Helping your teen handle delayed coming-of-age.
Teens enter puberty at different ages. Some may feel that they are being left behind if they don’t develop at the same time as their friends and classmates. Some may even be teased. While most teens will eventually catch up, knowing about certain health and medical conditions that can affect your adolescent’s growth and development can help reduce stress in your household.
The Onset of Puberty
Puberty generally begins between ages 8 and 13 for girls, and 9 and 14 for boys, although it can start earlier or later. There is a wide age range for the beginning of puberty, depending on race, ethnicity, medical history and family development history. Signs that girls have begun puberty include breast development, growth spurt and menstruation. For boys, an increase in musculature, growth spurt, testicle/penis size and voice-deepening signal puberty onset. Occasionally, teens may pass this age range without developing body changes associated with puberty. When this occurs, parents may worry that there is something wrong with their child.
Confirming Late Puberty
Late puberty is a concern if your daughter has not developed breasts by age 13, or has not had her first period by 14½ to 15 years old. With boys, delayed puberty is considered if there is no sign of testicular growth by age 14. Consulting your child’s provider for an evaluation can help determine possible causes. The provider may take blood samples and X-rays, and investigate your family history. Results from these tests will help decide if puberty is delayed and why.
Causes of Delayed Puberty
Constitutional delay. More often than not, delays are due to a pattern of development within a family. Mothers and fathers who reached puberty later will often have children who follow the same pattern. Oftentimes, there is a pattern of development in a family where aunts, uncles and grandparents also began puberty later than their peers. Teens with constitutional delay will eventually develop normally and catch up with their peers. No treatment is needed.
Medical conditions. Health conditions such as diabetes, kidney disease, heart problems, cystic fibrosis or other medical issues can make it difficult for the body to focus energy on growth and development. Problems in the pituitary gland, thyroid or chromosomes can also lead to delayed puberty due to a decrease or absence of necessary hormones that signal the body to start puberty. Additionally, malnutrition (not enough food or essential nutrients) due to lack of resources or eating disorders can also lead to a delay in puberty. Certain medications can also sometimes cause a delay. Your child’s provider can help determine if a health condition is affecting your teen’s development.
Over-exercising. Occasionally, young women who are very physically active will experience a delay in beginning their menstrual cycle. Girls will usually have their first period about 2 to 2½ years after the first sign of puberty (which is usually breast development). However, participating in sports and activities that call for low body fat and intense practicing — such as ballet, gymnastics and swimming — may encourage low body weight, which can lead to unhealthy eating habits in order to stay thin. This combination of poor diet and extreme exercise can have unhealthy consequences — including nutritional deficiencies, fatigue, loss of lean body mass, and delay of puberty, especially menstruation.
Most male teens will have a testicular examination as part of a sports physical or a checkup. If your son is developing more slowly than his peers, this type of examination may help reassure him or identify potential issues. Becoming educated about testicular health is important, as testicular changes include several potentially serious conditions.
Testicular torsion. In torsion, the spermatic cord that provides blood flow to the testicle twists. This cuts off the testicle’s blood supply and causes sudden, severe pain and swelling. The cause of torsion is unknown, but prompt treatment is essential to make sure that there are no long-term problems. Torsion is a medical emergency. If your son has testicular pain, he needs to be evaluated by a medical professional so the cord can be untwisted.
Hydrocele. A hydrocele occurs when fluid builds up in the sac surrounding the testicles following an injury or an infection. Usually harmless, the fluid generally will be reabsorbed by the body. Treatment involves watching and waiting to make sure the fluid goes away.
Injury or trauma. Injury to the testicles can follow a bump or fall during sports or active play. Injuries can cause blood to leak out from small blood vessels called capillaries. This can result in soreness, swelling and bruises on the skin. A bruise will gradually become less painful and fade until it is gone (in about two weeks). These injuries are preventable by wearing a cup to protect the genitals during contact, ball or puck sports.
Varicocele. Varicocele occurs when a vein within the scrotal sac becomes swollen. Generally painless, the swelling occurs when the vein that drains the testicle of blood becomes damaged, usually on the left side. Overweight teens may be more likely to develop varicocele. The treatment is watching and waiting. Done rarely, surgery can decrease the size of the vein.
Spermatocele. Also called an epidydimal cyst, a spermatocele is formed by a collection of fluid in the tubes that are on top of and behind the testicle. This collection of fluid has an unknown cause and is usually painless. The treatment is usually watching and waiting, but may occasionally involve drainage if the fluid begins to cause pain.
Hernia into the scrotum. Hernias occur when part of the intestine moves through an opening in the lower part of the abdomen, near the groin, into the scrotum. The intestine can be trapped in the scrotum, which can cause swelling and pain. There is also a risk for the trapped intestine to pop, which can cause infection. Hernias can be felt during testicular examination, and are treated with surgery to put the intestine back into the abdomen and prevent further movement.
Coping With Late Puberty
A teen with delayed puberty may not feel normal, particularly if classmates notice a lack of development. Being supportive and allowing your child to discuss how it feels may help decrease stress and concern. Reassure your teen that everyone develops at different rates and that your child will develop when ready. Shopping for hygiene products, age-appropriate clothing/training bras or deodorants, even if your teen has not reached puberty yet, may help your child feel more “normal.” A book or video that helps explain puberty and other developmental changes will help teens realize they are not alone in their feelings. Talking with your provider about other ways to help your teen cope with delayed puberty may also be helpful.
Dr. Meara Peterson, DNP, RN, CPNP-PC, is a PNP in Adolescent Medicine at Children’s Hospital of Wisconsin. She is also an Associate Clinical Professor at Marquette University in Milwaukee, where she teaches in the PNP program.