Many adolescent females have special needs and concerns about their bodies as they change. As the average age of puberty continues to drift lower (more girls younger than 10 are demonstrating signs of puberty than in the past), the physical and emotional issues are presenting themselves to girls still in elementary school.
According to Ginny Ryan, MD, MA, assistant professor of obstetrics and gynecology and director of the pediatric and gynecology clinic at the University of Iowa, even defining adolescence can be a challenge.
“The only thing experts agree upon regarding adolescence is that it’s a period of transition between being a child and being an adult,” Ryan says. “Beyond that, adolescence varies greatly between cultures and genders.”
For example, there is biological adolescence – puberty through the termination of growth -- which the World Health Organization defines as being between 10 and 19 years old and the Centers for Disease Control says is between 10 and 24 years old. From the cognitive perspective, it’s the development of ability to reason and think abstractly. A social definition says adolescence is when people begin taking on adult roles.
“We may not be able to define it but parents know it when they see it,” she says with a smile.
Ryan says investing in the health and development of adolescents is crucial.
“One in five people alive today is an adolescent. That’s a time of major physical and psychological change, as well as great changes in social interactions and relationships. In many ways, it’s a time during which will determine how a person will view and interact with the world,” she says. “Keeping young women healthy and well isn’t limited to what we do in the doctor’s office. There are issues of general wellness, social wellness and sexual wellness. These are inextricably linked. This is true for all of us but especially for teens. For them, it’s all about having the resources, the mentorship, and the knowledge to make the right choices.”
Helping adolescent girls make good choices is an important key to their good health. A look at the leading causes of death among teen girls provides insight into Ryan’s statement. Car accidents are the #1 cause of death among teens across the country.
“Any attempt to address health and wellness issues in adolescents has to begin with cars,” says Ryan. “There are a few rules which, if followed, can reduce the number of deaths in car accidents. First, keep the cell phone in your purse. It’s been estimated that more than a quarter of all 16 and 17-year olds in the U.S. text while driving!”
“Second, wear a seatbelt. Teens are the group least likely to wear them. One in three deaths in car accidents in Iowa would have been prevented if the victim had been wearing a seatbelt.”
“Third, NO ALCOHOL. That seems obvious but studies have shown that teens are worse drivers than adults at any blood levels.”
“Fourth, keep boys out of the driver’s seat and other teens out of the car. Most teen deaths in car accidents happen when a boy is behind the wheel and the more people in the car, the more likely an accident is to happen.”
According to Ryan, another major health and wellness issue with which adolescent girls deal is depression.
“The first thing to know about depression in teen girls is that it often doesn’t show up as a classic depressed mood as it does in adults,” Ryan says. “It’s often hard to tell between typical adolescent behavior and signs of scary depression. Among the things to look for are uncharacteristic problems at school, running away, drug or alcohol abuse, low self-esteem, internet addiction, and reckless behavior. Those are all red flags for teen depression.”
“Another red flag is talking about suicide, even in a joking way. You should take any mention of suicide very seriously. Nationally, 12 percent of adolescent girls who die take their own life. There’s a national hotline to call if your children does start talking about suicide: 1-800-273-TALK.”
Ryan says one effective way to address many of the issues adolescent girls face is to encourage them to be physically active.
“Girls in their teen years should get 60 minutes of activity every day,” she says. “This is no longer possible in physical education classes alone. In fact, only one-third of children get an hour of physical activity every day. We can see the results in obesity rates; 17 percent of children between 2 and 19 are obese, triple the rate in 1980.”
“Daily activity must be modeled in the home. When kids see their parents being active, they are much more likely to get enough exercise.”
“It can sometimes be tough to balance wanting girls to engage in lots of physical activity with trying to avoid having them be hyper-focused on their body image,” Ryan adds. “Eating disorders often start when someone a girl looks up to – a coach or a mentor, for example – asks if the girls has put on a little weight lately. We have to be very careful about how things are framed for girls this age. That’s especially true for girls who are high achievers.”
“Think about it this way: a girl is going through many physical and emotional changes. They’re bodies are changing, their skin and their hair are changing. It’s a lot with which to deal, so many times eating disorders are an attempt to regain some control over their bodies. With all the media images out there, it’s easy for the image of your own body to be distorted.”
Ryan says there is an acronym from the U.K. that is helpful for parents when trying to figure out if they’re daughter has disordered eating. It’s called SCOFF:
- Do you make yourself (Sick) vomit because you are uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost 14 pounds (One stone in the UK) over a three-month period?
- Do you think you’re Fat when others think you’re thin?
- Would you say that Food dominates your life?
“If your daughter or loved one answered yes to two or more of these questions, that’s a big red flag,” Ryan says.
A more recent addition to the list of health issues among adolescent girls is the use (or overuse) of electronic media.
“Three out of four teen girls own a cellphone,” says Ryan. “Almost nine out of 10 text and the average is about 80 text messages a day. This is an area to which parents should pay attention for several reasons. First, extreme multitasking with digital devices has been shown to decrease social and emotional development in 8-12 year olds. These are girls who need face-to-face social time.”
“Another reason parents need to pay attention is the fact that internet predators are a real threat. Monitor what your daughter does online and teach her not to reveal personal information or identifying photos of any kind."
An issue that has been around forever but which has gotten much-increased attention of late is bullying – emotional, physical or verbal abuse or harassment -- which is more common in girls than in boys.
“Bullying is often subtle,” Ryan notes. “Incidents of bullying are become more common and more severe because cyberbullying is so easy.”
“Bullying is not harmless. It can affect social, emotional and physical health. We’ve also seen some highly publicized suicides that have been tied back to bullying. Girls can fight back. Schools are increasingly aware of the problem and many have taken steps to address it. I would also encourage you to visit www.netsmart.org/cyberbullying.”
While it may seem a daunting task to parents of adolescent girls, helping them learn how to live a healthy life is key during these important years.
“It’s difficult to understate the important role parental modeling plays in this process,” says Ryan. Girls watch what their parents and other adults they look up to do. It’s up to us to not just tell them how to be healthy but to show them by our own actions and by the rules we make and enforce during a time when they’re not ready or able to make good decisions on their own.”
This article is based on a lecture given by Dr. Ginny Ryan. To view the 45-minute lecture, click here.