, around the time that you start seeing the development in your child and in your daughter, especially if it's the breast budding as we talked about, you can get your period about two to three years after that. That is probably a good time, if not earlier, to talk about those things that may be coming sort of down the line, and this is how to be prepared for it, just kind of talking to them about that. Of course, you can bring your pediatrician in on those discussions, right? Because a pediatrician is going to do an examination and discuss these changes. So, that may be nice way to bring that conversation in.

Melanie Cole, MS: Now, as long as we're talking about visiting our pediatrician and gynecologist, what's different as the kids are going into puberty? I remember my kids filled out a questionnaire that they didn't when they were little. What's different with the well visits as they age?

Chandrika Sridharamurthy, MD: Yeah, that's a great question. So, things do change, you know, when you go to your pediatrician visits as the kids get older. First of all, of course, there's a myriad of physical and emotional changes. So, just having that general discussion at those yearly visits, that can help demystify those changes. And pediatricians just in general can serve as a support system for parents to have to field a lot of these like important questions and questions about changes from their teens.

During these visits, we'll discuss changes in the body. So as a pediatrician, I'll always offer a chance for the adolescent or the preteen to ask questions about the changes. The child certainly can ask questions about what's normal, what's not normal, we'll talk about that, what's again coming down the line. For example, if we're starting puberty, what could they expect in the next couple of years in terms of changes in their body?

And then in terms of sort of emotional changes, mental changes, that we'll talk about as well, right? We'll talk about school and your peers and how you're feeling, right? Mood changes, those kinds of things. And there are standard questionnaires that pediatricians offices will give to teens to fill out on their own so that we can assess for some of these potential mental health issues that may come about in a teen, right? So anxiety, depression, et cetera.

Melanie Cole, MS: And it's really important for the kids to have that private time, right? As parents, we have to step out of the room if that's what's needed at the time. I mean, it's not like we stand in there for all of these as they're starting to go through puberty because, I mean, I was lucky enough my daughter said stay at her first gyne visit. And so, I was able to stay and it made me all kind of weepy and, you know, gave me all the feels. But I do know that some kids are going to be like not want to discuss certain things if their parents are there.

Chandrika Sridharamurthy, MD: Exactly. Yeah. I mean, it's true because as children go into their teen years, you know, there's actually a couple of statistics out there that a lot of times, teenagers don't really want to go to the doctor. They avoid going to the doctor, right? And that's because they can be worried about these conversations, right? So, these conversations can be sensitive ones. And you're absolutely right. I mean, some kids may feel totally comfortable having their parents in the room. But even if they feel comfortable, it is a good idea. I think as a pediatrician, we are encouraged to do this, right? And actually, the American Academy of Pediatrics recommends that health providers who care for teens especially provide private and confidential care. Because you never know, there may be a conversation they want to have, but are a little hesitant to have in front of the parents.

And our job as pediatricians, and of course, as parents is to keep the child safe and really give them the education they need to make those healthy choices. So, it's really important, as you mentioned, to have the parents step out for a period of time, a short period of time, at an appropriate age, of course, and talk to teens about their mood and, you know, their sort of practices. Are they engaging in unhealthy maybe practices or risky behaviors? And if they are, how can we talk to them about changing their behaviors or being safer just in general.

Melanie Cole, MS: Well, along those lines, we think about the teens, there's vaccinations. And we don't have time in these episodes to go into all of those, but I would like you to touch on Gardasil, because this is when that's given, is the tweens and teens right around that time. But I'd like you to tell us a little bit about how we and how pediatricians talk to our children about sex, drugs, safety. Are they learning in school? Is there still sex education in schools? I suppose it depends where you live, but is that still going on? Is this the parents to do? Can our pediatricians help us? Cover all of that briefly, if you would, doctor.

Chandrika Sridharamurthy, MD: Yeah, absolutely. So, you're absolutely right with the vaccine topic, right? So, age 11 to 12, that's when we recommend or the CDC and the American Academy of Pediatrics, all the medical organizations recommend getting the HPV vaccine because it helps protect significantly against warts, genital warts and cervical cancer. That's the main thing. And there's a lot of evidence out there that it really has brought down in the past, you know, I think since 2006. It's brought down significantly the number of those incidences of cancer and things like that. So, it's a great, great vaccine in that sense to help protect your child for the future. It's really for the future, right? And you only need two doses of those vaccines if you get it before age 15. And if it's after age 15, you need three doses. So, it's a protective vaccine.

And then, when it comes to talking about the other things, the sex drugs, safety, all of that, talk honestly, openly with your kids about that. That's my advice if I can give advice to parents, right? Because the more you discuss these topics. Both at home and even with the pediatrician or with a group of friends is going to make it easier for a kid to come to you as a parent and say, "I am concerned about this," right? You want to have those open conversations. It helps develop a strong bond between the parents and the children as well, right? They can always feel comfortable discussing their concerns that way. They feel like you're not, you know, being overly judgmental and that you're open to discussions and you're guiding them rather than reprimanding them, right? And of course, bring your pediatrician, bring the pediatrician into those conversations if you're concerned. And of course, even the school counselors and teachers, right? If there's a larger issue going on, bring that community into the conversation.

Speaking of schools, when we talk about sexual education, health education. As you mentioned, it depends on where you live, right? For example, in New York City where I practice in public schools, it is required as part of the health education classes, right? You have to talk about sex. But it varies, right? It depends on the class, the area you're in. So again, it's always important if you can to talk about it at home so that they're getting the information in a safe manner, and that they are not going to the internet or to their friends who may not quite have the right information and they're getting it from an educated source.

Melanie Cole, MS: This is all such great information, Dr. Sridharamurthy. I'd like you to wrap up by giving us your best advice for getting through those teenage years and we could do a whole show on the teenage because that's a whole different thing. But those years and that time, those hormonal swings that our children go through as they're going through puberty is a very interesting time for parents. And it also tests our patience and our love, but it's so important that our kids kind of get through it on the other side in a good, healthy frame of mind. And our pediatricians are absolutely the best resource. You guys just literally blow me away because you are the best resource that we have. So, wrap it up with your best advice for parents about getting our children through puberty as they change and grow.

Chandrika Sridharamurthy, MD: Absolutely. Yeah. You know, I think the best and most succinct advice that I can give to parents is it's hard, it's tough, it's not easy, but you know, keep the conversation going with your kids, right? Conversations about changes and growth, they can be tailored to your child's unique circumstances, right? But letting them know that puberty is normal. All these crazy changes are totally normal. And, yeah, make them excited if you can, right? As you said, it's a transition into adulthood. It's exciting. There's lots of opportunities that come along with growth and maturity during these years. But it can be nerve-wracking. You know, let them know that all these like variations that they're noticing, especially if they're comparing themselves to other kids in school and things like that, that it's totally normal to be at a different level as a different child, right? Everyone kind of goes through their bodily changes and maturity at different stages. So, it's totally okay to be different from maybe the next kid at school, right?

And as a pediatrician, as you mentioned, I think it's important to educate children on the changes that are occurring in their body and to give them the tools and just the space to navigate these changes in the safest way possible. So, just keep talking about it and ask a lot of questions and I think that's the best advice I can give.

Melanie Cole, MS: Thank you so much doctor for joining us. You are an excellent educator and really a caring pediatrician, and thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast and Google Podcast. For more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole. Thanks so much for tuning in.

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