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Tips for getting through the pre-teen and teen years | Ask the Pediatrician

Doctor's advice for anticipating and getting through each stage of adolescence

Parenting is a fantastic exercise in flexibility. Just when we think we have it all dialed in, our kids do something new (walking, driving) and we need to recalibrate. Let’s talk about the stages of adolescence and what to expect as our kids go through these years.

Adolescence is wild: From changing bodies to emerging identities, there is a lot to unpack. Teens don’t need their parents in the way they did when they were babies, but they still need us to be involved and present and to help them navigate their world. Keeping the door open for questions and support, while honoring their need for privacy and socializing out of the home, is a tightrope to walk. Honestly, we are never going to get it perfect, but by knowing what to expect at each stage, having a sense of humor, and enjoying the ride, we can support our ever-changing adolescents.

It is helpful to think about adolescence in three stages: early, middle, and late. While no one follows the book completely, here is a broad brushstroke of each stage:

pre-teen or teen


Early adolescence (ages 10 to 13)

Early adolescents grow quickly, especially girls, or those assigned female at birth. Breasts will begin to develop during this stage (which leads to many conversations about bras). Menses typically occurs in early adolescence, about 2-3 years after breast development starts. Talking about menses early helps to demystify it: It is perfectly normal, not gross, and you can still do sports or anything you want when you are having your period.

Boys at this age, or those assigned male at birth, will notice that their testicles increase in size. Everyone has an increase in body hair and body odor. Our budding teens may not even realize this, so it may be a good time to gently drop some deodorant on their beds.

[ More from Dr. Block: Why does my kid suddenly stink? ]

Although your early adolescent will writhe and cringe when you talk about upcoming body changes, they will also listen. Sometimes checking in or having brief conversations in the car are low-pressure times when kids can get specific questions answered or you can share a nugget of info. There are also wonderful classes and books for children to peruse. My kids went into complete agony when I first gave them a book about puberty. They then hid the book — but only after reading the whole thing!

It is common for children this age to begin to explore their moral thinking and identify their ideals. Kids in early adolescence may also start to question their gender identity. While early adolescence is a time of concrete thinking, it is also a period when children start to wonder about their role in the wider world. All of this while feeling moody, engaging in limit testing, and exploring privacy — and sometimes wanting to be hugged and cuddled like little kids.

pre-teen or teen

Middle adolescence (ages 14 to 17)

Middle adolescents continue to cope with changing bodies. Boys, or those assigned male at birth, often have growth spurts and puberty-related vocal  changes (“voice cracking”) during this stage. Girls, or those assigned female at birth, typically have regular menses by now. All teens can develop acne. If you notice your child has acne, definitely make an appointment with their provider. Acne can be treated, and there is no need to suffer. If you notice it, you can be sure they notice it, even though they may not mention it.

Middle adolescents have increased impulse control and are somewhat better at complex decision making. That being said, there is definitely a focus on peer pressure and boundary testing. Teens at this age are working toward more independence, and this often means less time with family. This is also a time when many develop romantic and sexual relationships. For teens of all genders, self-stimulation, also called masturbation, is common. Open conversations about consent, sexually transmitted infections, and pregnancy are really important.

Late adolescence (18 to 21 … more or less)

These are your college students or young adults, new to the work force. Late adolescence is defined by a combination of social and emotional development milestones. Most teens are through the physical changes of adolescence and have increased individuality and impulse control and can better gauge risk and reward. This is often the stage where your relationship as a parent change to a more “adult” one with your children, even if they’ll always be your little ones.



Help your teen navigate the changes

Recognizing the transitions of adolescence and helping your child anticipate them can make a confusing time easier for both of you and can support healthy development.

  • Recognize their feelings. Keep open communication about physical changes, relationships, and sexuality, and accept they are working through big changes.
  • Set clear boundaries and limits. Have conversations about risky behaviors and offer chances for independence and privacy.
  • Stay positive. You may be worried about them or anxious about some of what adolescence brings, and they may be too. Staying realistically positive gives them a path forward.
  • Ask for help. Adolescence is a wild ride. Talk to your health care provider or a mental health counselor if you have questions.




More from Dr. Block and Kaiser Permanente in Seattle’s Child:

About the Author

Susanna Block

Dr. Susanna Block, MD, MPH, is a pediatrician with Kaiser Permanente in Seattle and lives with her family in Queen Anne.