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Reviewed by the Faculty of Harvard Medical School

Frequently Asked Questions: Middle Adolescence (15 Through 17 Years)

My daughter is 16 years old and has not gotten her period yet. All of her friends have theirs. Could there be something wrong?

It is likely that your daughter's development is normal. All girls get their periods (menstruate) toward the end of puberty, that time when the body goes through changes to become an adult. However, when this happens differs from girl to girl. Remember, it may be difficult for her to understand and accept this since many of her friends have already started to menstruate. No teen wants to be different!

For most girls, the first sign of puberty is breast growth, which usually happens between the ages of 8 and 13, starting with a small round lump (breast bud) under one or both nipples (boys start puberty a little later, somewhere between the ages of 9 and 14). Over the next few years, the breasts grow larger and the whole body changes shape and size. Girls gain weight and grow taller. The storage of body fat changes, as the hips, buttocks and legs get larger, while the waist seems to get smaller. Hair grows in the pubic area, on the legs, and under the arms. Glands in the skin make more oil and sweat, so body odor and acne can be noticed. In girls, the peak growth period (in height, weight, fat and muscle) occurs about one year after puberty has begun.

Usually about two years after the start of breast development, most girls will begin to have periods. On average, in the United States, girls get their first period (menarche) around age 12 and a half; however, the age varies and could be as early as 9 to 10 years or as late as 17 years old. Many girls have a clear or white discharge from their vagina for up to a year before they get their first period.

It is important that your daughter understands that each girl develops at her own rate, and that the age at which she will get her period depends on many things, including family history and ethnic background. Your daughter's development probably is normal, whether she gets her period early or late.

A few children start puberty either very early or very late. Although this is usually not due to any medical problem, parents should mention it to their child's doctor if a girl shows any signs of puberty before age 8 or a boy shows any signs before age 9. Likewise, parents should check with their child's doctor if there are no signs of puberty at all in a girl by age 13 or a boy by age 14.

I am worried that my daughter may be anorexic. What should I do?

Anorexia nervosa (sometimes simply called anorexia) is a serious medical and psychological eating disorder characterized by an intense fear of being fat. The cause of anorexia nervosa is not known. The problem usually begins in adolescence, often as puberty starts and the body shape changes. Eating disorders do tend to run in families and are likely caused by a combination of biological, psychological and social factors. Some examples include peer and societal pressure to be thin, fear of becoming an adult, family conflicts, depression and obsessive-compulsive tendencies.

While most teens worry about their weight and how they look, they do not have an eating disorder. Those with anorexia usually have taken these concerns to an extreme. Parents may notice these behaviors:

  • Strict dieting, severely limiting calories or skipping meals
  • Intense exercising
  • Drive for perfection, often a high achiever in school
  • Difficulty concentrating, making decisions, or thinking
  • Irritability
  • Depression or social withdrawal
  • Fainting, dizziness, lack of energy
  • Feeling cold when others feel warm

If you suspect your adolescent may have an eating disorder, seek medical help immediately. Severe weight loss or starvation can be a medical emergency, so early treatment is important. Anorexia nervosa is usually treated by a combination of psychotherapy, medication and nutritional counseling. In some cases, teens need to be hospitalized, either to address problematic behaviors that cannot be handled well as an outpatient or to treat medical complications.

My son wants to play football but is smaller than the other boys. Should he take a nutritional supplement such as creatine to increase his muscle?

It is important to realize that teens grow and develop at different rates. Your son may be smaller than the other boys because he has not experienced his growth spurt yet (he is a "late bloomer"). Nutritional supplements will not help speed this process along. Boys usually enter puberty, that time when the body goes through changes to become an adult, somewhere between 11 and 14 years of age, but their growth spurts happen at the end of puberty and it can take up to five years to complete the whole process. (In girls, the peak growth period occurs about one year after puberty has begun.) However, if your son has not shown any signs of pubertal development by age 15, or he has but you still are concerned, you should make an appointment with his pediatrician to be checked.

Many teens, especially athletes, want to be bigger and stronger. Your son may come to you and ask you about taking nutritional supplements to make him bigger. He may hear about professional athletes or have friends who are using them, or perhaps the coach suggested it. Before answering him, it is important for you to know the facts.

There are many different substances marketed to athletes that claim to boost athletic performance (performance-enhancing substances). These include illegal substances (for example, steroids and growth hormone) and nutritional supplements (for example, creatine and protein drinks).

The illegal substances are just that — illegal. Although your son may know others who use these substances, he should never use them unless his pediatrician prescribes them for a specific medical reason. Steroids can make muscles bigger, but steroids also have very dangerous, even life-threatening and long-lasting side effects, including heart damage, kidney problems, bone problems, and severe acne. You should talk with your son about steroids and let him know that these are not an option for him.

The problem with nutritional supplements like creatine is that doctors or the government have not formally studied them. The U.S. Food and Drug Administration, which normally checks the safety of foods and medicines before they come on the market, does not check the safety of nutritional supplements. This means that all of their side effects and what they do to someone who uses them are really not known. This is especially true when children or teens use these substances.

One such substance, creatine, is found naturally in the body, mostly in muscle. Some athletes think that if they take creatine supplements, their muscles will be bigger and stronger. In fact, creatine does not increase strength, though it may increase how well some athletes are able to train. The biggest effects seem to be for weight lifting and wrestling, rather than football or basketball. However, it is not clear whether creatine really builds up muscles or if it is more of a psychological effect, meaning that you become stronger because you think the creatine is making you stronger.

Unfortunately, the immediate and long-term safety of creatine is not known. Some reported side effects include muscle cramping, belly pain, diarrhea, vomiting, rash, seizure, heart-rhythm problems and kidney problems. Because of these side effects and the fact that it is not a regulated substance, it is probably best that your son not use supplements, without his physician's guidance.

The best way to be athletic and at the top of your game is to stay healthy. Remind your son to eat a well-balanced diet and exercise regularly. Make sure he is getting the amount of sleep he needs for his body to rest and grow. Also realize that if he has not completed puberty yet, he still has room to grow and will do so when the time is right for him. Finally, you can check with his coach about suggestions for a weight-training program that might help him to get ready for football.

Last updated February 11, 2011