Got Teens?

introduction

Who Are the Doctor Moms?

(AND, MORE IMPORTANTLY, WHY YOU NEED THIS BOOK)

DR. JENA WIDER

I am on the edge, straddling two worlds, and my anxiety is rising. As I write this, my ten-year-old daughter has but weeks left in elementary school, a place where she has been sheltered, looked after by teachers, recess monitors, and even the bus driver. This preteen world seems much safer than what lies ahead.

My own memories of middle school are hazy, though I remember being nervous, having books knocked out of my hands, and also being expected to act grown-up. But what about the world my daughter is entering? She, too, may be shoved around in the halls, and she, too, may be nervous. But her world also seems more fraught; it is one filled with gadgets and images that heighten both my anxiety and hers: iPhones, texting, YouTube, the Kardashians. It makes my head spin. I have spent the entirety of motherhood trying to protect my daughter from every scrape, bruise, and bump, trying to shield her from every unkind word or mean-spirited jab, and now that she is entering middle school, I can only hope that I have helped her harness a sense of independence, a sense of confidence, and the ability to make good, healthy decisions. My anxiety stems from a nagging fear: Have I in fact accomplished this as a parent?

As a physician and educator, on the other hand, I know what to expect. I have given hundreds of talks to parents on adolescent development, health, and sexuality education. In the questions I hear from parents, I sense desperation in their voices as they look for guidance and advice on how to approach their children or even initiate a conversation about the tough issues sure to arise in the near future. One mom, for example, had walked in on her son masturbating and had no clue if or how to talk to him. Another mom was worried that her fourth-grade daughter’s unibrow was so unsightly that the girl would be teased. Her daughter, on the other hand, was oblivious. When is the right age for grooming and beauty treatments, and would calling attention to this girl’s eyebrows actually make her more self-conscious? These are but two of the many similar questions I hear all the time that capture parents’ anxiety about handling these situations in this new era of their child’s development the right way.

What these parents are really asking is: Will I be able to communicate the important facts and lessons about puberty and adolescence to my children (who seem more interested in texting than in talking)? Will I be able to protect my children from embarrassment—or worse?

What I want to tell them is: Yes, yes, yes. You may have to open yourself up to unfamiliar and perhaps uncomfortable conversations at first, but it will get easier. Arm yourself with correct, solid information, and really think through your communication strategies. Because if you’re anxious, you may be tempted to not even deal with these issues at all. More important, what I want to tell parents is that such conversations shouldn’t even be “issues”—they should simply be a normal part of growing up. At the same time, though I am armed with these facts because I am a doctor, I am also a mother, and I totally get it.

DR. LOGAN LEVKOFF

Although my children are years away from middle school, they ask many of the same questions that older kids ask. Sure, part of that curiosity comes from the fact that because I am a sexuality educator, they are the consummate sex-ed guinea pigs: if they ask a question, they always get an answer. As such, they’ve learned to ask lots of questions. But they don’t ask just because they are my children (as much as I’d like to take all the credit). They ask because all of us are curious about our bodies and about that societally forbidden word: sex. While younger children and older adolescents may have identical questions, they ask for different reasons, obviously. Older children are curious about sex and relationships and bodies because those concepts relate directly to them. Younger children are just trying to decode language and make sense of the world around them.

Even though my children are not pubescent yet, I am acutely aware of the need for them (and their friends) to develop a healthy, positive sense of self. I see it going on in the classrooms regularly: grotesque slang references to body parts; language that perpetuates a vicious sexual double standard; jokes (often inadvertent ones) about being “gay.” I cringe at the thought of others sabotaging the work that I’ve been doing with my son and daughter since they were born; however, I know that our ongoing conversations will always be a good litmus test to identify the competing (and questionable) information and values they encounter.

But, like Jena’s, my two worlds are constantly colliding. As an educator who teaches schoolchildren, I am on the front lines of adolescent angst and am frustrated that my time with my students is limited to a forty-five-minute class period. But as a parent, I know that sexuality education doesn’t take place only in schools. It also goes on daily in our homes and in carpool lines, because parents are the primary sexuality educators for our children. We are the ones who tell our children that they are beautiful no matter what, that rejection hurts, that they will eventually develop—or that their peers will catch up. We do the heavy lifting. What we teach our children about puberty, sex, and critical thinking directly impacts the choices they make. And we can’t opt out of this. It’s our job, and we can do that job very well.

But that’s not exactly what happens, right? We stick our heads in the sand and pretend that if we don’t acknowledge it, it won’t happen. Or we rely on teachers to do it, but what happens when our children have a question, or an issue arises, and they are no longer sitting in their sex education class—if they even get one of those at all?

Sure, this may sound harsh, but it’s said with love. Seriously. My own girlfriends have the same issues that most parents have—they don’t know what to say or how to say it—until they sit down with me. I’ve spent many unbillable hours with them (typically over glasses of wine or margaritas), encouraging them to talk and empowering them with support and guidance.

THE DOCTOR MOMS

So here we are. Let us be your friends. Imagine us sitting next to you on a banquette at a restaurant somewhere. We’re laughing, we’re talking, we’re sharing stories, and we’re giving you the facts and support that you need to tackle challenging subjects. That’s who we are for the people in our lives; we want to do the same for you.

Not only are middle school-age children entering a new world with many unchecked influences from peers and the media, but they are leaving an old world in which we—their parents—intimately know every angle and curve of our children’s bodies. All of a sudden, these children whom we raised want privacy for those bodies. And we are caught between the emotional reality that our babies are growing up and the desire to (quite appropriately) respect the emotional and physical privacy that our middle schoolers crave. Understandably, this anxiety can lead to inaction—and even to inadvertent ignorance.

Study after study has suggested that good, honest, open communication between parent and child positively influences a child’s ability to make responsible choices. So where is the line between this openness and privacy? Pubescent children likely crave both. Yet many of us don’t realize that we should begin talking to our children about physical and sexual development much earlier than we do. In addition, many of the parents we talk to don’t follow through on the small openings their children provide and instead wind up cutting short communication at essential, pivotal times. In short, many parents have lost the ability to operate on instinct, so they don’t say anything.

Why don’t we say anything? At the heart of it, we’re probably embarrassed. We remember many less-than-ideal moments, including these two:

Logan was the first girl in her class to wear a bra (and get her period). When she was in sixth grade, a boy named Jeffrey (whom she despised) tried to grab her breasts. Logan pushed him off her—he never even came close to them—but he told her entire class that she had “soccer-ball tits.” She was eleven, and she was mortified.

The summer Jena got her period, she was turning thirteen and attending a coed sports camp. Her mom told her that it was okay to swim while menstruating—no reason to stress. So, like any other adolescent girl, she put on her bathing suit, wrapped an Always pad with wings around the bottom of the suit, and jumped off the ten-foot diving board into the deep end. She came up first, followed by her pad, which was the size of a personal pan pizza. Instead of disowning the incident, she grabbed the pad and quit camp the next day, humiliated.

MAYBE THIS KIND of embarrassing moment for you was getting an erection while giving a class presentation or having a bra snapped or developing a huge whitehead on school-picture day. It’s no wonder that when our children reach puberty, we feel their own awkwardness so acutely. And when our memories of that time in our own lives continue to stand out for us, it can be difficult for us to approach our children’s questions about their development and sexuality with openness and ease.

While it would be nice if our children never had to experience a single embarrassing moment in their lives, that isn’t going to happen anytime soon. Adolescence is chock-full of mortifying moments for children—not to mention parents who may flounder when confronted with a from-left-field question about, say, Brazilian bikini waxes. But, when armed with up-to-date, accurate information and a few strategies for handling the tough conversations, we have the opportunity (and, dare we say it, responsibility) to give our children the information and understanding they need to survive the precarious, precious time that is puberty. (Imagine how different your experience would have been if you had been equipped with solid, positive, loving information, instead of relying on the unchanged-since-1975 puberty-and-sex video that that you got in that sad excuse for a health class in the fifth grade.)

Besides, we like to think that we are different today. Maybe we could call it cool parenting. Maybe we could call it new-world parenting. We suppose it doesn’t really matter what label we slap on it, though. Our parenting responsibilities are the same; it’s the world that looks—that is—different.

This point hit home for Logan one day when she was with her children in her car, listening to the radio, and “Mother Mother,” by Tracy Bonham, came through the speakers. In her previous life, before she had children and a slew of grown-up responsibilities, Logan sang this very song in a band at a dive bar in Queens, New York. She still remembers the lyrics perfectly: “When you sent me off to see the world, were you scared that I might get hurt? Would I try a little tobacco? Would I keep on hiking up my skirt?” Back then it seemed like the perfect song of rebellion, a means of saying: Screw you! I’m on my own. And I’m, well, sort of fine about that. As a twenty-one-year-old, Logan could belt it out and imagine singing it to parents all over the world. Now she makes sense of it differently.

As she looked at her children rocking out in the backseat, she wondered if what Bonham sang about her own mother rings true for Logan as a mother today. Sure, she is scared that her children might get hurt, but that’s about it. She definitely doesn’t worry about her daughter hiking up her skirt (actually, she expects it); as for trying tobacco, she accepts that there are things in life that her children will try, against their (and Logan’s) better judgment. However, she hopes that the way she talks to her kids during their formative years can help them to reduce any harm that comes from experimentation.

It’s this type of reality-based parenting that we need today. No more judgments. We need to listen, we need to talk honestly, and we need to remember that we were young once, too.

1

Puberty, Body Development, and Anatomy

PART 1:

PUBERTY AND THE BODY

SO, YOUR ONCE-ANGELIC, patient, and loving child has recently turned into a werewolf: she snaps at you, loses her cool easily, and goes right to her room when she gets home. When you ask, “How was school?” her response is barely audible. Sometimes she’s fine and you get glimpses of the little girl with pigtails who used to hold your hand while watching Dora the Explorer; other times you barely recognize her. She’s moody, emotional, angry, and hard to talk to; you feel at a loss. Trust us, you are not alone. Millions of parents before you have dealt with this, and millions of parents after you will, too. Your child is going through puberty.

From a biological standpoint, puberty is a progression of physical changes that turn your child’s body into the body of an adult who is capable of sexual reproduction. It involves several stages that occur over a number of years. The onset of puberty can vary from person to person but always starts when the pituitary gland, a bean-shaped gland that sits at the base of the brain, releases special chemicals, called hormones, that signal different parts of the body. For boys, the hormones travel through the bloodstream and tell the testes to begin making testosterone; for girls, the hormones take the same path through the bloodstream but tell the ovaries to start producing estrogen. These sex hormones, estrogen and testosterone, cause most of the changes that your child will experience during puberty, including voice changes; breast development; facial, underarm, and pubic hair growth; genital growth; and menstruation.

But it’s not just their bodies that are affected; it’s their minds, too. The process can also have a dramatic effect on your child’s psychosocial and emotional development. And that’s why frequent mood swings, excessive emotional reactions, and a wide variety of feelings—like confusion, sadness, and anger—can play a central role.

We’ve given you a quick overview of the biology of puberty, but, as we all know, the physical changes are only one part of this transitional process. So take a deep breath, because this is going to take a while.

If you can manage the time and the emotional cost of a trip down memory lane, this is a good moment to bring out the old photographs. Yes, you know what we’re talking about—those awful pictures of you with the mouthful of braces and the shaggy-dog haircut (okay, that was Logan in fifth grade). Put yourself back in that time when everything felt overwhelming. Your body was changing, your emotions were running amok, and it seemed like your parents just didn’t understand you.

Remember those days? Well, now you are the parent who doesn’t understand. So do yourself a favor and let your children know that they are not the first (or the last) to feel this way. And don’t just tell them that you understand—show them. Yes, show them those awful photos. Take out your old yearbooks so that they can see how many millions of young people before them fumbled around during this time—including their parents.

Seriously, being perceived as human is half the battle for you. So, while you may want to yell and scream and lock up your kids until puberty ends, that’s just not realistic. It’s time to play nice and, in this case, play to their sensitivities, because whether you like it or not, you’ve been there. (And if you happen to be a perimenopausal woman, you are probably currently experiencing these highs and lows, too. Use that to your advantage.)

Try to relax; it will keep things in perspective. In the meantime, we’ll help you answer some of the most common questions raised by parents of adolescents.

Ask a bunch of pubescent kids what the most annoying part of puberty is, and many will tell you that it’s acne. No one likes to get pimples, but almost everyone gets them at one time or another, during puberty and beyond. Acne is caused by the same hormones responsible for the other changes that your child will experience during puberty.

As the level of puberty hormones increases in the body, the production of oil, known as sebum, increases as well. When sebum builds up to higher levels, it can block the pores or ducts of the skin. Dirt, bacteria, and dead skin cells can then build up in the pores and cause pimples to form.

There are many different types of acne, and it can occur in varying degrees of severity, depending on the person. If the top of the blocked pore closes and protrudes out from the skin, a whitehead forms. If the pore gets blocked but stays open, dirt and debris can accumulate and result in a blackhead. Acne that is deeper in the skin and thereby causes hard, painful cysts is known as cystic acne.

INTERESTING FACTS ABOUT ACNE

        More than 75 percent of adolescents, or three in four, will experience acne at some point during puberty, according to statistics from the US National Library of Medicine in Bethesda, Maryland.

        Acne most commonly shows up on the face and shoulders but can also appear on the trunk, arms, legs, and buttocks.

        Boys are more likely to get severe acne than girls.

        Severe acne is often an inherited condition, so if you suffered from it as a teenager, your child is more likely to experience it during puberty as well. (Hey, remember what we said earlier about sharing your experiences? Here’s a perfect example. If you had acne as a teen and haven’t burned those pictures, take them out!)

        Acne can flare up during different times in a girl’s (and woman’s) menstrual cycle, especially in the week or so leading up to menstruation.

        Recent research disproves the link between chocolate, nuts, and greasy foods and acne, but diets high in refined sugar may play a role in skin issues for some people.

Acne can be very disconcerting for your child; they wouldn’t be the first kid to want to hide under the bed to avoid a middle school dance. Even a mild case can send your child into a tailspin of self-consciousness, so definitely take their concerns seriously.

The good news is that there are preventive measures that you can encourage your child to take to lower their risk of acne breakouts. Keep in mind the factors that trigger acne, including poor hygiene, stress, cosmetic and hair products, certain medications, humidity, and sweating.

Encourage your child to:

        Develop a good cleansing program that consists of washing their face each morning and night with gentle soap and water.

        Stop touching their face. Hands are full of bacteria and can trigger an acne breakout.

        Keep their hair away from the face and avoid hair products (like hairspray and gel) that can clog pores.

        Change and discard razors frequently, especially if they are having facial breakouts.

        Try over-the-counter medications, like salicylic acid and benzoyl peroxide, which may help lower the incidence of acne.

        Bring in the professionals. See a dermatologist if a daily cleansing routine and over-the-counter medications aren’t working. The doctor can prescribe stronger medications that help keep acne under control.

Here’s the thing about acne: It looks awful, but young people incorrectly associate it with being dirty or greasy, even when they are meticulous about washing their face and body.

Everyone will have a pimple (or ten) at some point in their life. We still get them now. It’s never fun, but, well, things happen. But in addition to your child’s self-consciousness about the way they look, there is also the issue of how the outside world perceives them. Your child’s face is the one thing that people get to see instantly. And if they aren’t happy, they are going to want to hide their face from the world. What we need to do is give them the best tools available for bringing that face back into the open.

And they’re not alone. Even kids’ favorite celebrities are becoming more public about their tales of acne-ridden skin. Katy Perry and Justin Bieber are just two examples of pop stars who have appeared in advertisements for acne treatments, complete with photos of their broken-out faces. While we don’t always buy into what celebrities say or do, in this case we think it’s brave of them to put their “worst” face forward.

Though it may seem silly for our children to care about what their favorite stars think, they do. They want some way to connect with their idols. Showing them that the people they admire also deal with acne may be a helpful way for you to connect with your kids.

Getting a good night’s sleep is particularly important during puberty because the body is changing and growing rapidly. During this time, children need at least nine hours of sleep every night, but getting that much can be a challenge. Thanks to all those hormones, an adolescent’s body clock shifts during this time and makes it harder for them to wake up in the morning, even if they have had nine hours of peaceful rest. Many kids report that they don’t start to feel sleepy until later but that they then need to sleep in. This is usually impossible on the weekdays because of school. Others report that they wake up once or twice during the night, instead of sleeping straight through to the morning. As a result of these changes, many kids walk around chronically sleep-deprived.

Fatigue and exhaustion are issues for people of all ages, but they can have unique consequences for developing adolescents. Children who are sleep-deprived often have a harder time concentrating and remembering things, which can negatively impact their schoolwork. Sleep deprivation can also lessen a person’s ability to deal with everyday stresses. Middle school is a time of anxiety for many students, a delicate act of balancing new academic challenges and social pressure. Add sleep deprivation to the mix, and kids often feel overwhelmed, which can in turn exacerbate the existing irritability and moodiness that come along with puberty. A chronic lack of sleep can also lower teens’ immune response, making them more vulnerable to getting sick.

We all know how tough insomnia can be. Try to share a story or two with your child to let them know that it’s something we all have to deal with from time to time. Nothing bad will happen to them, other than their feeling sleepier than usual. Their bodies will most likely make up for lost sleep over the next few days. Jena remembers staying up late to study for a midterm exam in tenth grade; when she finally went to bed, it was well past 1:00 AM. But she couldn’t fall asleep and became more and more stressed watching the clock. She finally got up after a long struggle and watched one too many Family Ties reruns. She ended up doing fine on the exam, despite the extra stress, and slept like a baby the next night.

One of the best things you can do as a parent is to encourage proper sleep habits. Helping your child maximize the amount of sleep they get can lessen the stress cycle and promote their ability to manage the academic and social challenges they may face. Here are a few tips to keep in mind:

        Establish a routine: Your child should go to bed and wake up at roughly the same time every night and morning. Studies show that changing the schedule too often can deregulate their internal clock.

        Avoid caffeine late in the day. For some people, this means no caffeinated products—which include coffee, tea, certain soft drinks, and chocolate—after 3:00 PM. For others, it can be later.

        Exercise is great, but not too close to bedtime. Working out too close to bedtime can interfere with a good night’s sleep because the endorphins pumping through your child’s body will rev them up.