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Growing and Changing
Normal adolescent growth and development
Adolescence brings many changes in a person's life. A child enters this life stage and leaves several years later as an independent adult. The years between can cause concern for everyone around adolescents and often for the adolescents themselves.
Normal growth patterns of adolescents vary widely. Some children mature early and quickly while others take longer to go through the tremendous changes. Most accept the pace of change without too much difficulty but even the well-adjusted become preoccupied comparing their development with those around them.
Those who may not adjust well are those who are slow to develop. Many may be teased by their more "advanced" friends and they become anxious that they are not "normal." For these adolescents, the years of maturing can be the cause of great distress. One source of support for them is adults who understand adolescent growth and can reassure them through these difficult times.
Doctors regard adolescence as a stage of life that needs special attention. Unfortunately, unless teens have medical problems, most will not have regular examinations. When they do visit a doctor, they want to be in and out as quickly as possible. They do not stay long enough to ask their questions about healthy development. The result can be unnecessary anxiety in teenagers who wonder if they are normal.
Adolescent development includes both physical and psychological changes. This article will focus on physical changes with a brief overview of the psychological changes. Many of the psychological issues are dealt with in other Family Health articles.
First, let us examine the beginnings of adolescence, known as puberty. Puberty is the first stage toward sexual maturity when a person has the ability to reproduce. A sudden rise in sex hormones in late childhood signals the onset of puberty. In boys, it occurs about age 12 to 13, and in girls, at age 10 to 11.
This rise in hormone levels starts things rolling, causing more sex hormones to be released. The sexual glands and organs enlarge and the growth spurt begins. This happens just before sexual maturity.
1. Physical Changes
Teens grow unevenly with spurts and plateaus and ever-changing body proportions. The pattern varies but the general order is usually the same. The most dramatic physical changes occur in early adolescence.
Height and Weight
For girls, the typical growth spurt occurs at 10 to 14 years of age. They reach adult height and weight by age 15 or 16. For boys, the typ-ical growth spurt occurs between ages 12 and 16 with adult height and weight by age 17 or 18. A small number of teens are slower than this to develop.
Both height and weight are affected by environ-ment. However, height is more influenced by genetic and hormone factors while weight is influenced by nutrition and exercise. This is the case with most teens but not all.
The important point for adults is to recognize what is abnormal and needs a doctor's attention. There are several reasons why a teenager may not be gaining height and weight. Poor nutrition is possible but a doctor's assessment is important in accurate diagnosis.
Predicting adult height is a difficult task but by using a bone age measure and other methods, a general estimate can be made. For a bone age assessment, a radiologist will x-ray a bone and examine the growth potential remaining. From this, an estimate of final height can be made. Physical changes in body fat distribution and muscle mass also vary from person to person based on genetic makeup, as well as nutrition and exercise.
Problems and ConcernsThe rapid physical changes at this stage affect the way adolescents think about themselves, especially their body image. Most young ado-lescents, when asked what they dislike about themselves, mention physical characteristics far more often than anything else. The body changes are so rapid and so varied, teens worry that their bodies will be "right." For adoles-cents, school is a huge garden for their insecurities to grow where the more "well formed" and early-matured are admired and the smaller are made fun of.
These feelings about their bodies improve as adolescents progress to college age. Most changes have taken place by then and, more important, older adolescents have adjusted to their new body image.
Females tend to be more dissatisfied with their bodies than are males. This is consistent from junior high through to college although the dif-ference gets less as they grow older. In adulthood only slightly more females than males are unhappy with their bodies. Girls are generally more concerned with the physical appeal of their bodies while boys are more concerned with what their bodies can do. Whichever the case, in adolescence, both sexes are strongly influenced by body image stereotypes.
2. Sexual Maturation
The major changes sexually are pubic hair, breast development and development of testes and the penis. Doctors describe these changes according to a guideline called the Tanner Stages. See diagrams A, B & C. These ratings help to identify abnormal puberty or to reassure adolescents that they are normal.
An important development stage for girls is the start of menstruation (menarche). This event usually occurs at a consistent point in puberty (Sexual Maturity Rating 3 or 4 of the Tanner Stages). The average age is 12, but it ranges from 9 to 17. The age of menarche depends on many factors including race, heredity, nutrition, culture and socio-economic class.
Problems and ConcernsGirls may worry about breast size and when breasts will develop. They may also worry if their breasts develop unevenly and one is larger than the other or if the nipples are different from those of other girls. These concerns can be calmed with the reassurance that breasts vary widely in size and shape and are rarely identical in an individual. The only time for concern is if breast development is not in pace with the rest of the girl's sexual development according to the Tanner Stages.
Menarche for girls normally helps them to feel positively about themselves as females but they often worry about managing their periods. Adolescent girls need to be prepared well in advance for the start of menstruation. Early menarche usually leads to surprise, anxiety and stress while girls with late menarche regard themselves as abnormal and worry needlessly.
There are many reasons for a negative attitude to menstruation. For many girls there are the discomforts of cramps, headache, backache and breast tenderness. Some girls view the bleeding like having a physical injury and being wounded. Unfortunately for some, the concept of the "curse" is passed from mother to daugh-ter. Girls will adjust much better to menstruation if the negatives are not stressed and they see this change as a positive stage of development.
For boys, one of the main concerns is penis size. When the penis and testes are growing according to the Tanner Stages, boys can be reassured their development is normal. The differences tend to diminish with the erect length. More important, the length and circumference of a man's penis do not reflect his physique or his ability to give or receive sexual pleasure.
A more difficult aspect of sexual maturity is erection and the ejaculation of semen. Most boys are proud of their erection as an entrance to manhood but are embarrassed they cannot control when the erection may occur. The first time they have an ejaculation they may worry that something is wrong with them. This may occur as a "wet dream" during sleep. They can be reassured this is perfectly normal and occurs in most boys. Some girls may experience the equivalent but are much less likely to do so.
Boys in middle adolescence (age 13 to 15) many develop gynecomastia (breast develop-ment) which can persist for up to 18 months. It may be on one or both sides and is occasion-ally tender. This often leads to concern but again is completely normal.
3. Pyschological Changes
The table above overviews some important psychological changes of the adolescent. Adolescence has been divided into three stages:
- Early - 12 to 14 years (junior high school)
- Middle - 15 to 17 years (high school)
- Late -18 to 21 (college or four years of work after high school)
No adolescent fits into all these stages and tasks but they all follow a similar pattern.
Task |
Early Adolescence |
Middle Adolescence |
Late Adolescence |
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Where adolescence ends and adulthood starts is not clearly defined. The years between are full of drastic changes. It is easy to understand the concern of an adolescent who is confused by these changes. As well these days, adolescents face many other issues such as the environment or job futures.
It is clear why adolescence is a troubled time for many. These normal events are the source of severe depression for some teens who need help from adults, and sometimes the health care system, to adjust. However, with patience and support from those around them, most people make it through this period in good health and go on to be productive adults.
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