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Growth and Your 13- to 18-year-old

As children near adulthood, they continue to mature and grow. Eating a healthy, well-balanced diet, exercising at least three times weekly, and getting adequate rest will help ensure that they will grow and develop properly. Teens who have entered puberty will notice many changes in their developing bodies as fat deposits and muscles change shape. Often these changes are quite dramatic.

Growth charts are used to plot your teen's individual pattern of growth on a curve over a period of time. The curves are generated from weight and height information taken from data on thousands of children and are useful in comparing the growth of normal children and teens.

Using these standards, your teen's doctor can determine whether your teen may be too thin or fat in relation to her height. For example, if your child's weight for her height corresponds to the 85th percentile, then she is heavier than 85% of the other children of the same height. Generally, a teen may need special attention when her height is below the 5th percentile or if the teen's rate of growth is too slow for her age.

How Can I Help My Teen Grow Normally?
Normal growth - supported by good nutrition, adequate sleep, and regular exercise - is one of the best overall indicators of your child's good health. You should also be aware that various eating disorders - including anorexia and bulimia - could interfere with the growing process. A significantly malnourished child may be pushed off her "natural" genetically determined growth curve. Although she won't stop growing completely, there may be a slowing down or flattening of her growth on the doctor's chart and delay in appearance or progression of the other features of puberty. Malnutrition severe enough to affect a child's growth rate is uncommon today in the United States and other developed countries unless the child has an associated chronic illness or disorder. Your child's growth pattern is largely determined by genetics. Pushing a child with "short genes" to eat extra food or greater than recommended amounts of vitamins, minerals, or other nutrients will not increase her height.

Puberty
Puberty - or sexual maturation - is a time of dramatic change for both boys and girls. For both sexes, these hormone-driven changes are accompanied by growth spurts that transform children into physically mature teens as their bodies develop.

There is wide variation in the age at which the physical changes of puberty normally begin. Breast development is usually the first noticeable sign of puberty in girls. This may begin anytime between the ages of 7 and 13 years (as early as 6 in African-American girls). About 15% of girls will develop pubic hair before breast development starts.

The following characteristics describe the sequence of events in girls as they progress through puberty:

• Breasts begin to develop and hips become rounded.
• The increase in the rate of growth in height begins.
• Pubic hair begins to appear, usually within 6 to 12 months after the start of breast development.
• The uterus and vagina, as well as labia and clitoris, increase in size.
• Pubic hair is well established and breasts grow further.
• The rate of growth in height reaches its peak by about 2 years after puberty began (average age is 12 years).
• Menstruation begins, almost always after the peak growth rate in height has been reached (average age is 12.5 years).

Once girls start to menstruate, usually they grow about 1 or 2 more inches, reaching their final adult height by about age 14 or 15 years (younger or older depending on when puberty began).

Boys tend to show the first physical changes of puberty between the ages of 10 and 16 years. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop. Other features of puberty in boys include:

• The penis and testicles increase in size.
• Pubic hair appears, followed by underarm and facial hair.
• The voice deepens and may sometimes crack or break.
• The Adam's apple, or larynx cartilage, gets bigger.
• Testicles begin to produce sperm.

At the Doctor's Office

Normal growth - supported by good nutrition, adequate sleep, and regular exercise - is one of the best overall indicators of your child's good health. Despite data collected for growth charts, "normal" heights and weights are difficult to define. Your child's growth pattern is largely determined by genetics. Shorter parents, for instance, tend to have shorter children, whereas taller parents tend to have taller children.

Although you may worry if your child isn't as tall as her classmates, the more important question is whether your child is continuing to grow at a normal rate. If your child's doctor suspects a problem - such as a growth rate that had been proceeding normally but has recently flattened - he or she may track your child's measurements carefully over several months to determine whether the growth pattern suggests a possible health problem or is just a variation of normal.

It's not unusual for teens to have their own concerns about how they are growing and how they look. Girls can be very critical of their own weight, which can sometimes lead to unhealthy body image concerns and dieting practices. Boys tend to be more concerned with their height and muscle development, which can also lead to unhealthy practices, like using steroids and protein supplements.

If you're concerned about your teen's body image, or eating and exercise habits, the doctor's office is a good place to discuss this. Many teens worry a lot about being different from their peers and about anything that would make them not fit in or seem "normal." Encourage your child to bring up any of these concerns with the doctor, if he or she feels comfortable doing so. The doctor can reassure your teen that other kids have the same concerns about their size.

If you have any other concerns about your child's growth or development, talk with your child's doctor.