What is a Bone Age?

 

Bone age is helpful in assessing a child who is shorter or taller than predicted based on parent heights or if a child has early or late pubertal changes. It’s simply an x-ray of the child’s hand and wrist. It involves minimal radiation and doesn’t hurt. The bone age can help us approximate how much longer a child will grow and the expected height, but does not tell us why a child is shorter or taller than expected or hitting puberty at an unexpected age.

bone age can help identify final heightBone age is difficult to understand, and I hope this helps parents understand with some pictures.

I completely made up these growth charts. They do not reflect any real patient or any real diagnosis. They are solely to illustrate how we estimate the bone age on the growth chart to help assess final predicted height.

The reasons behind altered growth patterns are many and might require further evaluation.

Delayed bone age

A delayed bone age means that the bones think they are younger than the child actually is.

This can mean catch up growth after peers have stopped growing.

A delayed bone age can happen for many reasons, but a common one is due to late puberty and can run in families.

A history, physical exam and possibly labs can help asses the reason for delayed bone age.

Advanced bone age

If a child has an advanced bone age it means the bones appear older than the child’s actual age.

With this we expect them to stop growing earlier than most kids.

This means that even if they are tall for their age, they could end up shorter than average.

Advance bone age is often associated with early puberty and childhood obesity.

An advanced bone age needs further evaluation to identify the cause.

Normal bone age

If the bone age equals the actual age, you can estimate the final height to be about the same percentage as the current height.

We often repeat bone ages to see if they are changing at a different rate than the child grows.

How’s a bone age determined?

Radiologists and endocrinologists use books with x-rays of standard bones of various age groups to assess which age the child’s x-ray most closely resembles.

Since there are different bones that can develop at different rates, it is possible that two doctors will assign a different bone age.

It is not an exact science, but can give a good estimate of how much longer a child may grow.

The photo above is from Amazon’s bookstore. You can see how the bones of the youngest hand on the left are very different from those in the hand on the right. The radiologist or endocrinologist finds the image that is most like the child’s x-ray and call it that bone age.

How to read a growth chart

In the boy growth charts pictured below, the top set of lines is the height (stature) for age chart. The bottom set is the weight chart.

Hopefully these looks familiar because you’ve seen a graph like this at your child’s doctor. If you haven’t, be sure to ask to see it next time you’re there.

The ages that are used to plot a height and weight at a given time are listed at the top and bottom.

The heights and weights are listed on the right and left of the respective graph. I only marked the height graphs for the purpose of this blog.

The middle line is 50%, which reflects a height of 50% (taller than half/shorter than half of boys of the same age). The other lines are also labeled for their respective height percentiles on the far right.

What is normal on a height chart?

There are many “normal” heights, usually determined by genetics.

Tall parents tend to have tall kids, short parents have short kids.

There is no “correct” height or “best” height, the percentiles simply give us a way to follow the growth over time and estimate final adult height if a child hits puberty at a typical age (early puberty stops the growth early, late puberty allows for later growth).

Figure 1: Growth delay

In Figure 1, I filled in a fictitious child’s heights with blue dots.

Reading the chart

You can see that from 3 to 5 years this boy was at the 50th percentile for height. That means he was taller than half the boys his age and shorter than half. The fact that he’s in the middle doesn’t make it “normal” it just means that if his parents are average height, he is growing as expected because it’s consistent year to year and he is of average height like his parents.

At 6 years, he dropped to the 25th percentile, and at 8 years he fell to the 10th percentile. This consistent drop in growth often triggers a physician to look for reasons of the drop.

The red arrow on the right marks the actual height at 8 years (blue) at about 47 inches (120cm).

For this fictitious child, the bone age is 7 years, and if you plot 47 inches (the actual height at the time) at 7 years (the bone age), you will see this white dot is at the 50th percentile and marked by the red arrow on the left.

I finished out the growth plots, and this kiddo actually fell more (down to the 5th percentile) before he hit a late puberty and grew into late teens/early 20s to hit a final height at the 50th percentile.

bone age correlates to growth delay
Figure 1: Growth delay

Causes of growth delay

Maybe the parents are both very short.

A delay in bone age often coincides with a late growth spurt. A late puberty often follows a family pattern called constitutional growth delay.

It could be due to a medical problem, such as a hormonal imbalance.

Sometimes there is a family history of people having late growth spurts (called “constitutional growth delay”).

Treatment (if needed) varies depending on the cause. The bone age won’t give a cause, but once a cause is identified and treated, growth often returns to a normal rate.

Figure 2: Tall kids don’t always become tall adults

In Figure 2 below, a fictitious boy is tall for his age early on.

Reading the chart

At 6 years old his height (black dot) is at the 97th percentile (he is taller than 97 out of 100 of boys his age) at about 49.5 inches (125.5cm).

His bone age at the time (red dot) is 8 years 6 months, which is at the 25th percentile for height.

A year later he is off the height chart, taller than over 97% of boys his age, but the bone age is 10 years 9 months, again at the 25th percentile.

This chart shows an early growth spurt (as he looks taller than his peers) but an early puberty and a slowed growth faster than other boys.

His final height is only at the 25th percentile, much shorter than his early heights would have predicted.

tall kids don't always grow to become tall adults
Figure 2: Early puberty

Isn’t tall good?

Many parents are super excited when their children are tall and can’t comprehend when I talk about the possibility that it might not last.

I typically discuss this if both parents are short but the child is tall, if I see signs of early puberty, or if the child is obese – especially if parents are not as tall as the child’s height predicts.

The bone age does not give a reason for the altered growth rate, but can help identify a need for further evaluation and treatment if indicated.

Yearly well visits – even when kids are healthy!

Unexpected growth problems is one very important reason to do yearly well visits at your child’s primary care office.

If you move physician offices for whatever reason, be sure to have the medical records transferred before your first visit. This allows your child’s  growth to be properly followed.

If you do a sports physical at a school clinic or an urgent care, realize that it is not a substitute for a yearly visit in your child’s medical home.

At every well visit your child should have a height and weight measured and discussed with you.

If the yearly growth accelerates too fast or slows, talk to your doctor about possible reasons.

If a bone age is done, you can use a growth chart to estimate the bone age. This allows you to see how tall the final height estimate would be. It is also the reason to do the x-ray soon after your child’s height was measured. Waiting a few months requires another visit to look at the height at the time of the x-ray.

Yearly tracking isn’t a guarantee that your child will grow to his or her potential, but can be helpful in identifying problems early.


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Transitioning to The Big Kid Bed

Parents often try to keep the crib as long as possible to avoid the problem of their toddler/preschooler leaving the bed again and again at bedtime, but eventually they all need to take the plunge and get a big kid bed. How do you get a kid to stay in a bed?

Daycares do it

How do you know when your child's ready to move to the big kid bed?It always blows me away that daycares get 1 year olds to sleep on cots.

They stay there… how???

I suspect they are following what the older kids in the class are doing and they are never left alone. That makes it easier on many levels.  Parents don’t have that luxury at home when transitioning to the big kid bed.

When’s the right time?

Many parents are tempted to move their toddler to a bed before the child is really ready. Many experts advise continuing the crib until around 3 years of age.

Remember that the crib also is a place of security, so sleep problems can develop if kids are transitioned too soon.

Many kids that leave the crib before they can understand rules (around age 3) have a hard time staying in the bed.

Some kids are able to climb out of the crib, so parents think it’s safer to move to a bed. This is one solution, but you can also work on ways to keep your toddler in the crib.

Make sure the space is safe

Before you let kids sleep in a bed that they can easily get in and out of, make sure the room is safe.

This is a great time to check the smoke and carbon monoxide detectors. Change batteries when you change your clocks.

Furniture should be secured to walls so climbing kids won’t pull them down.

Don’t allow window cords to be reachable by kids. Too many kids get hurt from cords and window coverings.

Don’t put beds near windows.

Keep all medications and poisons out of your child’s room. This includes diaper rash cream and other “non-medicine” hazards.

If you have a bunk bed, be sure kids under 6 years of age don’t sleep on the top bunk. If your little ones won’t follow the rules, you should unbunk the beds.

Make sure kids can’t get out of their room without you hearing them. They could be at risk falling down the stairs or simply get into trouble helping themselves to junk food or extra tv time.

For more safety tips, check out Charlie’s House.

Build excitement

Parents can get the child excited about leaving the security of the crib by talking about the bed before it is used.

Have kids help pick out sheets or a pillow for the bed.

Remind them during the day how big they are when they ___ (fill in the blank with “use a spoon,” “pick up a toy,” etc). Warning:  This can backfire if they really are afraid of the bed and they do want to not be big, so they stop all the “big kid” behaviors.

Addressing fears

If kids are afraid of their new bed, lay together to read books at nap and bed time.

If you still have the crib available, ask if they want to sleep in the bed or the crib. Simply having the choice might empower them to want to stay in the bed.

Feel free to leave a light or night light on in the hall (or even in the room if they prefer).  Eventually they won’t need it, but it can really help if they want it!

Go through a routine of checking the closet (then closing the closet door), checking under the bed, and picking a favorite toy to be there while your child sleeps.

Use a comfort item. It’s amazing how much the power of suggestion that a stuffed toy will stay with them works!

Let them know you will check on them soon… and do, but wait a little longer each night until they are asleep when you check.

If your child has fears related to sleep, check out The Most Common Reasons Why Kids are Afraid to Sleep from AT Parenting’s Child Therapist & Author, Natasha Daniels.

Falling out

For kids who are prone to falling out of bed, decide what works best for that child.

Some parents put the mattress on the floor instead of on a bed frame, so if they roll off it’s no big deal.

Many parents use bed rails that keep kids in the bed.  Unfortunately if they roll hard enough, they can get trapped between the mattress and bed rail.  I know this from experience! My son would do that and it would FREAK him out. He usually went to sleep without much fuss, but after he would get stuck in the rails he was too scared to sleep. We finally just put the bed against one wall and moved everything away from the other side of the bed except a nice layer of pillows and blankets. When he fell out of bed (yes, most nights…) he landed on the pillow pile and kept sleeping.  Problem solved!

Pick a reasonable bedtime

Account for all the time it will take to do all the stall tactics when picking the bedtime.

If sleep time needs to be by 7:30, and you know they will resist brushing teeth, need to potty a 2nd time, get a drink, check the closet and under the bed, and read 3 books… get started in plenty of time to do all of that and still have them tucked in for the last time before 7:30.

Ironically as kids get more tired, they get more wired, so DO NOT allow this process to run too late! They will hit a 2nd wind and be up far too long.  We all know what kind of day tomorrow will be if they are up too late tonight… and it isn’t pretty!  Then they are overly tired for the routine the next night, which can lead to an earlier 2nd wind and more troubles!

Card trick

One trick I’ve learned that works well for older toddlers and preschoolers is the card trick.

They start each night with 3 cards.

Every time they leave their bed for another hug, a drink, to potty, etc, they surrender a card to you.

Once all 3 cards are gone, they can’t leave the bed any more.

If they have cards left over in the morning, they get a sticker for each card.

They can earn up to 3 stickers (or make it special to get an extra sticker if they have all 3 cards!)

When they reach a set number of stickers they earn a prize.

Supplies:

Cards

You can use cards from a regular deck, or you can make it even more fun by having your child make his own cards.

Sticker chart

I also suggest making a simple sticker reward chart, keeping in mind how difficult you think it will be to earn stickers and set a realistic goal for all the needed stickers to be earned within a week.

If they don’t earn the prize fast enough at the beginning they might lose interest (but it needs to be enough time that they earn it). You can make it more difficult over time, as their bedtime routine gets better.

For ideas of reward charts, check out this fantastic free site!

Simple prizes

Prizes shouldn’t break the bank.

You can find trinket toys inexpensively or even pick an “event” as a prize. Maybe your child has been wanting to go to a new park. Maybe they want to have an extra book read at bedtime.

The most important thing is that the child will want to earn the prize.

Playing the game

Go over the rules of the cards and stickers during the day several times so they know the rules before you start the system.

At bedtime minimize the talking and just let them figure it out when you ask for cards or refuse to let them have a 4th resistance tactic.

Remember that each day is new, so they start with 3 cards and you can talk up how much you know they can keep them all!

Praise all the good choices.

If they struggle with it, find positives to praise… “You kept your cards a little longer last night. I can tell you’re working on keeping them all night!”

When kids leave their bed

If kids end up in your bed in the middle of the night and you don’t want them there, you must firmly but without much discussion bring them back to their room.

Too much snuggling, talking, or other interactions will only reinforce them coming to you again.

And again.

Night after night they get to spend more time with you– that’s what they see every time you give them attention when you need to limit the interaction.

Attempt to get them to walk themselves, but if they refuse, carry them with outstretched arms facing away from you to decrease body contact.

Family bed

If you don’t mind them in your bed, be sure you’re ready for a long term commitment to a family bed. Once the habit’s started it will be harder to break until the child wants to sleep independently.

Sleep deprivation makes parents do things they never thought they would…  you just want to get sleep.

Yes, I’m one of those parents who succumbed to being tired and let a little one stay in my bed. I realized I was kicked and punched often throughout the night by my lovely little angel who was not a great bedfellow. She affected my quality of sleep for quite awhile. She wasn’t sleeping well either. We all needed to have our own space. Her nightly visits didn’t stop until we made a firm decision to stop the behavior.

Weaning from a family bed

When we decided we simply couldn’t do the family bed anymore, we tried several methods to get our daughter back to her room. Many of these are discussed by Dr. Craig Canapari’s At Long Last: Sleep Training Tools For the Exhausted Parent.

The thing that finally worked was a slow wean.

We made a bed on the floor of our bedroom and let her sleep there. We slowly moved that bed further from our bed, then into the hall, and finally into her room. Eventually she even made it to her own bed.

If problems continue

If all else fails, talk to your child’s doctor about sleep problems.

Some sleep problems are due to real medical conditions and these should be evaluated.

If sleep problems continue, loss of sleep can affect growth, learning, behavior, and more… don’t let it get to that point!


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First Period Q&A with Teens

Over the years I’ve talked with many girls about what to expect during puberty. Some of the biggest questions we all have involve the mysterious first period. I have dug into the recesses of my brain to come up with all the questions asked over the years to put all the information down in one place, though I’m sure I’ve missed a few.

******Exciting news! This post was picked up by STRONG. THE MAGAZINE FOR GIRLS. I love each edition of this magazine, and highly recommend it for your daughters, nieces, and any other girls you know. It’s absolutely wonderful! Give it as a gift or read the STRONG issue 5 for FREE. It has a lot more than what I’ve written here – truly everything you need to know about periods! I am not getting any money from STRONG, I just think it’s great so I’m happy to help them out! *******

If you have a daughter starting puberty, please share this information with her.

Are there any other questions she has? Put them in the comments section and we’ll tackle them!

Is there a good way to know when I’ll start my period the first time?

puberty, periods, menstrual cycleYou will never know exactly when your period will start, but good clues that it is getting close to time:

  • It’s been about 2 years since your breasts started growing. (Remember those first bumps?)
  • There’s clear, white, or yellow stuff in your underwear sometimes. It can look like dried boogers or just a little crusty stuff in your underwear, but it’s not from being unclean or peeing in your pants. Your body is just getting ready for the full cycle of ovulation (when the egg is released) and the period. Your vagina is moistened with a clear fluid that can drain onto your underwear. Another thing you might notice is mucus is released once a month, about half way between your periods when the egg is released from your ovary once you’re on a regular monthly cycle. It often begins before the period starts. As long as there is no pain or funny odor, this discharge is normal. Talk to your doctor if it does smell bad or if you hurt or itch in that area.
  • Pimples. Pimples are common with puberty (and for years following). Many girls will notice that the pimples tend to worsen right before their period starts.


I’m too young for a period. None of my friends even have boobs! Can I stop it?

Puberty has such a wide range of normal ages so it is common for one girl to go things much sooner than her friends.

Puberty is most common between 9 and 16 years of age (though some girls notice breast buds as early as 7 or 8 years old).

The common age for a period to start is between 10-15 years old.

If you are outside of this normal age range, talk to your doctor about it because there are many reasons. Some can be as simple as your family tree (when did your mom or sisters start?) but some can be a medical issue that can and should be treated.

And the opposite issue:  All my friends have had their periods for a long time, but I barely have boobs. When will I start?

Again, there is a wide range of normal (see the question above).

Some families have a later puberty than others, so it might just be in your genes.

There are other reasons that deserve talking with your doctor about, such as being underweight– which delays puberty, and other medical issues that need an investigation to uncover a cause that might need to be treated. (That sounds like a mystery book, but your doctor will know what to do!)

Bottom line for early or late puberty: 

If you are outside the normal age range, please talk with your doctor.

Don’t be embarrassed to bring it up!

They might either reassure you that things are still okay, or they might help find the reason and get your body the treatment it needs. Some of these can be serious problems, so don’t be shy about going to the doctor.

This is one reason that a yearly physical exam is especially important until growth is complete — your doctor can help keep track of a normal growth progression.

How much blood will there be, and what does it feel like?

The amount of bleeding varies from day to day, month to month, and person to person.  It is common for the first 2 years to have irregular cycles, but many girls can begin to predict their blood flow volume pattern after a few cycles.

Many girls have some pain during their period. The blood flow does not hurt, but as the uterus contracts it can cramp. Like other muscle cramps, there can be pain from period cramps, but the amount of pain varies in different people.

Some girls have cramping with every period while others never feel anything.

It’s okay to take over-the-counter pain relievers (like ibuprofen or naproxen) to relieve pain. Some girls find it helpful to take ibuprofen or naproxen 2-3 times/day (per package directions) starting 3 days before the period is supposed to start to prevent the cramps.

Eating healthy foods, getting regular exercise, and sleeping well every night also seem to help.

For severe period cramps that keep you from doing what you want (or need) to do, talk to your doctor.

What do I do if I start my first period and I don’t have any pads around or I’m not at home?

First, don’t panic!

Wipe yourself well and put a wad of toilet paper in your underwear. This is only a temporary fix and isn’t very comfortable, but it will suffice for a short time to help protect leakage through your clothes.

Remember that ALL women have periods, so it’s nothing weird to adult women (or men, for that matter, since they live in a world with women).

Ask a teacher, school nurse, friend’s mom, aunt, or whoever is around for help. She will not judge you or get freaked out. Really.

How long should I wear a pad or tampon?

Pads should be changed if they are visibly full or after 4 hours, whichever is first. (Except overnight.) If left on longer, they start to have a foul odor, and you don’t want that!

Tampons should be changed every 2-6 hours, depending on the amount of blood flow you have that day. Tampons come in different sizes for light days, regular days, and heavy days. Don’t ever wear a tampon longer than 6 hours because it can allow germs to grow and cause a serious infection. For that reason I don’t recommend wearing them overnight.

Once your cycle becomes more regular, you should be able to predict the flow by the day of the period (and time of day, since that often varies too). Use a calendar to track the amount of flow as well as the days of your period until you get it all straight. Either an old fashioned paper calendar or an app designed to track periods can help. (Search for “period calendar” or “menstrual calendar” in your app store if you have a smart phone or tablet.)

What do I do with the pad or tampon after it’s been used?

Most pads are disposable. You can roll it up, wrap it in a little toilet paper (or the wrap it originally came in) and throw it in the trash can. (Use a single layer, ladies! Don’t be wasteful with a wad of TP!)

If you use re-usable pads, they will have to be washed before the next use. Talk to your parent about where to keep them between uses.

Many people flush tampons down the toilet, but that can lead to clogged toilets in many sewage systems. Never flush into a toilet that uses a septic tank. Tampons do not break up like toilet paper does and they will clog a septic tank system. If you aren’t sure, you can wrap it in toilet paper and throw it in the trashcan.

Never flush a plastic applicator. You can either put it back in the wrapper or wrap in toilet paper and throw it in the trash.

I leaked! Not only am I totally embarrassed that everyone will know, what do I do to clean up my underwear?

When a period first starts, it often comes without warning and underwear can get soiled.

Heavy flow days can also cause leakage onto your underwear. If you expect a heavy flow day, you can wear old underwear, prepare with a product designed for heavier flow, and go to the bathroom more often to change the pad or tampon.

Despite the best techniques, all women sometimes soil their underwear and even their outer clothes. If you can change right away, fresh blood is easier to clean than dried blood. (This goes for just about any spill in the kitchen too, so clean up as soon as you spill!)

If you’re at school, go to the nurse’s office. She can help and it probably won’t be the first time a girl has come to her for help– really! If you’re at a friend’s house, see if she has something you can borrow if you don’t have an emergency change of clothes.

In general, cold water to rinse out blood is better than hot. Because blood is made of proteins that change in heat, the heat can “cook” the blood into the clothing and make the stain permanent.  If you have laundry detergent you can put a few drops on the stain and rub it in. If you have a spray or stick stain remover, you can use that. Allow that to soak overnight in some cold water before putting in the regular laundry.

Basic tips:

  • Carry a clean set of underwear (and pants if needed) in a plastic bag to use in case of emergency.
  • Carry a stain stick (they sell these near the laundry detergent) if desired.
  • Rinse in cold water as soon as you can.
  • Rub stain remover or laundry detergent into the stain and let it soak. Put it in the plastic bag you carry if you aren’t home.
  • As soon as you get home put the soiled clothes in cold water (rub in more stain remover or laundry detergent as needed). Allow clothing to soak overnight.
  • After soaking overnight, rinse in cold water. Repeat a scrub and soak in detergent if needed.
  • Once you don’t see the stain any more, you can wash with the rest of your clothes like normal.

What about when a pad won’t work, like swimming or ballet? Am I too young for a tampon?

Tampons frighten a lot of girls, but they’re safe to use as soon as you’re comfortable using them.

They do not affect your virginity.

Tampons simply are a product that will collect the blood inside you so you don’t need to wear a pad on the outside.

Many girls use one with their first period. Others don’t use them at all. It’s up to you!

How exactly do you get the tampon in? 

First, some general anatomy. You need to know what things look like down there. You can use a hand held mirror to look at yourself and compare to this picture. This is a drawing, so you will look a little different, but you should be able to see the basic parts.

Tampons are inserted directly into the vagina (labeled “vaginal orifice” in the picture).

Much like an absorbent sponge, a tampon will gently swell as it becomes soaked with blood.

A string allows for easy removal from the body.

Tampons are convenient for swimming or exercising and can be paired with a panty liner – a type of thin pad or a regular pad for extra protection on heavy flow days.

When using tampons, women should change them every 4-6 hours.

It’s time to change the tampon, but I can’t find the string. Did it get lost up there somewhere? 

First: Don’t panic! Your tampon is not lost forever!

Sometimes the string can stick to the skin between your labia (labeled “labium magus” and “labium minus” above). You might need to feel around a bit. If there’s a mirror nearby, you can use it to look. Sometimes going pee can help the string fall down if it’s stuck around the skin somewhere.

If the string really is up in the vagina, you can put your finger into the vagina to see if you can slip the string back out.

If you can’t get the tampon out, tell an adult as soon as possible. If they can’t help you get it out (or if you don’t want them to try) you might have to go to the doctor to have it removed.

NEVER forget about a tampon that has been put in… you could get a serious infection if you leave one in too long.

I seem to always get spotting on my underwear when I wear a tampon, but the tampon isn’t full of blood yet. Why is that?

There are several reasons I can think of that blood can get on your underwear.

The first, of course is the tampon overflows because it was left in too long for the amount of flow you have at that time. But you can tell that when there is no more white showing on the tampon. If it isn’t full, there are other reasons to consider.

Was the blood on your skin when you put the tampon in? If you wipe after putting the tampon in, that can help this issue. Actually, more than wiping, pushing the toilet paper (TP) up towards where the tampon is (with the string out of the way) can show if there’s blood in the area. Repeat until the TP is clean. You can also wipe the folds of skin with a flushable wet wipe that is sold near the other feminine hygiene products or near the diaper wipes. This follows the same concept but wiping with a wet cloth works better than dry TP for many issues.

Another cause would be if the tampon is not inserted properly. Be sure it is completely in. Signs that it isn’t in also include being able to feel it when you walk or sit. If it’s in all the way, you should never feel it.

Did you pee or poop with the tampon in? This can move the tampon enough to let blood leak around it. Try changing the tampon and wipe after placing it each time you go to the bathroom.

Why do I need to pee so much when I’m on my period?

Many women gain water weight just before their period.

Have you heard women complaining of bloating? That’s the water.

Your body’s hormone changes cause this slow gain, and they also cause the release of the excess water back out of your body (called diruresis). This increases urine production.

Look at it in a positive light: you have to go to the bathroom often, so it reminds you to change your pad or tampon frequently!

Can you pee or poop with a tampon in?

Short answer: Yes.

But if you do, it is possible to have the tampon shift and cause leakage, especially if you have a bowel movement (poop).

If it is too soon to change the tampon and you need to go, you can hold the string to the side so it doesn’t get as soiled while you go.

Wipe carefully so you don’t pull on the string– you can keep holding it to the side while you wipe too.

My school uniform doesn’t have pockets. How can I carry a pad or tampon to the bathroom?

If your uniform is a skirt, you can wear shorts with a pocket underneath.

Some girls will be able to wear a tampon with a pad so that when they remove the pad mid-day, they leave the un-soiled pad on for the afternoon.

If you’re allowed to carry a purse, carry one every day for unexpected first period days and to get in the habit of always having it.

You can also talk with your school nurse or a teacher about what other girls do.

I track my periods on a calendar, but there doesn’t seem to be any pattern. Why aren’t they once a month like they should be?

Once a month is more of a phrase than a reality.

A typical cycle is about 21 – 35 days from start to start.

Bleeding can be as little as 2 days and up to 7 days.

The first 2 years after starting a period, many girls are irregular. After those 2 years, it becomes more predictable.

You might be different than your friend, but your cycle should be about the same each month after the first 2 years.

It does help if you track your cycles on a calendar or app.

My bleeding seems so heavy. I soak a pad within an hour and there are sometimes clumps in the blood. What is that?

If you’re having very heavy bleeding, talk to your doctor because you can be at risk for anemia (too low of blood counts from blood loss).

This can sometimes simply be your body adjusting to a period, but it can also be from a treatable condition.

Your doctor can help you decide what needs to be done.

How long will the bleeding last? 

The amount of bleeding and how long it lasts varies from person to person.

Some days there will be barely any blood (called spotting because it looks like just a spot of blood).

Other days are heavier.

Bleeding can last between 2-7 days normally.

Again, charting it on a calendar or app can help you figure out your pattern.

How do I keep from getting stinky?

Change is good

First, be sure to regularly change your tampon or pad.

If it goes without being changed, bacteria start to make a very foul odor.

You should change pads or tampons at least every 6 hours (except overnight, when the pad can be left on as long as you sleep). This is important to avoid infections as well as bad smells!

wipes

You can use flushable wet wipes instead of toilet paper to help clean the area better.

If you need them outside of your home you can carry some in a plastic zip lock bag and keep with your pads or tampons.

deodorant products?

There are feminine hygiene products with deodorant available, but who wants to smell flowery?

Seriously, I don’t recommend these because too many girls have an allergic reaction to them and who wants to have an itchy rash in the place you can’t publicly scratch?

Wash!

Once you go through puberty, your body in general smells more, so it is important to bathe regularly.

Don’t forget to do a daily wash of all the skin folds between your legs.

You can use any soap (avoid fragrances if your skin is sensitive), but be sure to rinse well! Soap that remains between the folds can cause rashes.

You can rinse the area by splashing a cup of clean water between your legs a few times. If you have a hand-held shower head available, that makes it easy to rinse the area well. You can also lift a leg so the shower water can rinse between your legs — but hold on so you don’t fall!

Do I need to wear protection between periods?

You might want to wear a panty liner when it is getting close to your next period, just in case you start, but it’s not necessary.

How do I know when the next one will be?

Over time it becomes easier to predict.

Keep track of the dates of bleeding as well as how heavy it is and any other symptoms. These can include pimples, cramping, mood swings, tiredness, constipation or diarrhea, back pain, sore breasts, bloating, food cravings, or headaches. All of these symptoms can help predict your cycle.

There are several apps available on the computer, smart phones, or tablets, many of which are free. I suggest going to your app store and reading reviews to pick your favorite.

How much more will I grow since I started my period?

Growth speeds during the years before your period, then slows after your period.

Some girls stop growing all together, but most still grow for the next 1-2 years.

Ask adult family members how they grew (if they remember) because growth patterns tend to follow parents and other family members.

What is PMS?

Common effects of PMS (Pre-Menstrual Syndrome) include: bloating, cramps, fatigue, moodiness, headaches, or pimples.

There are over-the-counter medications that can ease these symptoms. Ibuprofen or naproxen tend to work well.

If you have severe cramping and you are expecting your period, you can start the ibuprofen or naproxen three days before your symptoms start. This decreases the pain better than starting the medicine when the cramps start.

Some girls prefer wearing loose clothing or using warm compresses on their stomach.

Regular exercise can help monthly cramping, plus it’s healthy for your body, so keep moving!

Sleep helps regulate our mood. Many girls and women need extra sleep before and during their period. Listen to your body!

Mothers can share with their daughters their own tricks for coping.

My boobs hurt with my periods. Why is that?

Many girls notice breast tenderness during PMS (Pre Menstrual Syndrome).

Your hormones are changing at this time and they can cause the breasts to swell. The swelling causes tenderness.

You can help minimize this by eating right, exercising, and getting enough sleep (all month long).

Caffeine can worsen it, so avoid things with caffeine.

Where can I get more information?


ThePeriodBlog has a lot of great information, including how to insert a tamponinformation about your body,  counting your cycle, and more.

I rarely hear questions about the hormones or technicalities of puberty, but for more on the menstrual cycle check out All About Menstruation by TeensHealth. (They also include more related topics links at the bottom.)

A good review of puberty, including how it is staged is found on Young Women’s Health (Boston’s Children’s Hospital).

My favorite book for girls about puberty is now a series of books. The Care and Keeping of You and The Care and Keeping of You 2 are available from many retailers. I like that they go over everything from staying clean to eating right to the importance of sleep and more.

I’m a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. I link to these books because I recommend them highly, regardless of where you purchase them.



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Is Sport Specialization A Good Idea?

I’ve seen many young athletes have their athletic careers cut short due to preventable injuries and / or burnout. We live in a competitive time and everyone likes to feel successful. When kids do well in a sport, we want to encourage them to be their best, so we let them try out for the competitive team and even play on several teams throughout the year. While this can seem to help them improve their skills and grow to be a better player, it often has the opposite effects.

sportsThe American Orthopaedic Society for Sports Medicine has released a Consensus Statement on this topic. Many parts echo the consensus statement of the American Medical Society for Sports Medicine.

A consensus statement is basically a summary of what leading experts believe based on current research and understanding.

If you don’t want to read the entire summary below, just know that experts aren’t in favor of it.

They do acknowledge that there are a few sports- such as gymnastics, figure skating, swimming and dance- that might benefit from earlier specialization because their peak years are in the teens and twenties.

Current research shows that before puberty children should be encouraged to participate in a variety of sports that match their level of ability.

They should also be allowed free play that does not have direct coaching from adults.

Playing various sports helps to develop muscle strength and skills that can be protective of injury. Playing various sports and including unstructured playtime helps develop not only sports-related skills, but also helps them develop psychologically and socially.

What do the consensus statements say?

They start by defining early sport specialization as the following:

  • Participation in organized sports more than 8 months per year
  • Participation in one sport rather than several different sports
  • Children before the pubertal years, which they state is roughly 7th grade or 12 years, but ranges considerably and is typically 8-13 years in girls and 10-15 years in boys


Risks of early sport specialization include:

  • Over scheduling
  • Burnout
  • Overuse injuries
Over scheduling risks

Over scheduling can lead to increased stress and anxiety and overall poor habits.

It can decrease the amount of time a student can study. Obviously children need to have time to study so they can learn the most they can in school to prepare them for life.

Organized sports do not allow children to interact in an unstructured way with other kids. The time lost in free play can set kids behind peers in social skills.

Being over scheduled often results in sleep loss, which can contribute to mood and behavior changes as well as poor growth.

As families run from activity to activity, they often miss out on family meals. Family meals are important for family bonding and are associated with healthier eating.

When families run through a drive thru or get pizza between practices and games, they are foregoing a healthy balance of lean proteins, fruits, and vegetables.

Burnout

When kids live a sport day in and day out they are at risk of burnout.

A child who once loved soccer or baseball might one day decide they want to quit the sport all together if they don’t have balance in life.

They often plateau or decline in sport performance. This might be a part of a larger depression or anxiety, or simply a desire to scale back or to try something new.

Signs of burnout include moodiness, irritability, trouble focusing, appetite loss, headaches, stomach aches, decreased strength and coordination, and increased rates of illness.

Overuse injuries

Overuse injuries are common when kids do the same activity over and over, day after day without time for adequate rest between activities.

Prevention can include taking proper time to rest, slowing increasing intensity, strength training and rotating types of activity throughout the year.

Some suggestions made in the consensus statements listed above to avoid injuries and burnout include:

  • Rest at least 1 day each week
  • Take at least 3 months off each year (1 month every 3 months)
  • Increase intensity only 10% each week
  • Limit sport-specific repetitive movements (such as pitching)
  • Play on only one team per season
  • Use conditioning programs to strengthen supporting muscles
  • Learn and use proper techniques
  • Keep play fun
  • Play no more hours per week than age (i.e. 12 hours / week maximum for a 12 year old)
  • Insure proper sleep for age
  • Maintain a healthy diet
  • Wear proper sport – specific protective gear that is the right size and in good condition

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When should my child start shaving?

 

In my last blog I discussed the common question about when it’s appropriate to start using deodorant or antiperspirants, which led me to think of all those questions beginning, “When is my child old enough…”

One of these questions: When is my child old enough to shave?

This is another question without a one-size fits all answer.

Girls and boys differ in needs and ages of puberty.

I told my own daughter that she could shave her legs when she needed to shave under her arms, since I know that under arm hair becomes longer during puberty, which is also when leg hairs thicken and grow. This just seemed like an easy answer to me. We are born with hairs on our legs, so deciding when those hairs are too long is tricky. It’s not of a question of age, but one of quantity, color, and thickness of hairs.

When a boy starts to get visible peach fuzz on his upper lip it may be time to consider shaving, but it depends on the hair color, length, and his desires. Some schools include a “no facial hair” policy, which forces the issue.

Kids can be naturally hairier than their friends, making them feel self conscious. Some have dark hair, others light hair. Puberty increases hair growth on the arms, legs, armpit, and in the groin in both sexes. In boys it also increases hair growth on the face. The age of puberty varies widely. Culture plays a part in the family’s decision whether or not to shave body hairs.

The maturity of a child should be considered. A girl with thick, dark hair entering puberty at 9 years of age who is getting teased at school about her hairy legs might have a strong desire to shave, but if her fine motor skills are weak and she cannot safely handle a razor, it might not be appropriate for her to shave yet – at least not with a standard razor.

Options for hair removal

If a child has body hair that is bothersome and they want it removed but they are not able to safely use a standard razor, options might include other forms of hair removal, such as the chemical hair removal products, waxing, electric razors, or allowing a parent to help them shave. Each of these has its own issues to consider.

Chemical

Chemical hair removal products generally work by weakening the hair so that it is easily broken off at the skin level.

These products might lead to skin irritation or allergic reaction, but are well tolerated by most people.

If you are planning to use it on the face, be sure to get a product specifically for the face and test a small area first to be sure they don’t react to it negatively.

Chemical hair removal products are relatively easy to use, can be done at home, and last for several days.

Young children should be supervised so that the chemical does not get on other body parts or all over the bathroom…

wax

Waxing is an option for many girls and women. It can also be used for boys and men, though is less commonly used by men.

The benefits of waxing are that it lasts several days and over time might cause the hair to grow in thinner (or not at all- which might not be a great idea for a boy who one day might want a beard).

It can be painful, which might not be tolerable for some kids.

You can go to a salon for a professional wax, but this is more expensive than the many do-it-yourself kits you can buy at local stores. Look online for tips on how to find the best waxing product for your needs and how to wax.

electric

Electric razors offer the benefit of a safer cut, but can take more time and often don’t get as close to the skin as a standard razor. If your child is using an electric razor, warn about the hazards of using something electric next to a water source (such as the sink or tub). There are many types available, and I would recommend searching for reviews online prior to purchasing. Follow package directions on keeping the razor clean.

razors

If you allow your child to shave with a razor be sure to get a new one just for that child. Never share razors since this can lead to sharing of germs that cause infection.

Talk about when to change the razor blade. It depends on how often (s)he shaves, how large of an area being shaved, and the body hair type. Someone with thick, coarse and curly hair that grows super fast will need more frequent blade changes than someone who is shaving fine peach-fuzz hair off every few days.

Any blade that’s rusted must be changed immediately.

When a blade feels like it’s tugging on the hair instead of gliding smoothly, it is time to change. If you’re using an older blade and notice nicks or rashes or razor-burn bumps, it’s past time to change it.

After each use a razor should be rinsed clean of all hairs and soaps/creams and allowed to dry. Don’t lay it in a soap dish because it will stay wet. Wetness allows germs to grow and encourages rust, both of which are dangerous.

Laser

I am not familiar with laser hair removal, but here’s a blog that covers the risks and benefits from Dr. Michelle Ramírez, a pediatric critical care physician: TIME TO SHED YOUR WINTER COAT? CHECK OUT THE BEST HAIR REMOVAL HACK.

Other considerations

The choice of using a shaving gel or cream or just shower soap is a personal choice.

If you would be most comfortable shaving your child’s skin, you can certainly try this with his or her permission. Be careful though, because if you nick the skin, you will never be forgiven! Kids are like that…

The best time?

When it comes down to when it is the best time to shave, I think it is a very personal decision.

I’m sometimes asked about the bumps and skin irritation that come from shaving. This blog about natural remedies for razor bumps was shared by the author and has some tips that might help.

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When should my child start wearing deodorant?

I get asked all the time when kids should start wearing deodorant or antiperspirants.

When Depends

deodorant, puberty, adolescent, body odorThere’s no standard answer since kids have different needs.

Some kids are active outside and simply carry the smells of the great outdoors and sweat on their body. This isn’t puberty sweat, just musty body odor in most young smelly children. Sweat in general makes conditions ripe for bacteria to grow on our skin, and the bacteria make us smell. Kids enter puberty at different ages, and puberty affects how we smell in addition to many other obvious things because sweat glands become more active.

First things first: get clean!

Body odor is often related to bathing, since some early elementary school aged kids shower independently, but don’t do the best job at actually using soap in all the areas it’s needed. Or they argue about needing to get clean daily. Every other day might work in the winter (if they don’t sweat a lot with play) but in the summer they need a daily cleansing if they smell offensively.

Daily bathing

The first step I always recommend is making sure kids who have that funky smell shower (or take a bath) daily with the same cleanser that the parents use, not a baby wash. Many families buy baby washes for the first year of life and keep using them during toddlerhood and childhood out of habit. Baby washes don’t lather up well (which leads to less body surface areas getting lathered up) and aren’t designed to get the oil, dirt, and smell off like regular cleansers. There really is no need to continue to use these washes for kids beyond infancy.

Talk to your kids about getting soap suds on all body parts. I think using a shower pouf with a body wash makes it fun for kids to see all the bubbles – and it helps them to see what parts are done and which need suds. If your child likes to play in the bath tub, it might help for them to end with a quick wash and/or rinse in the shower, since they’re sitting in the dirty water during the bath. It’s hard to wash the submerged body parts with soap, since the cloth or pouf rinses out under water. They will need to stand to wash the lower half of their body properly.

A note about the poufs

Be sure to show your kids how to rinse the bubbles out of the pouf after the shower or bath and hang it to dry between uses. You’ll also want to wash the poufs weekly. I usually throw them into the washing machine with our towels, but that takes the life out of them more quickly than soaking in vinegar and water.

Hair

It is tricky for kids to massage all parts of their scalp when washing hair, so show them to use their fingertips up and down then side to side to cover all parts of the head. The frequency of how often hair needs to be washed can be debated. Hair can trap pollen and other outdoor smells and the scalp’s sweat can lead to funky odor, so hair needs to be washed at least a couple days per week and daily for those with allergies to pollens that are in the environment at that time.

Face

Kids won’t want to get soap in their eyes so many parents just have them rinse with water, but many kids need to actually wash with a mild soap or cleanser. Eyelids can get what my parents used to call “sleep dust” – little crusties – if they are never washed. You can use a baby “no tears” shampoo to wash eyelashes if needed or a mild soap or cleanser with closed lids and careful rinsing. When kids start getting oily skin on the face they should wash it twice a day. A quick reminder not directly related to cleaning: A daily moisturizer with sunscreen is great all year long for our faces, which are exposed to the sun and elements every day.

Armpits

While it seems obvious when you’ve talked to your kids about having smelly pits, you’d be surprised that it doesn’t always equate to kids being conscious of washing those pits. With soap. Kids just don’t make the connections you think are obvious.

The whole back

It is hard for any of us to wash our own back, so show your kids how to use a back scrubber or wash cloth to reach all areas.

Belly, arms, and legs

Again, have them look to see where the suds are and where they’re missing to hit all the areas.

feet

Show kids how to hold on to something when washing their feet and consider adding a non-slip surface to your shower or tub. Have them wash one at a time so they can stand on the non-soapy foot. Soapy feet are slick!

Between the legs

Kids need to be taught to wash between the buttocks and around their genitals, with special care given to rinsing these areas well. Trapped soaps can irritate the skin and cause rashes, so rinsing should get special attention in these sensitive areas. I really like removable shower heads that can come down to help rinse, but kids can also use several cups of clean water to rinse hard to reach areas. Girls might need to sit in the tub to do this rinsing with a cup because it’s hard to splash the water up between skin folds sufficiently.

Clothing

Kids might have a favorite shirt that they want to wear every day, but clothing (especially shirts, socks, and underwear) must be washed regularly. Putting stinky clothes on a clean kid just makes the kid stinky.
Avoid polyester (except the special polyester in performance wear- designed to wick sweat away) and rayon clothes, since they do not absorb the sweat well. Cotton is a great choice: it absorbs sweat well and is relatively inexpensive.
If kids have sweaty feet, white socks might be better than colored ones due to the coloring irritating the feet. Changing socks when the feet get sweaty, such as after playing a sport, can help. Changing shoes and allowing each pair to dry thoroughly between wears can help too.

Deodorant vs Antiperspirant?

Deodorant is used to cover up smells. It’s often what I recommend for those younger kids who sweat during active play or outside in the heat.
Antiperspirant is designed to decrease sweating and often is mixed with a deodorant. Before puberty a deodorant is probably sufficient, but during puberty our sweat glands are activated and we sweat a lot more, especially under the arms, on hands and feet, and in the groin. It’s personal choice if one wants to decrease underarm sweating with an antiperspirant.
Over the years I have seen many concerns with the aluminum in antiperspirants – everything from it causes Alzheimer’s to it causes cancer. Studies do not support those claims. You can read more about the proposed risks of antiperspirants on WebMD.

When is sweating abnormal?

Sweating is abnormal if it’s excessive for the body’s needs or if a child has other signs of puberty before the normal ages (8 years in girls, 10 years in boys- some sources say 7 years in girls and 9 years in boys).
There are many reasons for excessive sweat that are relatively uncommon, so I won’t go into detail here. If you think your child sweats excessively or is entering puberty too early, please take him or her to their doctor to be evaluated. (A phone call isn’t sufficient because they will need to look for associated signs and symptoms on an exam.)

Next up…

I will cover “When should my child shave?” next since it’s also a very common question!
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