Puberty: Tips for Parents to Prepare with Dr. Edith Bracho-Sanchez

Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

 This week we’re diving into what may be the most awkward, yet pivotal moments of a person’s life: puberty. 

I had a chance to talk with Dr. Edith Bracho-Sanchez, a pediatrician at the Ambulatory Care Network at NewYork-Presbyterian and Columbia University Irving Medical Center.

We talked about the fact that puberty is happening earlier and earlier in children. Dr. Bracho-Sanchez shared some potential reasons behind this trend as well as tips on how parents can talk to their children about those big emotional and physical changes. 

Faith: Hello, Dr. Bracho-Sanchez

Dr. Bracho-Sanchez: Hello, Faith. It is so nice to be with you.

Faith: So today we’re talking about a topic that we’ve all been through, but maybe don’t know everything about. So can you tell us, physically and scientifically, what is puberty?

Dr. Bracho-Sanchez: It really starts in the hypothalamus. It is a small little part in the brain that sort of drives all the hormones in the body. And the hypothalamus tells the rest of the body what to do.

In girls, it starts with the breasts getting a little bit larger. In boys, it starts with the testicles getting a little bit larger.

I hope there’s no taboo words in this podcast because we talk about things by their name.

Faith: Go for it.

Dr. Bracho-Sanchez: It sort of demystifies a little bit of what’s going on, right?

So we’re talking about a hormonal process that leads to physical changes in the body, and it is a period of understanding yourself, understanding your body, of growing, of transitioning into the next phase of your life.

And my hope is that really there is an adult that is guiding the conversation.

Faith: As I understand it, during puberty, the hypothalamus is releasing what are called… gonadotropins. Is that right?

Dr. Bracho-Sanchez: Yes!

Faith: And so hair, right?

Dr. Bracho-Sanchez: Hair.

Faith: Voice changes?

Dr. Bracho-Sanchez: Definitely voice changes. It’s one of the things that signals puberty in boys.

There’s also a growth spurt that happens. It happens a little bit earlier in boys, but definitely happens in girls as well.

Along comes all the conversations around that as well, right? I want everyone to know and be prepared for that being part of puberty too, right? Like noticing who got a little taller, who got a little hair, whose voice changed. Like, all of that is happening as kids relate to their peers.

Faith: Do parents always know it’s happening? Puberty comes in so many bursts and starts and some of it kids may not articulate, right?

Dr. Bracho-Sanchez: Yeah. What I see in my clinic is that parents know because they notice things like… they smell a little bit.

Faith: Yeah.

Dr. Bracho-Sanchez: So there’s little things that come up. Or the other thing that I’ve had come up is changes in shoe sizes.

Faith: When should parents start having conversations about puberty with their children? I’m going to guess before puberty starts?

Dr. Bracho-Sanchez: Absolutely before puberty starts. And I actually think as soon as kids develop body awareness and start pointing to body parts, right?

So my child is one and a half. He already can point to his head, to his ears, to his tongue, to his nose, and I’m starting to say, “where’s your pee-pee?” But the minute he’s able to articulate body parts, you bet he will be calling it a penis. Right? Right now we’re just developing a little bit of body awareness. If you can say “arm”, if you can say “leg” – you should be able to say “penis.” You should be able to say “vagina.”

And we can start to talk about it in those terms as like a positive thing to prepare them really?

Faith: Absolutely. I have found that making sure it’s a family conversation is really important.

Dr. Bracho-Sanchez: A lot of what I see in my clinic is, you know, a mom who tells me “I have not talked to my boy about this, but I asked dad to talk to him about it.”

That thinking that only dad can talk to the boy in the family, or only mom can talk to the girl in the family – you can certainly model. But it is so important that we don’t silo kids.

And if you think about the environment that we want our kids to go to school in, imagine if we all were confident that when a girl gets a period, she’s not going to be mocked, ridiculed or feel stigma for asking to go to the bathroom or for having a tampon in her pocket. Right?

Faith: Or to be surprised by it or have any shame whatsoever.

Dr. Bracho-Sanchez: Exactly.

Faith: What are some other tips that you have to begin the puberty conversation?

Dr. Bracho-Sanchez: Always start with “what have you heard?” When you do that, you open the space for kids to articulate their fears. You also open the door to learning about misconceptions because when we don’t fill that space for them, when we don’t provide them with good, accurate information –  just because we didn’t do it…

Faith: …other kids will!

Dr. Bracho-Sanchez: You know that other kids in their classroom are going to be talking about these things, right?

So when you ask, “What have you heard about this?” You get all that information, all of those things that they may have heard from classmates, on TV, social media- oof, which is a whole other thing these days – but really, you open the door to that.

Faith: I love starting with “What have you heard?” because then the child can present his or her thoughts and feelings at their level.

Then what do you suggest that a parent says to help children understand what’s going on?

Dr. Bracho-Sanchez: Different families have different communication styles, right? And different families may feel like they can be more explicit or less explicit.

So you absolutely should be telling your child what’s going to happen to their body and normalizing that.

And how much more you want to share – it’s really sort of a gradual thing that you start to lean into as a family with what works for you as a family. It doesn’t have to be a one time, “Sit down, we’re going to talk about all of this” conversation.

You start with giving accurate little bits of information, addressing fears, “what have you heard?” All of those good things. And then you continue the conversation.

Faith: I also have found myself empathizing when I talk to my kids about puberty, because it’s my lived experience too. It’s telling them, “Hey, this happened to me and this is how I felt about it.” And I felt lots of things at once.

Dr. Bracho-Sanchez: When you do that and you show your vulnerability and how this affected you and how you went through it, you are telling your child it is OK for you to feel this way.

I’ll tell you, Faith, a story. This poor little girl knew nothing about puberty. And one day, as we all do, she bled. She thought she was dying, Faith.

Faith: Hmm.

Dr. Bracho-Sanchez: Looking back, like after we hadn’t had a whole conversation with her, the mom talked to her. Then, you know, she made an appointment with me. We were able to laugh about it. Right? Like, oh my gosh, you thought you were dying about this thing that happens to every woman.

But in the moment, it can be so scary for a child who’s not prepared for this.

Faith: Do you have books, movies, resources that you recommend? I have to say what’s coming to mind is the movie Turning Red.

Dr. Bracho-Sanchez: Turning Red is so good. It really, really normalizes it if people haven’t watched it at home. I think that’s where I would start these days.

There are definitely books. I hesitate to send parents to a million places to talk about something that’s really simple in a way if you embrace it.

You just need to sit down and talk to your child about something that you know about because all parents know about puberty, really, but I just don’t want to make this more complicated than it needs to be. It’s really not that complicated.

Faith: I think parents do need to trust themselves more as their own North Star. It’s an ongoing conversation.

Dr. Bracho-Sanchez: Exactly.

Faith: Shifting gears, can you talk about this phenomenon of puberty happening earlier and earlier?

Dr. Bracho-Sanchez: When it comes to girls, it is four out of ten girls Faith that are now going through puberty early. And when we say early, just to be clear, for girls, we’re talking about 8 to 13 being the range for beginning puberty.

Faith: So I thought 8 was young. So you’re saying eight is at the low end of the normal range?

Dr. Bracho-Sanchez: It is at the low end of the normal range. Anytime before that though, you’re talking about precocious puberty.

And for boys we’re talking 9 to 14 as the range.

Faith: Just to put this in perspective, in the past century, the age of puberty for girls has dropped almost four years. That is a lot!

Dr. Bracho-Sanchez: It is a lot and it is still going on.

The latest data we have is every decade it’s dropping by another three months. There are some studies that say that these last few years, pandemic years, it may have happened even faster.

Faith: Do we know why the onset of puberty keeps dropping?

Dr. Bracho-Sanchez: So there are studies that show that stress may be related to this, that obesity may be related to this. The certain chemicals in beauty products and things like that can be contributing as well.

And I think where most experts land on this is, it’s likely a combination of factors that are leading to this. It’s a combination of environment and genes that are being activated by environment and other things that are going on in our lives.

Faith: Can you articulate what the mental health consequences are?

Dr. Bracho-Sanchez: Of course. So, it’s really so distressing to so many kids to enter puberty early. And big-picture studies are showing us that kids who enter puberty earlier have higher rates of depression, higher rates of anxiety. And it’s really playing out in all of our homes, in all of our communities.

There’s so many things at play here in the way that children relate to other children, to adults, what we expect of them, that then ultimately leads to those higher rates of depression, of anxiety, of having a poor relationship with their bodies and a whole host of other issues.

And really just to give a trigger warning here: there are studies also showing that girls who enter puberty earlier have a higher likelihood of being victims of sexual abuse. I don’t mean to scare people by this, but it is real. The data is showing this.

If children are not necessarily prepared to enter and navigate different situations — and now adults perceive them differently — it just puts them in a really vulnerable place.

Faith: You and I have been talking about pretty weighty things because these stakes are so high for these kids.

We gotta talk about social media because it pervades all of our lives.

How does social media and technology impact young people’s mental health during puberty?

Dr. Bracho-Sanchez: I think when you see your friends on social media going through changes it can make you feel like you’re going through it with other people.

But the problem with social media is that body expectations are so fake and so not real and so problematic. And I think when you open the door to social media, you really have to prepare your kids to go through that door.

Like whether it is or whether it isn’t the right option for your family is important too. Right? So taking that step back and saying, is my child ready to take in the train that comes with opening the door to social media, right?

It is so much that kids can be exposed to. Some of it can be good, but a lot of it can be really bad.

Faith: What specific steps can parents take to mitigate the bad?

Dr. Bracho-Sanchez: Sit down with your child and go through their feeds and guide them and talk about some of the things that they are seeing.

“What are you going to do when someone posts or says something about you that may not make you feel good?”

Just all the scenarios — and we can’t possibly prepare them for all of them — but what is my child going to do when they encounter some ridiculous TikTok challenge? What are they going to do if they are bullied and have a plan and have your child be part of that plan.

If you take the time to ask those questions, and if you sit with your child and be curious about it, I think social media can become safer or less dangerous.

Faith: It sounds like you’re encouraging parents to lead kids through a kind of lesson in critical thinking.

Dr. Bracho-Sanchez: Yes.

Faith: How can parents and caregivers talk to their children about the mental health aspect of this?

Dr. Bracho-Sanchez: So most kids who have the support of their families are going to be able to navigate puberty and maybe even enjoy, see the humor, you know, embrace it for what it is and things are going to go well.

I think that being intentional is the first step, and it looks different for different families, but opening that door once again, right? And saying, you know, you may feel changes in your mood, you may feel that you have more opinions, maybe…

Faith: …you may feel impatient with us, your parents.

Dr. Bracho-Sanchez: Yes! And just saying, you know, “It’s okay. I’m here. I love you.”

Faith: And remind them that it’s okay to ask for help beyond your parents, right? To talk to people who aren’t mom and dad?

Dr. Bracho-Sanchez: Absolutely. One of the things that have been really good in recent years is that we have made it easier for teens to reach out to us as medical providers, independent of their parents.

Parents may be like, “You mean my child’s going to get treatment without my knowledge?” And what I would say is, we are just there as a resource in the off-chance that they don’t want to worry you.

And sometimes it’s not that your child is trying to hide something from you, although sometimes they might, but a lot of times they’re not trying to hide anything from you. They’re just trying to have a place where they can express concerns and ask for help.

And I would just encourage parents to allow that and to embrace it, knowing that we on the backend will always, always try to involve you or encourage your team to bring you in as much as we can.

We are not as pediatricians going to purposely leave you out because you are such an important part of your child’s wellbeing.

Faith Salie: I can imagine how easy it is for your patients to want to reach out to you.

Dr. Bracho-Sanchez: Thank you!

Faith: Dr. Edith Bracho-Sanchez, thank you so much for joining us.

Dr. Bracho-Sanchez: Of course, Faith. It was a pleasure.

Our thanks to Dr. Bracho-Sanchez

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