Problems at puberty

Puberty is the normal process by which our bodies change from those of children to those of adults. For girls it includes changes in hormone levels, body shape, spots and periods, growth spurts, and fitting in with other identi-kit adolescents! For boys and girls it can be an emotionally volatile time, as the children begin to develop and experiment with their new identity, form their own values and friendships, and explore their place in an adult world. The bodily changes usually happen between the ages of 11 to 13, and young people often feel a heightened sense of being different if they develop more slowly than their friends. The pattern of a child’s development is influenced by the pattern their parents experienced, for example if Mum had her first period when she was thirteen, this is the age when her daughter is likely to do so.

Any young people with a serious illness can experience delays or interruptions in their development because their body is using much of its available energy to cope with the illness. Young people with chronic arthritis, who have had treatment for many years, commonly find that the changes at puberty are delayed. In a very, very few people with arthritis, the normal growth spurts do not occur.

To be the smallest, and most physically child-like student at school is distressing and a daily challenge for young people. These young people need a lot of support from understanding friends, parents and clinicians, but this help is not always available.

What can help if puberty is delayed

• Openly recognise that her development seems overdue, but is far more likely to be delayed not absent.
• Be available to listen to her anxieties, heartaches and daily challenges at school that she may believe are due to her lack of height or development.
• Emotional encouragement and verbal praise for her attitudes, achievements and for just ‘being her’, by BOTH parents are very important. Dads can make a huge difference in helping a young person feel cherished and valued.
• Address the practical consequences together:
   - help the young person find fashionable clothes even if they will need adjusting in order to fit a smaller person.
   - allow her perhaps to wear shoes with higher heels for short periods when she is with friends at social events.
   - help her learn to use age-appropriate make-up and hair styling that promotes their confidence and self-esteem.
   - encourage her to develop her interests and skills with different groups of people (for example playing musical instruments, acting, artwork, or cooking) because these help her develop confidence and assertiveness and an awareness that people come in all shapes and sizes, and are still interesting to be with.
  
• If you are really worried, talk together with the rheumatologist or paediatrician who may be able to discuss strategies that may help. In exceptional circumstances, this may include using growth hormone but will involve extra clinical examinations, visits, blood tests and greater focus upon symptoms rather than getting on with life.
• Be sensitive about how aware, anxious or distressed you are. Is it you who needs the child to grow/develop faster?
• Try to keep a sense of humour and make space to do ‘treat’ things together which will at the very least cause a distraction for a few hours!