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Anticipatory Guidance for Adolescents (ages 11-18):

Growth & Development: Adolescents will go through their final growth spurts during this time. Females will typically grow 2-3 additional inches after menarche and then stop. Males will continue growth for 2 years longer than females. Puberty occurs during this time, which is the process of developing their secondary sexual characteristics and fertility. With puberty, comes significant changes in their emotional, cognitive, and social climate. It is important for parents to familiarize yourselves with the normal progression and developmental changes of puberty and have open discussions with your child about what to expect and how to manage this without shame or discomfort. Females begin these changes before males, as do certain races. Parents need to be aware that, while the adolescent can appear to be capable of independence, their prefrontal cortex is not fully developed and can impair their ability to have good judgement and decision-making (Garzon et al., 2025).

Nutrition: When your child is going through a growth spurt or starts their period, they need increased amounts of calcium and iron in their diet. Adolescents have independent eating habits by this age and may express desire to adhere to alternative diets, like vegan or vegetarian. If so, please consult a dietician to ensure that they have the information and tools to continue to meet their metabolic needs. Additionally, this is an important time to pay attention to any pathologic or maladaptive eating disorders. While it is not uncommon for them to have inconsistent eating patterns, like eating snacks late at night or skipping meals, you need to make sure that this is not persistent and/or motivated by poor body image or peer influences (Garzon et al., 2025).

Sleep: Adolescents need 8-10 hours of sleep per night. This age group experiences more sleep disturbances than any other pediatric population. When a child enters puberty, their natural circadian rhythm shifts forward by two hours. This is why you notice that your child has a difficult time going to bed and waking up early. This is complicated by early start times for school and busy after school schedules with sports/clubs/homework. The American Academy of Pediatrics has urged schools to move back start times for this age group in the past unsuccessfully, as this forced wake time can lead to long term issues from sleep deprivation (Garzon et al., 2025). As parents, do your best to foster a healthy sleep routine that accommodates your growing childâ€™s changing needs.

Safety: Adolescents need to be closely monitored for high-risk behaviors, as these lead to a significant portion of morbidity and mortality for this population. This includes things like experimentation with drugs/alcohol/smoking, sexual activity, disordered eating, unsafe/distracted driving, self-mutilation, fighting, etc. Parents need to know where their adolescent is at all times, monitor social media and internet use, communicate clear boundaries and uphold consequences, and model good behavior (Garzon et al., 2025).

What influences have the greatest effect on these areas during this time?

Adolescence is heavily characterized by their transition from a child to an adult. During this time, puberty occurs and there is a shift from their parents as the greatest influence in their lives to peers and media (Garzon et al., 2025). It is essential that parents establish a strong relationship and open communication with their child prior to this stage in order to remain involved and engaged in their needs during this time. While it can be uncomfortable for the parent and the child to discuss the bodily changes of puberty and sexuality, it is so important and adolescents want the information, despite how they act and what they say. Parents should not rely on peers or school programs to educate their children about sex and how to care for their new adult bodies. One study showed that over 80% of adolescents expressed a lack of information on pubertal changes were an unmet sexual and reproductive health need (Agu et al., 2024).

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