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Quick reference medical handouts used by Pediatric offices

Growth Milestones - 14 Years

"The Age of Rapid Changes"

During middle adolescence, puberty is well underway, and is complete in many teenagers. There is a decreased preoccupation with the body and an increased involvement with peers. Parental conflicts develop over independence, since the peer group often serves as the adolescent's reference for their standards of behavior.

This age is often called the neglected age of pediatrics, according to pediatrician William Crook, M.D. "It is 'no man's land' between childhood and adulthood." The maturing teen does not want to be treated like a child, and often balks at having to go to the "baby doctor" for checkups. Yet, at the same time, the adolescent does not want to go to a new adult physician who may be unfamiliar with issues important to this age group. The result is that often the youngster ends up going to neither. This is unfortunate since middle adolescence is a period of rapid development during which time checkups are important.

This can be a difficult time for parents, who must cope with their adolescent while trying to keep the channel of communication open. Love your teen with no strings attached.

Parents do best when they understand the normal characteristics of the middle teen years, otherwise known as the five "I"'s and six "M"'s (courtesy of the Parent and Child Guidance Center, Pittsburg, Pennsylvania)

The five "I's"

  • Impulsive
  • Intense
  • Idealistic
  • Immediate (wanting everything now)
  • Industructable (thinking nothing can hurt them, they can not get pregnant, they will not get into an auto accident, etc.)

The six "M's":

  • Moody
  • Messy
  • Monosyllabic
  • Mouthy
  • Money-oriented
  • ME-centered.
Parenting and Behavioral
  • Basic survival strategies for parents of adolescents are (courtesy of the Parent and Child Guidance Center, Pittsburg, Pennsylvania):
    1. Choose your battles carefully. Settle for something less than perfection on issues that don't really matter. Remain calm, and don't match his/her level of emotional intensity.
    2. Be available to your adolescent without directing or controlling him/her. The time when they want you is often at teen's choosing, not yours. Be there if possible.
    3. Help him/her regulate his/her lifeand consider alternatives.
    4. Establish networks with parents of your teen's friends, even if they are new to you.
    5. Let teens know they can always call you when in trouble, without fear of recrimination.
  • Parents should remember that adolescents can be especially worried about their bodies, diets and sexual abilities. Will they be normal? Can they perform? How will others perceive them? Parents need to remember that the adolescent's interest in body changes and sexual topics is a natural, normal development and does not necessarily indicate movement into sexual activity. One must take care not to label emerging instinct/behaviors as "wrong," "sick" or "immoral." ." Nor should parents jump to conclusions about behaviors based soley on hunches or feelings.
  • Increased emotionality is a hallmark of the period. Teens can be excessively modest, insecure and feel isolated and alone, as they discover the tenuousness of their peer relationships.
  • Adolescents usually require privacy in which to contemplate changes taking place within their own bodies. Ideally the youth should be allowed to have his/her own room, but if this is not possible some private space needs to be made available so the teen can go and not be bothered by older or younger siblings or parents!
  • Teasing an adolescent child about physical changes is inappropriate, because it may cause self-consciousness and embarrassment.
  • The teenager's quest for independence is normal development and need not be looked upon by the parent as rejection or a loss of control. Examples include (1) young teenagers may not want to join the family on all family outings; (2) Young teens may not want their parents around the school at social functions as chaperones; (3) Young teens may begin to confide in an adult outside the family rather than in mothers or fathers as in previous years.
  • To be of most benefit to the growing adolescent, parents need to remain a constant and consistent figure, available as a sounding board for the youth's ideas without dominating and overtaking the emerging, independent identity of the young person.
  • Most 14-year olds focus on social life, friends and school. They have chosen friendships with members of the same sex. Sometimes, a teenager's best friends becomes a parent substitute and confidante. These friendships, however, may change abruptly, causing hurt feelings.
  • Teens need to learn to respect the rights and needs of others, follow family rules, such as those for curfews, television viewing, and chores. Share in household chores.
  • Parents need to serve as a positive ethical and behavioral role model.
  • Teach the adolescent techniques for resisting peer pressure.
  • Parents should learn the signs of adolescent depression and drug abuse!
Characteristics of the "teen friendly" parent:
  • Praises, approves, supports and shows interest in their adolescent. Attends events in which their son or daughter is a participant.
  • Encourages reasonable independence, friendships and interests outside of the home.
  • Finds time to be with and listen to the adolescent.
  • Is a good ethical and behavorial model.
  • Establishes realistic expectations for family rules, with increasing responsibility given to the adolescent.
  • Establish and communicate clear limits and consequences for breaking rules. Does not repeatedly warn or threaten. Simply follows the protocol already agreed upon and is consistent.
  • Is present at home or makes arrangements for the adolescent's supervision in their absence.
  • Assigns chores around the home and provides an allowance.
  • Demonstrate interest in the adolescent's school activities and emphasize the importance of school.
  • Takes pleasure in their son's or daughter's abilities and achievements
  • Respects the adolescent's privacy - bedroom, bathroom, mail, phone calls.
  • Enhances the teens self-esteem by providing praise and recognizing positive behavior and achievements.
  • Minimizes criticism, nagging, derogatory comments, and other belittling or demeaning messages.
  • Is not necessarily the teens best friend. Remembers that their role is to teach and parent
  • Shows respect for their teen. Listens to their side without interrupting or judging.
  • Gets to know their teen's friends, and avoids making quick judgments based on appearance only. Whenever possible, avoids downgrading their friends.
  • Encourages their son or daughter to invite peers home.
  • Allows their son or daughter to make age-appropriate decisions and selections (for example, choosing clothes).
  • Involves their teen in decision making regarding their role in family chores, supervision of younger sibling, etc.
  • Assumes a role in the teen's sex education, perhaps with the help of books recommended by the physician
Traits of the adolescent who is doing well:
  • Is in good health or functions up to capacity if has a chronic condition; has good food habits.
  • Believes he/she will do well.
  • Has self-confidence and a sense of pride and competence.
  • Enjoys close interactions with peers (especially same-sex friendships).
  • Enjoys recreational activities.
  • Recognizes the need for rules and fair play.
  • Is energetic, enthusiastic and vital.
  • Has reasonable athletic ability.
  • Has dramatic, artistic or musical talents.
  • Does well in school.
  • Takes appropriate responsibility for homework with little prodding.
  • Assumes responsibility for his/her own health.
  • Is comfortable in asking parents questions.
  • Generally cooperative and considerate, although at times is inconsistent and unpredictable

How to talk so your teen will listen

Respect - getting what you give

Tips for raising teenagers

Oral Health for the Adolescent
  • Brushes teeth twice a day with a fluoridated toothpaste and flosses daily.
  • Knows what to do in the cause of a dental emergency, especially the loss or fracture of a tooth.
  • Has seen a dentist within the last six months unless your dentist determines otherwise based on his/her individual needs/susceptibility to disease
  • Does not smoke or use chewing tobacco.
Nutrition for the Adolescent

14-year olds seem to eat continuously and appetite rarely is a problem. Unfortunately, many 14 and 15 year olds consume fast foods daily. They eat snacks that are high in calories and fat.

  • Eat three meals per day. Breakfast is especially important. Do your best to make sure your 14-year old has a nutritious breakfast daily.
  • Choose a variety of healthy foods.
  • Choose nutritious snacks rich in complex carbohydrates. Limit high-fat or low-nutrient foods and beverages such as candy, chips or soft drinks.
  • Choose plenty of fruits and vegetables; breads, cereals and other grain products; low-fat dairy products; lean meats; and foods prepared with little or no fat. Include foods rich in calcium and iron in your diet. Girls may suffer anemia at this time so make sure they are receiving sufficient iron in their diet to replace menstrual losses.
  • Select a nutritious meal from the school cafeteria or pack a balanced lunch.
  • At this age it is especially important to evaluate your 14-year old's food consumption in relation to the amount of exercise they do. Obesity can be a problem in 14 and 15 year olds. Studies have shown that children who are overweight at this age group have a great chance of being overweight as an adult. Achieve and maintain a healthy weight. Manage weight through appropriate eating habits and regular exercise.


  • You may think that your 14-year old "sleeps" their life away (especially on weekends), but many children this age are actually sleep-deprived. Children this age need 9-10 hours of sleep per night. Lost sleep can not be made up later

Is your teen having trouble sleeping at night?

How Much sleep is Normal?

Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced, it is always best to seek the advice of your child's health care provider concerning your child's vaccine schedule.
  • Most children should have received the following vaccines and no immunizations are usually given at this age. All 14 year olds should have had:

5 doses of DtaP
1 dose of  TdaP, to be followed with tetanus boosters every 10 years

4 doses of IPV (polio)
4 doses of HiB
doses of Chickenpox vaccine
4 doses of pneumonia  vaccine (if born after 1999)
3 doses of Hepatitis B vaccine
2 doses of MMR vaccine
The HPV (humanpapilomavirus) vaccine series (girls)
Meningococcal vaccine

Kidsgrowth Vaccine Guide
The Vaccines and the Diseases they Prevent
Keep a record of your child's immunizations.
   Click to download a blank immunization record)


*Annual flu vaccines for children with
chronic illnesses like asthma, diabetes and
heart defects. Check with your

*Vision and hearing, as well as blood
and urine and blood pressure are usually checked at this visit. Other screening done at this age may include a tuberculin test (if indicated). If there is a family history of elevated cholesterol, some physicians will also obtain a screening blood test.

*Measure and plot on a standard chart the adolescent’s height and weight. Determine the body mass index. (BMI)
If an adolescent has a BMI >95th percentile for age and gender, or < 5th percentile, refer for dietary assessment and counseling. Adolescents with a BMI between the 85th and 95th percentile need initial evaluation and counseling the prevention of obesity.

*Special referrals should be considered at this age for;
(1) adolescent girls who have not begun breast development or boys who have not experienced testicular enlargement,
(2) Boys or girls who do not follow the normal pattern of pubertal development (for example, menstruation before breast development)

(3) Families that are in prolong conflict - some turbulence is expected in all families, but a decline in the families ability to communicate or prolonged conflict should not be expected.
(4) The adolescent who is a loner

Sexuality for the Adolescent
  • Find a supportive adult who can give you accurate information about sex.
  • Ask your doctor about any questions you have about body changes during puberty, including variations from individual to individual.
  • Ask any questions you have about birth control or sexually transmitted diseases.
  • Having sexual feelings is normal, but you should wait to have sex.
  • Not having sexual intercourse is the safest way to prevent pregnancy. and sexually transmitted diseases, including HIV infection/AIDS.
  • Learn about ways to say no to sex. If you have already said "yes," talk with your doctor about ways to prevent pregnancy and STDs.
  • Pay attention to personal safety from physical or sexual assault (that is, do not accept rides from or hitchhike with strangers.
Talking to teens about sexuality

Are you an askable parent?

It's time for the big talk - now what?

Say "No" to substance use/abuse
  • Do not smoke, use smokeless tobacco, drink alcohol, or use drugs, diet pills, or steroids. Do not become involved in selling drugs.
  • If you smoke, discuss smoking cessation with the health professional.
  • Avoid situations where drugs or alcohol are easily available.
  • Support friends who choose not to use tobacco, alcohol, drugs,
    steroids or diet pills.
  • Become a peer counselor to
    prevent substance abuse.

Health Promotion
  • Get adequate sleep.
  • Exercise vigorously at least three times per week. Encourage friends and family members to exercise.
  • Discuss with the health professional
    or your coach athletic conditioning, weight training, fluids and weight
    gain or loss.
  • Limit television viewing to an average of one hour per day.
Children riding in Pickup Trucks

Ask your neighbor if there is a gun in the house

Help steer kids away from alcohol

How to choose a safe car for your teen

Protect your ears: Turn the radio down

Check your child's progress with our Growth Charts.

The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics' Guidelines for Health Supervision and Bright Futures' Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.. Updated 05-12-07



As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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