August 11, 2026

Growing Up Looks Different for Everyone

August 11, 2026   | Episode 68

Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast

SPEAKERS: Marcus Thorpe, Katie Lowe, Guest: Dr. Natalie Dick

Marcus Thorpe 0:14

And welcome back to the Wellness Conversation and OhioHealth Podcast. We are tackling those big health topics for you and your family. I'm Marcus Thorpe,

Katie Lowe 0:21

and I'm Katie Lowe. And today we are talking about a topic that every family experiences, but one that can sometimes feel a little uncomfortable to discuss, and that's puberty.

Marcus Thorpe 0:32

You might have an elementary school student who's starting to ask some questions, or maybe you have that teenager, and you are right in the midst of all of the chaos that comes with that. We're excited about having those maybe not easy conversations, not normal conversations, but also really important conversations to be having as families.

Katie Lowe 0:49

Absolutely. And today, joining us, we have Dr. Natalie Dick. She's here to help us separate myths from facts, give parents some practical advice for navigating this important stage of life. So, Dr. Dick, thank you so much for being here. We've got a lot of questions for you.

Dr. Natalie Dick

Thank you.

Marcus Thorpe 1:07

All right, let's talk about basics. People hear the word puberty. Obviously, it's a big part of life. Anytime you're going through those really big changes, it's teenagers what we always think about. But let's just talk, kind of big picture, medically speaking, what's actually happening with puberty?

ND 1:23

Okay, so puberty-it's the process of physical maturation when a child develops their secondary sexual characteristics, undergoes a lot of hormonal and physical changes, and then the the end game of all of it is when they reach that sexual maturity. So medically speaking, that's kind of the process and what we're going through.

Katie Lowe 1:42

OK, so what about what what exactly is happening inside the body?

ND 1 1:47

Okay, so inside it's driven by hormonal changes. That's not uncommon. Lots of people think of puberty and they think of hormones. So it involves what we call the hypothalamic-pituitary-gonadal axis, and so that's meaning we're involving a lots of areas of the body when it when it comes to this. This includes things like growth spurts, development of reproductive organs, secondary sexual characteristics such as breast development, starting your period in the girls, genital growth when the boys' voices deepen, pubic hair, axillary hair in both boys and girls, all of that along with other body systems that we'll kind of talk about later, how they all mature.

Marcus Thorpe 2:27

This is kind of a fun topic because I have teenagers. I'm right in the middle of all of it. Katie's got really young kids, so she is like dreading the day that she's got this.,

Katie Lowe 2:37

You know when I first went through the script, I was like, "Oh my gosh, I can't even picture you know this stage of life, but it's going to be here before I know it.

Marcus Thorpe 2:44

Dr. Dick, you're like me. We have kids that are right in the middle of it, right in the throws of it

Dr. Natalie Dick

2:47

I have three teenagers at home right now.

Marcus Thorpe 2:49

Yes, so every day's an adventure for sure. Let's talk about when you should expect these kind of changes, right? I mean, look, kids are very different. There's lots of hormones that are coming at different times of their lives, are there specific times or ages where you start to really see the puberty ramping up?

Dr. Natalie Dick

3:08

So again, along with everything with development, there is a wide range of normal in the kids. So girls typically puberty can begin anywhere from eight to 13. So with 1110, being about about your common with boys. It's just a little bit later. We're looking at about nine to 14 for the boys, and then they progress through the standard stages of puberty from your prepubertal all the way to the the full maturity. So again, it's it's a wide range. So you never quite know when when it's going to hit.

Marcus Thorpe 3:40

It was so interesting playing. My son plays hockey, and we would have a couple girls on our team every year. And this was in their like eight to 12 year old range, and all the boys would be really short, and the girls would just go boom, and they would be so tall. And you would look at it and think to yourself, these kids are all the same age. How is this happening? You're a tall girl. I'm assuming that happened with you, right?

Katie Lowe 4:01

Yes, this sounds quite familiar. I remember one year. I think it was seventh grade. I grew seven inches in a year. Yeah, but I was always so much taller than the guys. It was just you know part of life, and I think that's a hard part about being a parent. I see it even now, and I only have a two and a half year old and a baby. But through all stages, you have that comparison, and so you're seeing, like you just said, some boys may be a lot shorter and girls much taller, or even you know, looking at same gender. There can be such a difference. How much variation is actually normal?

Dr. Natalie Dick

4:37

So it can be a huge, like you said. I mean, you go out there. You look even even boys to boys and girls to girls in the same age group can be drastically different, and all kids are different to them. And you look at them even like you have a small toddler. I mean, when they're babies, when they're toddlers, there's a wide variety of sizes in these children, and it can all be within normal. And I'm. Talking about growth charts with parents, I'm like, okay, your child's following on their curve. I am happy about that. I always say, you know, somebody's got to be that fifth percentile, somebody's got to be that 95th percentile. So you will see that, and then imagine some going through puberty earlier than others. It's it's going to make that difference so much more drastic.

Marcus Thorpe 5:20

I want to talk about families. Let's first talk about genetics. How much does genetics truly play in puberty when you start when you're complete with kind of that puberty cycle?

Dr. Natalie Dick

5:33

So, I mean, genetics is probably one of the major determinants in the timing and progression of puberty, they say if you look at some studies, 50 to 80% even up to 90% of the measures looking at like the timing of specifically growth spurts are genetically based. So at the age where girls start their periods, where you get breast development, testicular enlargement, the voice changes in the boys, all of those those milestones have a very strong family resemblance. The parents, the times that they went through puberty, is also very telling of when the children might. There is a strong association between those two, especially moms to daughters, dads to sons. So you you will see that a lot. So when I get to ask that question, like, "Hey, when did mom? When did you start your period? Not like it's going to be exact, but that can give us sometimes a ballpark range.

Speaker 1 6:30

I'd say, and then when also, while rare genetics also can play a part in our early and late puberty, which would be more of clinical significance. So, a lot of single gene mutations can cause the disorders that cause central precocious puberty, which is early puberty, and then even delayed or absent puberty. So again, genetics has a big a big portion in it.

Marcus Thorpe 6:53

So that's the genetic part of it. What about environmental factors? How much do they play a role in what we're seeing, especially these days where so much has changed?

Dr. Natalie Dick

7:00

Yes, yes. So looking at environment, there's nutrition, sleep, overall health of the child. Huge, huge part of it. Nutrition is one of the most important. I'll say modifiable influences on the timing and the progression of puberty. So, we'll see. It accounts for even up to 25% of the variations that we see in pubertal onset, both excess and deficiencies of nutrition can can skew puberty outside of your typical ranges. So we're looking at higher BMIs, extra adipose, or fat tissue in children. What we call overnutrition in some of them, especially during childhood, are linked to earlier puberty, especially in our female population, in the girls. With the boys, it's a little less consistent. Some suggest that the higher BMI might advance it. Some say it might slow it. Definitely a chronic malnutrition in both boys and girls. Lower body fat percentage, lower weight, energy restriction that can definitely delay the puberty in in both of them. Kind of a later onset of secondary sexual characteristics, slower progression, even some blunting sometimes of that growth spurt or where it's delayed. You know, and then extreme examples of that undernutrition: looking at anorexia, restrictive eating disorders, chronic illnesses. You'll see a lot of kids who just had a chronic illness. They were, they've always been little, and they're just not. Their body is consuming so many calories to keep the them going with the chronic illness that they just can't. They don't have the excess to grow properly like they should.

Marcus Thorpe 8:41

I didn't even think about all of that. That that comes into play.

Dr. Natalie Dick

8:45

Yes, yes. There's a lot. Sleep is another huge thing that affects it in children. The so sleep is fun. It's a bidirectional relationship with it. So sleep affects puberty, and puberty affects sleep, so that that makes it fun. It can shorter sleep durations, later bedtimes. Those can be associated with higher puberty, higher central precocious puberty, especially in your girl patients. They can have. We see it some in the boys too, but but more with the girls. And then, as I said earlier, the puberty can causes reorganization in the brain and reorganization of the sleep patterns. So that's why, as I'm sure you're experiencing with your teenagers, now all of a sudden they're they're up all night. There's sleep delays, later bedtime, later wake time. The classic night owl that starts coming out, and that is because of hormones and everything in the brain. And I know you're laughing because with the younger one, you're like, oh my gosh, would you just sleep when they're going through the sleep progression? And I get parents, they're not sleeping. What do I do to get them to sleep? And then they come back and see. When they're teenagers, they're sleeping too much. How do I get them to wake up?

Katie Lowe 10:03

I mean, and so it's just never ending. Never ending. Yes, exactly.

Dr. Natalie Dick

10:06

It's all part of the natural cycle.

Katie Lowe 10:10

I know that this all sounds quite familiar to you, Marcus. I was gonna say, like,

Marcus Thorpe 10:14

I'm almost 50, and I'm going through puberty of just my eye bags because they just keep getting bigger because I don't get any sleep for these kids is exhausting. My goodness!

Dr. Natalie Dick

10:22

But the sleep is is so important because if you've ever heard the parents, I swear my kid grew two inches overnight. Well, you're not totally wrong, and they probably didn't actually grow two inches overnight. But it definitely the pulses in the growth hormone occur during your your slow wave or your deep sleep, and so that's why we do want these kids. So kids who are chronically restricted in sleep can have a reduction in this growth hormone secretion. So it's not like they have a deficiency of it. It's just we're not getting the best bang for our buck.

Marcus Thorpe 10:55

This is like gold for parents of podcasting. Like I'm thinking to myself, like if I was a parent listening to this, it explains so much of what we're thinking about.

Katie Lowe 11:03

It's so incredibly interesting to hear about. I'm curious. You gave a range, and it was quite a large range for when puberty can happen. At what point, you know, does a parent or should they ever start to worry or feel concerned if they're having one of those late bloomers, and at what what point do you get to where you should go to your doctor and say, and just bring it up?

Dr. Natalie Dick

11:30

So, for if it's too early, too late. So we're looking at precocious puberty, early puberty. So that is the development of the breast tissue, pubic hair, all of that prior to age eight in girls and prior to age nine in boys. Like I said, the the eight to 13 for the girls and nine to 14 for the boys. So if you're just outside of that, is when you would want to at least go go talk to their doctor about it. And then for delayed puberty, no breast development by 13 if they haven't started their periods by 15 to 16, and no testicular enlargement in the boys by 14, those are-I don't want to say red flags, but those would definitely be when you'd at least want to have that conversation with their doctor, just to make sure everything's okay.

Marcus Thorpe 12:16

Yeah, I want to talk about emotions. I know it's one of those things where, look, when you're in the toddler stage, like Katie is, the emotions are all over the place, and then you get kind of a leveling off. I will say, I've seen with both of my boys, once things start to change, and you can tell that there's voice changes and and physical changes, the emotions really get big. Like those feelings that at one point kind of slowed down. They're big emotions again. Can you talk about that? You know that eight to 1314-year-old, range where the emotions start to really get big, and you start to have some of these conflicts sometimes inside of a household.

Dr. Natalie Dick

12:51

Yes, yes. So you said the emotions are big. There's emotional changes, and that is that's normal and expected. Though sometimes that's the part I think parents struggle with the most. That kind of blindsides them the most, especially if they've had a kid who's pretty been pretty even keeled up until then, and it's it's a combination of rising and fluctuating sex hormones, the brain remodeling, like we talked about when it messes with sleep. There's big changes going on in the brain, social psychological challenges of being a child, which I think is much harder nowadays, even than it was when when we were all children. And then it's they're so much bigger because they're frequent, they're unpredictable. Parents can seem blindsided by it because the child can shift moods quickly without an apparent cause. You know, kind of like when you're dealing with toddlers and they start getting upset because you ask them to put their shoes on. Pretty much the same thing can happen when they're teenagers, and and they're they're still trying to figure out how to deal with it. So some of the moods, emotions that we'll see are increased sensitivity and reactivity. So these teens, they're hurt more by criticism, even what isn't actually criticism, perceived rejection, all that sort of stuff can take a bigger toll on them. Irritability, short tempers-that is from that heightened. They can get more frequently frustrated, argumentative with with more so with parents. Keep going, doctor. Keep going. Anxiety, self-consciousness-that really hits hard. We I see this in the boys too a little bit more in the girls, but their bodies are changing either faster than their peers or slower than their peers. Sometimes that can add on to the anxiety. They worry about peer acceptance. They worry about performance in in sports or you know theater, the arts, all that sort of stuff. Body image. I mean, that's a huge thing that these kids are dealing with these days. They're exploring their identity. They're trying to figure out who they are, and they want a little independence. And as much as mom and dad, we try to give it to them. We also have to remember they are still teenagers. That you know might not be making the best decisions, but that involves. That's why they're pushing back. On the limits, and and their shifting of their social priorities, which you like to think, hey, they love mom and dad, they want to hang out with us all the time, but now we're not always quite top on their list of everything they want to be around. Low on the totem pole. Yes, I get it.

Katie Lowe 15:15

This is so good to know because I think you know everybody talks about these huge big feelings of the toddlers. That's right, and you're with them all the time. I don't think it's as much talked about when they get to this age. That it's just something to keep in mind when you know you're interacting with them, and also you know a reminder to give them grace based on their reaction. Something you had mentioned is they might feel more anxiety. How do you know if they're just having these big feelings and mood swings, or whether you're seeing signs of anxiety and depression?

Dr. Natalie Dick

15:49

Okay, so again, we worry these kids. A lot of the teenagers will start internalizing their problems, which which can be normal. They think that they can deal with it on their own, or they're going to talk to their friends who are also dealing with the same things, so so that we we do have that risk. The rates of anxiety, depression, and in some cases other more serious mood difficulties do arise during puberty, and and that can be normal because this is also a normal time where we see these actually come forward versus is it just them them dealing with their emotions? So mild to moderate mood swings, increased sensitivity, you know, temporary irritability. That is all normal. If it becomes persistent, if it is impairing things like prolonged sadness, they're becoming completely withdrawn, intense anxiety, aggression, loss of interest in things that they used to love doing; those can all be bigger signs that maybe there's a little bit more going on, you know, and that we need to look into it. And then seeing their doctor, like I said, I would, you know, much rather have a parent come in say, "Hey, you know, little Johnny is just, you know, he's sad, he's sleeping more. It's this, and and it be normal than them go, and he go years and years truly battling anxiety and depression.

Marcus Thorpe 17:08

I love that. I think as parents and even kids, we become more normalized by having those conversations than maybe we ever have before. And I think it's so great. I mean, I love the openness that we're seeing of these young people advocating for themselves, even at a young age, and parents kind of saying, "Well, this is normal now. I need to have these conversations. So I love that. One size fits all. That is certainly not parenting. We know that. You know, you have to kind of adapt and adjust based on who your kid is and how they respond and react to things. Should parents wait until kids start asking the questions first, or do you think it's something that parents should kind of lead and start when it comes to puberty with their kids?

Dr. Natalie Dick

17:51

So, again, I don't think that there's a correct age. If you look it up, they'll tell you maybe start at seven or eight. I think you know your child and that so some kids are inquisitive, want to know everything, and they're just going to come at you with 1000 questions. Others are not, and so you know your child. So normally I say, hey, you'd want to maybe start it a little bit before some of these changes occur, so they're not scared, so they're not blindsided, you know, by by this happening, and then and you can approach them. You can wait for them to approach you. And if they haven't said anything by the time you're noticing some of these changes, maybe you just kind of casually bring it up in conversation, and and you know, and kind of kind of do it that way. So again, you know your child best. But I think if they haven't come to you by the time you're noticing changes, then I would suggest definitely having a conversation.

Marcus Thorpe 18:43

It's so interesting too because you could have kids from the exact same household with the exact same parents. My younger, my older one really didn't bring it up or want to talk much about it, so we kind of engaged him. My younger one, maybe because he saw his older brother, was instantaneously asking me questions when he was like 678, about puberty. I'm like, oh my gosh, where is this coming from? Catching you off guard. Just so different. Yeah, and kids from the same household.

Katie Lowe 19:07

Yeah,

Dr. Natalie Dick