Overview

Children usually move in natural, predictable steps as they grow and develop language, cognitive, social, and sensory and motor skills. But each child gains skills at their own pace. It's common for a child to be ahead in one area, such as language, but a little behind in another.

At routine checkups, your child's doctor will check for milestones. This is to make sure that your child is growing and developing as they should. Your doctor can help you know what milestones to watch for as your child gets older. Or you can look for sources of information and support nearby. Public health clinics, parent groups, and child development programs may help. Knowing what to expect can help you spot problems early. And it can help you feel better about how your child is doing.

Talk with your doctor about any concerns you have about your child's health, growth, or behavior. Do this even if you aren't sure what worries you.

Your relationship with your child will change as your child gains new skills and develops independence. As your child's world gets bigger, you can help your child grow in healthy ways. Here are a few things you can do. Spend time together. Be a good role model. Show your child love and affection.

What to Expect

The ages 11 through 14 years are often referred to as early adolescence. These years are an exciting time of many changes. Your child grows taller and stronger and also starts to feel and think in more mature ways. You may feel amazed as you watch your child start to turn into an adult. But this can be a confusing time for both kids and parents. Both must get used to the new person the child is becoming.

Each adolescent develops at their own pace. In general, a child grows and changes in four main areas:

• Physical development.

  Adolescence is a time of change throughout the body. Growth spurts usually start around ages 11 to 13. A growth spurt comes before or at the same time as puberty. The doctor may track your child's height and weight using a growth chart. Puberty is when sex characteristics begin to develop. Pubic hair grows. In females, breasts begin to develop and periods start. Males grow facial hair. It's important to reassure your child that these physical changes are normal, whether they occur earlier or later than average. These changes may cause distress for a child whose body doesn't match with their gender identity.

• Cognitive development.

  Children this age typically focus on the present. But they are starting to understand that what they do now can have long-term effects. Even so, they often don't accept that they can be personally affected by them. For example, adolescents may know that too much sun exposure can cause premature aging and skin cancer. But they may not accept that this can happen to them. They're also starting to see that some issues aren't clear-cut and that information can be interpreted in different ways.

• Emotional and social development.

  As they start to move from childhood into adulthood, adolescents feel the urge to be more independent from their families. When at home, adolescents may prefer to spend time alone rather than being part of the family. Often they prefer being with friends, and friends may replace parents as a source of advice. Make sure to include your child in family events even if they resist. Family activities help adolescents form a strong sense of self. This is especially important at a time when puberty can have an impact on their self-image.

• Sensory and motor development.

  Children this age may be a little awkward or clumsy. Their brains need time to adjust to longer limbs and bigger bodies. Getting regular moderate exercise can improve coordination. It can also help your child build healthy habits.

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Common Concerns

The years 11 through 14 are exciting and confusing. Many parents have concerns about how their children will handle the many physical and emotional changes that usually happen during this time. Some common concerns include:

• Your child's transition into middle school or junior high. Things that can cause worry include more homework and difficult social settings. Listen to your child's concerns. Ask if you can help. For example, maybe your child is anxious about joining a school-related activity, such as band or a team sport. You can make sure that your child has the right equipment and knows when and where the practices will be held.
• How your child will handle the challenges of puberty. The way puberty affects your child may in part depend on the timing of puberty—whether your child starts puberty early, late, or at about the average age. It can help if you explain the effects of puberty before physical changes start to happen. (These changes may cause distress for a child whose body doesn't match with their gender identity.) Offer some age-appropriate books about puberty. Share some of your own experiences. And let your child know that it's normal to feel uncertain at times.
• Confusion about what matters to your adolescent. You may remember some of the anxiety of these years. But what causes these anxieties is always changing. Be involved in your child's life. Go to school events, and encourage your child to invite friends to your house while you're home. This can help you learn more about your child's world.
• How to talk about sex. Approach the subject before the information is needed. But don't expect your child to want to talk about it. Offer information little by little. Don't overwhelm your adolescent with too many facts at one time. Be aware that children have easy online access to sexual content and pornography. Monitor and discuss your child's media use.
• Whether your child will avoid tobacco, drugs, and alcohol. Don't smoke, drink, or take drugs if you expect your child to avoid them. Set firm, fair, and consistent limits for your child. Help your child understand the short-term and long-term consequences of substance use. These include falling grades and poor health as an adult. Give your child a chance to practice how to respond when a harmful substance is offered. For example, they can say, "No, thanks," and then change the subject. Look for community programs led by youth (peer education). And talk to your child right away if you see signs of substance use.

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Promoting Healthy Growth and Development

You have an influence during these years. Talk openly with your child. Be positive and provide clear, fair, and consistent rules. You have a big influence on your adolescent's habits and attitudes, choices, and adjustments to physical changes. But realize that your child's way of doing things doesn't have to exactly match yours.

Help your child to identify important issues and to prepare for more responsibilities. Give your child the freedom to figure things out in their own way within the boundaries you have set. Parents walk a fine line between respecting a child's need for independence and privacy and making sure that the child doesn't make mistakes that have lifelong consequences.

• Help your adolescent build healthy eating habits.

  Support your child in making healthy choices by talking about what things make it easier or harder to eat well.

• Encourage your child to exercise every day.

  Exercise helps your child feel good, have a healthy heart, and have a healthy weight. If your child isn't used to exercise, encourage light to moderate exercise, such as walking, at first. Have your child take breaks from computer, cell phone, and TV use and be active instead. Limit TV, video games, and computer time.

• Promote a healthy body image.

  Help your adolescent recognize that the media often produce unrealistic and unattainable images of the ideal body. Stress the importance of being healthy, rather than focusing on looks. Be aware of the things you say about how you and other people look.

• Recognize changing sleep patterns.

  Rapidly growing and busy adolescents need a lot of sleep. Starting sometime in adolescence, your child's natural sleeping pattern may gradually shift. Many adolescents start going to bed later at night and sleeping in. This pattern can make it hard to get up for school. To help your child get enough rest, discourage phone and computer use and TV-watching after a certain evening hour.

• Help your child who is using drugs or alcohol.

  If you believe that your adolescent is using drugs or alcohol, talk with them about it. Discuss how your child gets the alcohol, tobacco, or drugs and in what kind of setting they are used. Seek advice from a doctor if the behavior continues.

• Address problems and concerns.

  Building trust gradually will help your adolescent feel safe talking with you about sensitive subjects. When trying to talk with your child about problems or concerns, schedule time in a private and quiet place. It's okay if you don't know all the answers. For example, you may say, "You know, I need to find out more information and think about this. Can we talk about it later?" Then set a specific time and place to further discuss that issue.

• Prevent involvement in violence.

  Be a good role model for how to handle disagreements, such as by talking calmly. Help your child come up with ways to defuse potentially violent situations, such as using humor or acknowledging another person's point of view. Praise your child for successfully avoiding a confrontation, such as by saying, "I'm proud of you for staying calm." Closely supervise the websites and computer games that your child uses. Talk to your child about healthy relationships. Dating abuse is common among preteens and teens.

• Help your child learn more mature ways of thinking.

  Let your child make as many of their own decisions as possible. This includes involving your adolescent in setting household rules and schedules. Talk about current issues together, whether it be school projects or world affairs. Brainstorm different ways to solve problems, and discuss their possible outcomes. Some families give an allowance. It can help teach your child about financial responsibility.

• Recognize the warning signs of suicide.

  To reduce suicide risk, prepare your child for the emotional problems that sometimes occur between the ages of 11 and 14 years. Offer suggestions on how to handle feelings of inadequacy or sadness, such as keeping a journal, volunteering, and getting adequate rest and exercise. If your child shows signs of depression, such as withdrawing from others and being sad much of the time, talk about it. Get help from a doctor if it doesn't improve.

  Where to get help 24 hours a day, 7 days a week

  If your child talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

  • Call the Suicide and Crisis Lifeline at 988.
  • Call 1-800-273-TALK (1-800-273-8255).
  • Text HOME to 741741 to access the Crisis Text Line.

  Consider saving these numbers in your phone.

  Go to 988lifeline.org for more information or to chat online.

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When to Call a Doctor

Your child's doctor can help you discuss difficult issues with your adolescent if you ever have trouble doing so on your own. Keep in mind that important subjects, such as sex, should be addressed long before you think your child will face them.

Talk to your child's doctor if you are concerned about your child's health or other issues. These issues may include:

• A significant delay in physical or sexual development—for example, if puberty has not begun by age 14.
• Becoming sexually active. Teens who are sexually active need to be educated about birth control and sexually transmitted infections (STIs).
• Being overweight or underweight.
• A significant change in appetite, weight, or eating behaviors. These may signal an eating disorder.
• Severe acne.
• Struggling to understand or use spoken or written language. Having learning problems in school could be a sign of a learning disability.
• Showing signs of attention deficit hyperactivity disorder (ADHD)—such as inattention, impulsivity, and hyperactivity—that are causing problems at home or school.

Call a doctor or a mental health professional if your child develops behavioral problems or signs of mental health problems. Signs may include:

• Expressing a lack of self-worth.
• Acting physically aggressive.
• Dropping out of school or failing classes.
• Drinking alcohol or using drugs or tobacco.
• Having serious relationship problems with friends and family that affect home or school life.
• Showing signs of depression, such as a lack of interest in normal activities and withdrawing from others.
• Regularly experiencing severe mood swings, such as being happy and excited one minute and sad the next.

Routine Checkups

Yearly doctor visits are important to find problems and to make sure your adolescent is growing and developing as expected. During these visits, the doctor will do a physical exam. Your child will get any needed shots. To see how your child is doing, the doctor will also ask questions about their friends, school, and activities.

You also can discuss any concerns you have during these appointments. It may help you to go with a prepared list of questions.

It's a good idea to give an adolescent some time alone with the doctor. This gives your child a chance to ask questions they may not feel comfortable asking you. State laws vary about adolescents' and teens' rights to medical confidentiality. But most doctors will clarify expectations with you and your child.

Adolescents should also have yearly dental checkups to make sure their teeth are strong and healthy. Your child will be encouraged to brush and floss regularly.

Children need an eye exam every 1 to 2 years.

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