Puberty

Dear Lisa,

My daughter is 13 years old and she hasn’t gotten her period yet. All of her friends all so well developed and they all got their periods already. Should I be worried that something is wrong?

“Waiting for period”

Dear “Waiting for period”,

Normal healthy adolescent girls free from any chronic medical conditions usually start puberty between 10 to 11 years old. It is also normal for some girls to start puberty as early as 8 years old, or as late as 13 years old. (1) The change of a child’s body into an adult occurs in stages over the span of 3 to 4 years. There is a normal progression of events starting with darkening of the hair on the legs, widening of the hips and the onset of body odor as the beginning phase. Next breast buds develop as well as the development of sparse dark mostly straight pubic hair. Following this the pubic hair becomes darker, coarser and more curly and begins to spread. You will also see further enlargement and elevation of the breasts. During this stage a female enters a skeletal growth spurt which results in the attainment of 6-11 cm of height per year. When the pubic hair becomes more adult in type and approximately two years after the onset of breast development, menarche or a girl’s first period typically occurs. (1)

Physical examinations by your daughter’s health care practitioner are just as important at this stage of development as they were when she was just an infant. Annual physical examinations can monitor your daughter’s stage of development, screen for abnormalities and provide anticipatory guidance as well as reassurance regarding her sexual development. In particular, girls need to be checked regularly to rule out any skeletal deformities, such as Scoliosis which tend to occur at this time due to the increased velocity of skeletal growth. (2) In addition yearly evaluations can monitor for the development of psychological problems such as depression or eating disorders which may rear their head when a young girl’s body experiences so many changes.

If you notice that your daughter is following these normal steps of development be assured that the process takes time. If you haven’t noticed any of these normal changes or if the progression through these stages takes more than 5 years, it would be a good idea to contact your daughter’s health care provider for an evaluation.

(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York: Delmar Publishers Inc. 1984:438-440.
(2)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass: Year Book Medical Publishers, Inc 1990:80-85.


Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Updated Daily