Real Talk Podcast: How is Puberty Changing In Our Kids

November 23, 2022
real talk with susan and kristina podcast

In this episode of Real Talk, KJK Student Defense Attorneys Susan Stone and Kristina Supler are joined by Dr. Cara Natterson, a pediatrician, consultant, and New York Times bestselling author of puberty and parenting books.  They discuss puberty. The conversation includes what changes in puberty have professionals seen over the years, the contributing factors that affect puberty in adolescents, and the best methods for helping kids and their parents go through puberty successfully.

Links Mentioned In the Show:



Show Notes:

  • (03:07)  What goal is the Puberty Podcast trying to achieve? 
  • (05:15) How hormones affect children’s behavior as they go through adolescence
  • (06:41) Are kids mentally prepared for puberty once it hits? 
  • (08:28) Why are kids nowadays experiencing puberty earlier than previous generations?
  • (09:07) What are the possible factors that are speeding up the occurrence of puberty in adolescents?
  • (10:36) Has the breast size of the young females of this generation increased compared to that of the former?
  • (12:10) Is the spike of obesity in recent years the main reason behind bigger boobs in adolescent girls?
  • (13:41) How a life-changing product and survival guide on how to get through puberty especially for kids was born
  • (14:33) Should young ladies be wearing sports bras when they hit puberty?
  • (15:05) What is the best type of bra for girls to start with?
  • (16:05) Can underwear offer both comfort and health benefits?
  • (16:30) How Dr. Cara is giving a voice to children going through puberty
  • (18:25) Should the age at which kids go through puberty determine when we should treat them as adults?
  • (19:00) Why are female early bloomers at a higher risk for sexual predation?
  • (21:01) Is it scientifically proven that the pandemic has negatively affected the mental health of students?
  • (22:33) What’s the one piece of advice you would give to parents about their children and their mental health?
  • (24:12) How has the adaptation of the body positivity movement impacted children’s mental health when it comes to their weight?
  • (24:31) Has the context of eating disorders and body image in boys and girls evolved throughout the years?
  • (26:47) Should parents initiate, “the birds and the bees” talk with their kids even if they don’t ask about sex?
  • (28:51) How can parents help their children deal with weight and acne problems without hurting their feelings?
  • (31:22) How have periods transformed over the years?
  • (34:31) Has the rate of ADHD in boys surged recently?
  • (36:58) What does sleep do to our bodies?
  • (38:05) Are sleeping patterns of teenagers different from other age groups?
  • (39:19) What can you do for your child when they can’t sleep and begin to overthink?
  • (39:47) Are sleeping aids such as melatonin supplements or gummies safe for teens who have trouble falling asleep?
  • (41:13) How do you know when you should seek professional help for insomnia? 
  • (42:25) What’s one piece of advice you would give to kids who have low self-esteem?



Susan Stone: So today we’re gonna talk about something that somehow has become a lost topic, and that is puberty. 

Kristina Supler: Just saying that word is making me have these like awkward flashbacks,

Susan Stone: but it shouldn’t. 

You know, I have to say I think of puberty very differently now that my oldest is 25 and I’ve seen them go through everything.

And as a Jewish mama, I think of puberty kids at their bar and Bos mitzvah talking about, No, I am a man. A man. And you see this little guy going, Today, I am a man. And I’m like, No, you’re a little pisser. Um, and for those out there, you get it. If you’ve been to a bar mitzvah and then something magical happens, Puberty.

And then the voice drops and the boobs grow. And indeed they do look like little men and women. So 

we’re gonna talk about puberty today. 

Kristina Supler: Well, and this is an issue that’s particularly, uh, topical. is pertinent for the Supler household. My daughter would be mortified, but she is, um, in sixth grade. And so lots of conversations are starting to happen in our house.

And indeed, A book that we’re gonna talk about today has been purchased, so it’s fortuitous to have our guests today. Today we are joined by Dr. Cara Natterson. Cara is a pediatrician, consultant, speaker, and New York Times best selling author of multiple books, including The Care and Keeping of You, the American Girl Library Series.

And she has sold more than 6 million copies of that book. And indeed, I have purchased that book. Um, additionally, she’s recently published Decoding Boys. And in 2020, Carra launched OOMLA, which is basically a a puberty positive company that we’re gonna talk more about. Thank you for joining us, Kara. 

Dr. Cara Natterson: Thank you so much for having me.

I’m so excited to be here, and yours is not the only horrified child. My two children were just just deeply dismayed by what I did when they were going through puberty. 

Susan Stone: That’s amazing and we, we welcome you. I wanna start by talking about your podcast, The Puberty Podcast. So Kristina and I are sort of new to the podcasting world and apparently it is a world so newish ish.

We’re newish. It’s been like a year, and we we’re very proud of our Real Talk with Susan and Kristina podcast that you’re on. Because we think that podcasting is just a wonderful way to reach audiences. So on your podcast, you talk about all things adolescence from body image and behavioral changes to sex and consent.

Tell us, Cara, what is the real goal and what are you trying to accomplish with your podcast? 

Dr. Cara Natterson: So we, we call it the Puberty podcast. But people think about puberty as being specific to the body changes that are happening, and that’s the very narrow definition of puberty. It’s the path through sexual maturity.

The reason we call it the Puberty Podcast and talk about all these other adjacent topics as well, is that the same hormones that make your boobs grow and that make your shoulders broad and that make you hairy, and that make you smell all of those same hormones also impact your moods and your feelings, and therefore your friendships and therefore your family dynamics.

And so there are all these downstream. Issues that used to be called adolescence, and those two buckets were really separate. Like there was puberty, which was your body, and there was adolescence, which was everything else. But what has become really clear is that those two things are actually quite synonymous.

The Venn diagram overlap of those two topics is massive. And so we like to talk about all of it. Because it is the one stage of life that regardless of your gender, regardless of your background, regardless of where on the globe you are growing up, you will go through puberty. This is a universal rite of passage, and it’s a much longer rite of passage than it used.

Susan Stone: You know, 

I don’t know if you will agree with this statement, but when Kristina and I first became law Partners, her children were just, I think the preschool age and a little older.

Kristina Supler: Yeah, that’s about right.

Susan Stone: And I remember saying to her, At that time, you are in your golden years. Mm-hmm. ? Mm-hmm. . I think post potty training and before puberty is just the sweetest time when a parent is with a child.

Why do kids become little monsters once they hit puberty? 

It’s, And do you agree with me? 

Dr. Cara Natterson: It’s such a good question. I do agree with you that in that time between when they learn to walk and talk and when their, their sex hormones, estrogen and, and testosterone in particular, start to surge, the, the most common question out of their mouth is, you know, do you wanna know how much I love you?

I mean, it’s wrote, I can’t beat it. Right. You really can’t beat it. So, but what happens is, and it’s by the way, it used to happen at 10 or 11, and now it’s happening at eight on average for girls, and between nine and 10 on average for boys. Is that the, the sex hormones are starting to get ramped up in the body.

The ovaries produce estrogen in the female body. The testicles produce testosterone in the male body, and those hormones don’t just circulate below the neck. Those hormones circulate up in the brain and they impact the way kids feel. And we all know this. Every single person has felt this. We felt the highs and the lows of hormone surges.

This is new to kids. They don’t know how to manage it. Their brains are getting used to it, and that’s what you are seeing and feeling when kids hit their tween and teen years.

Susan Stone: I have a question. 

Dr. Cara Natterson: Sure.

Susan Stone: Now that it’s puberty is happening so young a. Are they mentally ready for this ? 

Dr. Cara Natterson: None of us are mentally ready for this.

They are not. And this is a humongous piece of this puzzle. It really, um, it shouldn’t matter when they enter puberty in so far as. It should just be a natural process in life. And it happens when it happens. And by the way, the range is very broad. So there are of course kids who start earlier and kids who start later, but it shouldn’t matter.

The problem is we live in a world in a context where it really does matter. So think about it this way. Um, the average age for cell phone ownership in this country is 10. It’s 10. Okay? Now I’ve just told you more than half of all kids have either estrogen or testosterone coursing through their bodies by the time they’re 10.

So now you’re gonna combine a brain that’s pretty immature with these hormones that are pretty potent and devices, and no, the answer to your question is they’re not ready. The brain is not going to be able to make consistently smart consequential decisions until it’s close to 30. That’s two more decades, so the puberty is happening earlier.

It is not happening faster, and brain development is not happening faster. It just means we have to parent them a little bit differently. 

Kristina Supler: So you’ve touched on something that Susan and I in preparation for today, Cara, what we were sort of wrestling with and talking through is that notion or question of, it seems like our children today are going through puberty earlier, at least than it in my tween years.

And, and Susan indicated the same and, and you’ve acknowledged that. Why though? Why is that happening? 

Dr. Cara Natterson: That’s the question. The most common question I get, most common question I get. The really unfortunate answer is I don’t know. I, I do know, and I work with a number of specialists. One of my favorite people, um, who is truly an expert on this subject is a woman named Louise Greenspan.

She wrote a phenomenal book called The New Puberty. It came out in 2014, but it’s just as relevant today as when it came out, and it answered that question. She is a researcher based in Northern California. She runs a lot of the studies that make headlines in the papers about when kids are going through puberty and why, and here’s what she says.

She says, it’s everything we put into and onto our bodies. It’s the food we eat. It’s the liquids we drink. It’s the cosmetics we’re putting onto our bodies. It is the air we breathe and we just don’t know the lowest common denominator. We don’t know what we can take out of those things in order to fix the situation.

Louise on. We did a podcast with her. Um, Recently, relatively recently, where she talked a little bit about antibiotics, and this is one, people talk about endocrine disrupting hormones all the time, but they don’t talk about antibiotics. And Louise connected the dots and helped to explain why antibiotics that are given to poultry and to cows milk.

Milk are directly impacting the way that these hormones work. And I can’t do it justice here, but she has a really elegant description of it. 

Susan Stone: So, I’m gonna ask you a question that’s not so elegant. Hmm, 

Dr. Cara Natterson: Go for it.

Susan Stone: Can I ask you? Yeah. Okay. My readers are gonna be horrified and Kristina, feel free to kick me, but is it my imagination, but are boobs bigger?

It’s a really fair question, , 

Kristina Supler: and I wonder if there’s a, a, a correlation to maybe childhood obesity as well. I, I don’t know, 

Susan Stone: Cara, So give us the answer. 

Dr. Cara Natterson: Great question. 

Susan Stone: I mean, of course it didn’t help me out. I know. I’m sharing. I’m oversharing, guys. . 

Dr. Cara Natterson: I could overshare here too. But you know, my daughter is so tired of me oversharing that I’m gonna, I’m gonna just answer the questions I could, but I won’t.

Exactly. Um, I have learned my lesson over time. Um, so the, the answer is anecdotally, I agree with you. Um, there is no data that shows it, but I definitely see what you see. Um, and there are probably a couple of contributing factors, and one is exactly what Kristina just pointed to, which is that, um, the average body weight in this country has gone up and up and up.

Um, so about 20% of all tweens and teens are overweight or obese. Uh, we are looking at 33, 34% of all adults in this country who are obese. If you add overweight adults, we get to 74, 75% of the entire population. Breasts are made of water and fat tissue, and then duct systems. And so yes, when we accumulate extra body fat, that is one of the parts of the body where the body fat accumulates. But I actually think there’s probably something else going on as well. And just go with me here. I’m gonna give you like 10 seconds of science. Sure. 

Susan Stone: I thought it was a dumb question and I thought I was imagining it. Literally, my daughter goes to an all-girl school and look, my oldest is 25, so I’m talking about a change from a a couple years and I was looking and I went, What is going on here? 

Dr. Cara Natterson: No, and, and here’s one really interesting way of thinking about it. I don’t know that this is scientifically what’s going on, but the more fat cells we have in the body, the more ability the body has to convert hormones from one form into another.

Because fat cells do what’s called peripheral conversion. They actually change hormones from one form to another. So as body weights have gone up, hor, different levels of hormones have gone up in the body as a function of the fat cells being present. And I do think that’s probably a contributor, although I don’t know, and I’m not a researcher in this field, but I think it’s very real.

The other thing anecdotally that I’ve seen change, and again, no studies here, but in the world of pediatrics, definitely much more acne. Oh, I’m at too, right? And the acne is much more intense. Like it’s not a few pimples, it’s scarring. Full-face, full back, full chest. Same drivers here. Same drivers.

Kristina Supler: Hormones. Powerful stuff. Yep. Uh, so I’d love to switch gears and talk about the business you launched OOMLA, which aims to make puberty comfortable, and you have all sorts of content for teens and tweens, and then also parents. Tell us about the mission of OOMLA and why you decided to launch that endeavor when it it seems like you have so much other stuff going on as well. 

Dr. Cara Natterson: Yeah, I have the thing or two. So when I was writing the American girl books, I was traveling all over the country and it was a, an unbelievable opportunity to speak with parents and kids everywhere. And what became very clear to me was that there’s lots of information about how to get through puberty aimed at adults only. Very little aimed at kids and there is no product solution. 

So boobs. Perfect example. Everyone who has two X chromosomes and goes through a typical puberty will get breasts. But no one seemed to care that there was an on ramp of consumers who needed a bra that felt good and comfortable and fit them well. 

Susan Stone: Don’t they wear their sports bras?

Dr. Cara Natterson: I have an issue with that because when they wear their sports bras, their sports bras bind them so tightly. And again, I don’t have science to back this up. I just have scientific reasoning. Any tissue that’s growing against resistance is going to grow differently. So breast tissue that’s growing against sports bra resistance all day, every day. I think that is breast tissue that is more likely to get cystic or dense. 

That I think is going to create a type out that’s,

Susan Stone: that’s interesting.

Dr. Cara Natterson: There’s just no question. The other is the chafing, the irritation, and the smell of a sports bra. So what we did is I, I started a product. I said, I gotta fix the bra. That’s the first thing we have to fix. 

And so we created the OOMBra and the OOMbra is super soft, cotton reversible. So you can wear it on either side. And there’s a cute print. Truly cute print, not ugly, cute print. I was gonna say two. You got it. And then so you can flip it and sign out. But there’s a middle panel that does I’d call it like a half measure of a sports bra. 

It doesn’t bind you tight. It’s almost like a piece of paper. It’s got no stretch. So it hugs you but doesn’t bind you, which to me feels safer. And why does it feel safer? Because when you take off your OOMbra at the end of the day, you don’t exhale. You don’t feel better. Which is the sign that you’re not being bound too tight. 

So that’s the first thing we fix. Then we launch shorts that are the opposite of underpants. They have low crotch, wide legs, and they air you out because you’re in sweaty underpants all day long. And that’s where smells come from and that’s where yeast growth comes from.

And all this stuffs right. You got it. So we did that. Oh my gosh. The best is yet to come. We have socks coming this winter that do not smell. 

Kristina Supler: Whoa. That’s cool. 

Dr. Cara Natterson: I, I know. It’s amazing. So that’s the product line. We love, love, love what we do on the product side. More important than that is the content side. So we do have a lot of content aimed at adults. But the content that I care the most about is called our puberty portal.

And it is articles about puberty written by and for tweens and teens. That’s amazing. It is awesome. It is a, a, an 18 year old is telling a 12 year old how it feels to go through a certain stage of life. And I’m reading everything. So it’s all medically accurate. But it’s through the lens of someone who just went through it.

And it is to me that’s, That’s the gold. That’s the gold. 

Susan Stone: So Kristina and I represent students when they have issues being accused either in the criminal justice system or at their school with basically violations of a Title IX policy, sexual harassment, sexual assault. And typically our work with younger kids is to secure accommodations and better IEPs, individual education plans. 

And I’m hearing you talk about puberty happening earlier and boobs getting bigger, hygiene issues and hygiene issues, but I, I, I wanna say just because your child is maturing physically more and going through puberty, Wouldn’t you say that doesn’t mean necessarily that they are advancing sexually? And that it’s still okay to treat them in an age appropriate way that a 10 year old is still a 10 year old.

So just because they may look like a 16 year old looked maybe when I went to high school, that they’re still young. I, I just feel like we’re trying to make them older too quickly. 

Dr. Cara Natterson: I think that needs to be said in bold with highlighter and exclamation points. It is not just, It’s just not just, okay. It’s critical that we let kids be kids.

Yes, we must treat them the age they are not the age they look. And by the way, this goes for kids who are late to puberty as well, who look young. And are treated younger than they actually are, um, because they have issues around that. But in the group that you’re discussing, you know, these are kids who are at high risk.

We know that girls who go through puberty early are at higher risk for sexual predation. We know that. Why? Because they present as older and they find themselves in situations that their brain cannot handle. The world has to treat them like kids. The world needs to protect them like kids. It makes me so, so sad when I see people treat kids as if they’re mini adults and I know exactly what’s going on in their brain.

Their brain can’t handle that kind of thinking at 25. Their brain can’t handle that kind of thinking. I 

Susan Stone: What’s the rush? I know that there’s a lot of talk. I, I’ve heard other parents talk, especially as you know, my children were in early high school about boyfriends. You know, I never had that talk with my children.

I really worked very hard to make my kids stay as young for as long as possible while having conversations about sex education. You can do both at the same time. 

Kristina Supler: Well, and I think, Susan, to your point though, even more, I think the, the sentiment you’re expressing is even more important in today’s time when our children at and adults, all of us are constantly bombarded by social media and advertising and all of this material that is really encouraging it’s kids to grow up faster. 

And you know, I think that students are now living through, um, The impact of Covid and the constant bombardment of social media. And it really presents a lot of challenges. I know, uh, last year the surgeon General issued an advisory on mental health. And I’m just wondering, Cara, as a pediatrician, have you noticed a direct correlation between the pandemic and mental health among students? 

Dr. Cara Natterson: Everything that you’ve read about in the paper, everything that you’ve heard about in terms of the mental health emergency is true. And in some regard, this sometimes an understatement. The mental health impact of Covid was so massive. Um, I live in Los Angeles. Our schools were shut for 16 months.

Imagine. Right that, And listen, I, as a physician, I understood, I understood how the decisions were being made to prioritize physical, biological safety, but the mental health implications are so massive. We’re so massive. 

Susan Stone: We’re still suffering. 

Dr. Cara Natterson: You bet. And they’re massive everywhere. By the way, it doesn’t matter if you were here where everything was shut, or if you were in places where school reopened six weeks, eight weeks into the pandemic.

It really actually, it really didn’t matter. The mental health crisis in this country is so phenomenally large. So much so that I think it’s hard for a lot of parents to even begin to read about it and think about it. It’s overwhelming. It’s scary. 

When we talk about kids who have suicidal ideation, it’s terrifying. When we talk about kids who are cutting themselves or who are restricting their eating. This is heavy, big stuff. 

And, um, I, this summer I wrote a book with my, um, partner at OOMLA. Um, we wrote a book that’s called Modern Puberty, How it’s Changed and How to Talk about It.

Susan Stone: Is the book out yet?

Dr. Cara Natterson: It comes out in 2023. 

 What chapter did we wait to write until last?

Mental health. Because even though we work in this field, it’s a lot for anyone to think through and to manage, but you have to, And so the one piece of advice I have for all parents is find your team of supporters. So that might be other parents, but it’s a school official, an administrator or a counselor at school who can help your kid. A physician, whether it’s a pediatrician, a family healthcare provider who can help your kid. A therapist or a counselor who can help your kid. A mentor, a coach, an inspiration who can help your kid.

These are all people who have eyes on your kid and can tell you in different context how they’re doing. This is your team and, and it’s important to lean into the team. 

Susan Stone: Speaking about mental health issues and I, Kristina, you brought up seeing, you know, the rise in body weight, part of me thinks that this is not a bad thing and I’m going to just express why.

I recall when I went to college and still to this day, knowing a lot of people with very serious eating disorders, lots of anorexia. And I’m just wondering, I, I think I would rather see a little extra, you know, love on a child versus starvation or bulimia. 

Would you agree that this change in po body positivity and even if it means that our kids are a little bit and they weigh more or more than their BMI should be, it’s, it’s in balance a good thing.

Dr. Cara Natterson: So I’m gonna reframe it a little and I’m gonna say a couple of different things. The first is the body positivity movement is wonderful. I love it. And it is a, yeah, it’s a very important piece to this puzzle. But when we talk about disordered eating, those of us who are raised in the eighties and early nineties, think about 

Susan Stone: guilty , 

Dr. Cara Natterson: right? Think about weight loss and being too thin. And actually the eating disorder world encompasses people of all different weights and shapes and sizes. There are people who are restricting. There are people who are purging through exercise, or they’re taking laxatives. Or they’re vomiting. Those are people who are trying to lose weight.

But especially among boys, they’re totally missed because they’re not trying to lose weight, they’re trying to bulk up. They actually want more muscle. They don’t wanna be the thin kid, and so often you get disordered behaviors on the other end of the spectrum. And this is an important piece to recognize, is that our old school, thinking of what disordered eating looks like is very narrow.

And very limited. And there are people who need help and want help across the spectrum. So while I think Bos body positivity is wonderful, um, and while I also think that the, the broadening of female body ideals has been really positive, we’re not there yet. But it’s not just stick thin, that’s the ideal anymore.

Curvy is ideal. Strong and muscular is ideal. The the, the genetic male there’s been no evolution for them in terms of body ideals. There’s been no moving of the needle. The same body ideal that existed in the sixties and seventies exists today. The only difference is you’re allowed to shave your head now, but the six pack abs and the broad shoulders and you know, you go kind of walk down all the features of a GI Joe doll, that’s still the male body ideal.

And so we have a long way to go in order to honor half of the population and recognize their struggles in any number of directions. 

Kristina Supler: I’d like to sort of transition to a new topic, sex education. And in, in your book, Decoding Boys, you mention that, uh, waiting for your child to ask questions about sex ed is often a great way to gauge where the child is at mentally.

But what happens if your child just, just never asks? Do you feel that parents should open the conversation up on their own, or what are your thoughts for parents who are facing that issue? 

Dr. Cara Natterson: I hope it was clear in Decoding Boys, for sure in Modern Puberty, we have pages and pages and pages about when you need to talk about sex with your kids.

It’s sooner than you think. Um, most of your kids are not coming to you when they need the information. You do need to start opening those lines of communication before they prompt you with the question. So if, if an eight year old comes to you and asks you questions, Answer the questions that are being asked. But if a 10 or 11 year old has not come to you, well then let’s contextualize it.

The average age for first porn viewing in this country, if you are male, is between 11 and 13. So the adults in those kids’ lives want to sex educate their kids before their kids are sex educated by strangers on a screen. So I usually use 10 or 11 as my cutoff for if they haven’t come to you, you do need to start going to them and opening the lines of communication because of what’s on their screens.

If they’re the youngest of five. You’re gonna go to them sooner, right? If they’re kids who have lots of older kid influences, you’re gonna go to them sooner. The question is as much, how do you go to them as when do you go to them? And so, you know, there are some strategies that you can use. Um, and there’s a lot of language that you can use around that.

But opening up the conversation is critical.

Susan Stone: I like what you’re saying about opening up the conversation and I, I wanna circle back to, and I know we’re flip flopping guys, but you’re making us think. And sometimes the brain processes. Can we go back to the, when you see a child having a lot of acne or maybe being a little too heavy. You don’t wanna shame them. But you do want them to keep their skin clean or eat healthy. What’s the balance and what’s the advice you would give parents? 

Dr. Cara Natterson: So my partner, Vanessa and I talk about how often we mess this up on our podcast. Every week we talk about how parents and the adults who are helping to raise kids will screw up this conversation time and time and time again.

And our advice is, however, you can bring something up in a non shaming, non-judgemental way, try it. But if it falls flat or if it lands poorly, Take the do-over. So a good example is with acne, um, I’ve messed this up 12 different times in my own house with my own kids. There are ways to show your kids how to wash their face.

Ask them if they need new products. Suggest that they not pop pimples. Explain why. At the end of the day, some of it’s gonna land and some of it’s not. Sometimes you’re gonna choose the wrong time or the wrong tone, and your child’s gonna let you know. and they’re gonna be very clear with you. They’re either gonna tell you or they’re gonna walk out of the room and shut the conversation down. So it’s really appropriate to circle back with them, not immediately, but a little bit later and say, I think I really messed that one up.

My goal is to just talk to you about hygiene and how to take care of your skin. I’m here to answer any questions and then you try again another day with another round of, would you like this cleanser or another round of, Are you, you know, in my house the other day it was, Hey, are you using a clean towel?

When you wipe your face at the end of the day, you wash your face. 

Kristina Supler: Oh, sure. Yes, yes, yes. 

Dr. Cara Natterson: Right. That was my attempt in and it was not shut down entirely , but where it doesn’t matter if you do this for a living or not, these are hard conversations. Just no shame, no judgment. 

Kristina Supler: One other question about puberty and development, um, I’m wondering, With everything you’ve spoken a lot about, uh, hormones and bodies being impacted by what we eat and what we put on our skin and so on and so forth. I’m wondering also, kind of in line with Susan’s question are, are our breasts getting bigger now among adolescents, females? What about periods are, are periods becoming more painful, uh, taking place for a longer period of time?

What can you say about that? Heavier, heavier, heavier flow? 

Dr. Cara Natterson: So, um, periods are, are one topic that we have a lot of data on. Um, one of the reasons we have a lot of data on is they’re measurable. You can see them, people talk about them these days. Think about 20 years ago, no one ever talked about period. Now, I mean, teenagers just talk, talk, talk, talk, talk about their period to the point where it’s almost astounding even to me.

Um, but they’re measurable. And also a lot of people are on these period apps, right? Where they’re tracking their periods and the apps are collecting that we know about those apps, right. And those apps, I would imagine the two lawyers on the other end of the microphone have the same feelings that the doctor has, which is, they’re great, but the privacy issues are huge on these apps.

So they’re pros and cons right to the, to the data collection there. And 

Susan Stone: they’re a poor form of birth control. 

Dr. Cara Natterson: Oh, they are not, Yes, they are not in our approved list of birth control. No, no, no, no, no, no, no, no, no. Um, so, but, but, um, what do we know about periods? We know this is the most amazing fact about periods. We know that puberty is beginning on average two years earlier for a genetic female.

But periods aren’t happening any earlier at all. They have remained basically stable for the last 60 years. Um, maybe you can argue they’ve moved up by a month or two, but the gap in breast development has shifted by two years. So what does that tell you? That tells you?

Kristina Supler: It’s bizarre. 

Dr. Cara Natterson: It’s bizarre. And what it tells you is puberty is stretching like taffy.

It is starting earlier, but it is happening slower, not faster. And this middle marker, people used to think of it as either the beginning of puberty or the end of puberty. It is neither. Getting your first period is a middle marker. This middle marker hasn’t changed. As we get more and more data about length of period and heaviness of flow and all that, we can answer questions more about, um, how hormone shifts are impacting that.

But right now, um, remember that the reporters who are telling us how heavy their periods are are 12 and 13 and 14, and they only have themselves to compare to mm-hmm. when it’s, is this a heavy period, how do they know? Right. What are they measuring against? And so right now the data looks like the periods themselves have really not changed very much at all.

Susan Stone: Can we talk about boys a little bit? Yeah. Yeah. So I, this is again, and, and right now I’m feeling pretty good about my observations, but I’m observing that almost every boy, Kristina, or young man or college age student has adhd. I mean, I don’t think I’ve met anybody recently who does not have ADHD or some form of ADD.

Is that just who we see in our, I mean, you wouldn’t know in our office, but is there a rise in ADD or ADHD in boys, or is it just we’re better at identifying it? Or is it the pandemic that’s made it worse? What’s going on with ADD in boys? 

Dr. Cara Natterson: There’s a very well-documented rise in medication for H ADHD in both genders over the past two or three decades.

Some people believe it’s accurate diagnosis and we’re better at picking kids up. Some people believe it’s over diagnosis, and it’s an over call because if any of us was on a stimulant every single day, we would do better. We would focus more, we would, I mean, I’m on a stimulant every day. It’s called caffeine. I do a cup of coffee and I lock in and feel like I can get my work done.

That is, that, that is what caffeine does. It is a stimulant. So, um, there’s a whole world of people who debate is. Is this rise and what you are seeing real or not real? I would have to guess that the community, the population you are dealing with are kids who are risk takers more impulsive. That’s a big issue.

Right, and And what is one of the diagnostic criteria of ADHD? Impulsivity. You don’t have to be impulsive to have the diagnosis, but boy are you likely to have the diagnosis if you’re highly impulsive. So I think probably in your population you have a skewed group. But that being said, I think we see much more impulsivity and hyperactivity and attentional issues now than we ever saw before.

Kristina Supler: I’m wondering also if. The impact of sleep on teens and tweens and with phones and social media, and you name it. Let’s face it, at least in my house, I mean, people are staying up much later than I’d like. And I know Susan, you’ve said that as well. 

Susan Stone: Well, I have to chime in. I am a terrible, terrible sleeper. I always was. Post-menopause it’s much worse. And. My kids are very bad sleepers. So the question is, are you seeing that everybody’s getting worse sleep? And how is that different for those in puberty? And when you have a kid, and, and I know I’m hearing it from my youngest saying I can’t sleep. Is it okay to give melatonin? Is it okay to maybe give NyQuil?

I mean, or should you just say, tough it out? Because when I say tough it out, she wakes up and she’s exhausted. 

Dr. Cara Natterson: Mm. Yeah. Okay. We have a much deeper appreciation for the need for sleep today than we’ve ever had before. And we understand that sleep does a number of things to the body, but the top four that I always share with kids when I’m teaching in the classroom are that number one, sleep resets your mood.

Okay? We all know that. Number two. It resets your metabolism because it impacts the way different metabolic hormones shift in your body. So it changes the way you feel hunger, and it changes the way you store your calories, either as fat or you burn through them. Number three, it files away memory. So if you cram for a test all night long, you’re not gonna do as well as if you go to bed and get a good night’s sleep because you need to sleep to store the memory.

And the fourth, this is the big selling point for kids, is that you grow when you sleep. Not when you lay down, not at night when you sleep. You 

Susan Stone: know, it’s, That doesn’t Interesting. You grow when you sleep. Yeah. That’s why I remember my mother always saying to me, I would say My leg hurts. She’d say, Oh, it’s growing pain, 

Dr. Cara Natterson: growing pains. Yep. And so here’s the thing about sleep, though, it doesn’t come easily to everyone, um, especially teenagers whose melatonin level. So melatonin is a natural hormone that your brain produces to tell your body it’s time for sleep. And most people have a melatonin surge that happens sometime between eight and 10:00 PM and then they get tired and then they fall asleep an hour or two later.

The three. But teenagers, Yeah, I mean, well, teenage brains, right? They do not have melatonin surges at 8 pm. Let me, Sorry. They do not have melatonin searches at 8:00 PM They have melatonin searches closer to 11:00 PM or midnight and said to me, What? 

That makes sense though, Why they wanna stay up? 


Kristina Supler: Yes. So I’m like dying to go to bed, but 

Dr. Cara Natterson: me too.

And so they may get into bed at 10 o’clock at night and want to do the right thing and get sleep and lay there and not be able to fall asleep. The worst. The other thing is there are some kids, and I have one of these kids who. They lay down in bed and what happens? They start processing the day. Mm-hmm.

And they cannot turn their brain off. And you know, Susan, that may be you. You know, that may be one of the things that keeps you up. It is. Right? 

Susan Stone: And what do we do? 

Dr. Cara Natterson: Okay. Meditation. Learning how meditation does not turn your brain off. Meditation teaches you how to quiet certain parts of your brain so that you can accomplish things like sleep.

I cannot tell you how many kids I know who have started listening to meditation apps and started to learn how to turn down the volume of their brain and it changes their sleep. 

Kristina Supler: How do you feel though about melatonin supplements or gummies or any of that? Yeah. 

Dr. Cara Natterson: You know, I mean, I think when used appropriately, they’re fine.

I think anyone can become dependent upon anything. The melatonin dependence issue is really more, um, psychological. Mm-hmm. , the physiological. Um, it’s hard to give someone enough melatonin every single day that they become physically dependent upon it. What happens is if you take melatonin, you just replace what your brain normally makes and you’re trying to game the system.

So you’re trying to shift the time so you fall asleep at the right time, but eventually your brain should take over and just start making it at that correct time. So, um, to me it’s more like a, there’s a more of a placebo effect than anything else where I’m gonna take my melatonin, okay, mentally, now I’m gonna start getting tired.

And your body then goes down through this ritual of getting tired. Not to say that the melatonin isn’t being absorbed and doesn’t work, but there’s a huge psychological component. So it would be really empowering to our kids and frankly to us to not be dependent upon taking something in order to fall asleep and instead use it when needed and then be able to transition off.

Susan Stone: What do you say though about the 3:00 AM or the 2:30 AM wake up? That’s not, I understand that’s not to get to sleep, but what do you do when you wake up in the middle of the night? I’m at the point where, Tell my child is get up and walk around. Don’t fight it. Yeah. Cause sometimes when you sit there and you get tense in your bed, I gotta fall asleep outta sleep.

You’re making it worse. 

Dr. Cara Natterson: Just get a hundred percent. And I would say for anyone of any eight who wakes up in the middle of the night and cannot fall back asleep, that is a person who should absolutely consult with someone who works in the field of sleep to get some real strategies for how to handle it. Because there is nothing worse than the anxiety that hangs over you when you’re laying awake thinking, Oh my God, tomorrow, right? I have a test, I have a this, I have a that, and, and you’re just dooming yourself. So definitely some professional help. 

Susan Stone: Cara, I just I’m so blown away. Not just that you are such an accomplished author, but you’re an entrepreneur and you are a podcast, and you are a doctor, and for someone who works with kids of all ages, You are so accomplished.

What’s a piece of advice you would have for that kid who’s in puberty with, as my kids call it, LSE, low self-esteem? What would you say so they could become a future doctor or entrepreneur or a podcaster like you? 

Dr. Cara Natterson: Well, this is what we tell kids all the time, and thank you for those kind words. Um, we say to kids that it’s completely unfair of us adults to expect you to feel great about everything that’s happening to your life and to your body, and to your friend groups. When you have no idea what is gonna happen to your life or your body or your friend groups, and that we recognize as adults who have been through it that the path doesn’t have a super clear endpoint, and that feels overwhelming, but we’re here to help you out and to support you through it.

I, I think if we tell kids to not feel perfect, but instead to just share how they feel. It works a lot better for us and for them. Because the expectations shouldn’t be that a 10 year old who doesn’t know how tall they’re gonna be, has no idea how curvy they’re gonna be. Has no idea how many zits they’re gonna get, doesn’t know what their bra size is gonna be, has no idea what their future holds for us to say everything’s gonna be fine and gonna work out. 

It’s not helpful to them and it’s not helpful to us. So for us to honor that in them and just say to them, Hey, we’re here, and you just, It’s effort in. It’s effort in and communication out, that’s what counts.

I think those are the kids that really thrive. 

Kristina Supler: That’s great advice for kids and adults, frankly. So thank you. I, I really like ending on that note. Uh, Cara Natterson,, thank you so much for joining us today. Really, this was a treat. We covered a ton of topics, but I, I think that was so cool in that we’ve given our listeners so much food for thought on various different teen and tween issues.

So thanks 

Susan Stone: for bouncing with us, 

Dr. Cara Natterson: the bouncers. I loved it. Thank you for having me. I really appreciate.