Growth Milestones - 16 years

"Friends, Clothes, Music, and More!" By the age of 16, most girls have completed the changes associated with puberty and have menstrual periods, and most boys are well on their way to finishing pubertal development, having gained muscle mass and strength as well as secondary sexual characteristics. Questions about identity center on "Who am I?" as 16 year olds sort out values and beliefs in their quest for a clearer sense of self. As friends assume greater importance, 16 year olds spend less time with their families. Teens of this age are extremely sensitive to the social norms of the peer group, including choices in dress, hairstyle, vocabulary and music. They tend to have a small group of friends who share similar values and behaviors. As adolescents deal with issues of independence, they continue to test rules and question authority. Sixteen year olds often become extremely opinionated and challenging, which frequently results in family conflict, especially over issues such as dress, music and social etiquette. New activities such as driving and dating require negotiating additional family rules. When at home, adolescents often seek privacy in their rooms. Middle adolescents have reached the legal age to drive in most states, gaining a mobility that offers risks as well as new opportunities and choices. Shopping malls and fast food restaurants become popular adolescent gathering places. With their increasing mobility and independence, there is potential for exploration of risky behaviors. Substance use and sexual activity increase with each successive year of high school. By 12th grade, almost 87 percent of students have used alcohol, with 39 percent reporting at least one episode of heavy drinking the previous month. Slighly more than 40 percent of seniors report having used marijuana, and more than 8 percent report having used cocaine. By 12th grade, 30 percent of students report occasional use of tobacco, with almost 16 percent smoking frequently. Many regular smokers report some failed efforts to quit. Chewing or smokeless tobacco poses the risk of oral cancer. Alcohol and drugs are major factors in deaths among adolescents, contributing to motor vehicle crashes, homicides and suicides. Parenting and Behavioral Parents must remember that times are different from those they knew as teenagers. Your adolescent has many more and new obstacles to overcome than you did while still going through the same physical and emotional changes. This can be an extremely difficult time. Parents must learn to cope with their adolescent while trying to keep the channel of communication open. Love with no strings attached. You will find yourself growing in wisdom as you struggle with the issues that teenagers force parents to face. Basic survival strategies for parents of adolescents are: 1. Choose your battles carefully. Settle for something less than perfection on issues that don't really matter. Remain calm, and don't match your teenager's level of emotional intensity. 2. Be available to your adolescent without directing or controlling him or her. The time when he or she will want you is often at the teen's choosing, not yours. Be there if possible. 3. Help your teen regulate his or 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. (courtesy of the Parent and Child Guidance Center, Pittsburg, Pennsylvania) Feelings of sadness and depression should not be dismissed as "normal" moodiness during this period. Situational losses—including the death of a pet, problems with girlfriends or boyfriends, school failure and parental disappointment—can lead to depression and even suicide. More than one-fourth of high school students during the past year have thought seriously about committing suicide, and more than 8 percent have actually attempted it. Effective education in the areas of sex, contraceptives, drugs, alcohol and cigarettes is extremely important. The AIDS problem has increased the importance of educating your child. It is appropriate and important to express your own moral values about these subjects. But try to be flexible and open-minded. Let your child ask questions and express his or her feelings without fear of judgment or punishment. Remember, peer acceptance is extremely important to your adolescent. The group sets their standards for behavior and rejection can be devastating. Listen to your child when situations occur that separate him or her from the group. You do not necessarily have to offer advice. Although it is often difficult, learn to adjust to the variations in hair and clothing. Try your best to be flexible. Adolescents usually require privacy in which to contemplate changes taking place within their own bodies. Ideally the youth should be allowed to have his or 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! The teenager's quest for independence is a 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. Teens need to learn to respect the rights and needs of others. They should follow family rules, such as those for curfews, television viewing and chores, and share in household chores. Parents need to serve as a positive ethical and behavioral role model. Teach your teen techniques for resisting peer pressure. Discuss with your adolescent possible contingency plans in the event that a car trip is necessary and the adolescent (or the person who is driving) is drunk or has taken drugs. Parents should learn the signs of adolescent depression and drug abuse! Characteristics of the "Teen Friendly" Parents: 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 their adolescent. Establishes realistic expectations for family rules, with increasing responsibility given to the adolescent. Establishes and communicates clear limits and consequences for breaking rules. Does not repeatedly warn or threaten. Simply follows the protocol already agreed upon and is consistent. Assigns chores around the home and provides an allowance. Demonstrates an interest in the adolescent's school activities and emphasizes 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 his or her side without interrupting or judging. Gets to know their teen's friends, and avoids making quick judgments based on appearances only.. Whenever possible, avoids downgrading their teen's 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 and has good food habits. Believes that he or 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 or her own health. Is comfortable in asking parents questions. Generally cooperative and considerate, although at times is inconsistent and unpredictable. Oral Health for the Adolescent Brushes teeth twice a day with a pea-size amount of fluoridated toothpaste and flosses daily. Takes fluoride supplements as recommended by the health professional based on the level of fluoride in your drinking water. Knows how to handle dental emergencies, 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 or her individual needs/susceptibility to disease. Does not smoke or use chewing tobacco. Nutrition for the Adolescent 16-year olds seem to eat continuously! But many eat an inadequate diet, and others are always on a diet. Many teens, especially females, are obsessed with physical appearance. Crash and fad dieting are common responses to the obsession with self-image. As a result, some teens become too thin. Like being overweight, eating disorders such as bulimia or anorexia are common during adolescence. Make sure your teenager eats three meals per day. Breakfast is especially important. Meals should be eaten with the family or residential group on a regular basis. Choose and prepare 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 the diet. Select a nutritious meal from the school cafeteria or pack a balanced lunch. Your teen should achieve and maintain a healthy weight. Weight can be managed through appropriate eating habits and regular exercise. It's a good idea for your teen to avoid "empty" calories such as soft drinks, chips, candy and cookies. Many girls develop anemia during this time. They need sufficient iron in their diet to replace menstrual loss. Sleep You may think your 16-year-old "sleeps" his or her life away (especially on weekends), but many children this age are actually sleep-deprived. Children this age need nine-10 hours of sleep per night. Lost sleep can not be made up later. Immunizations 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 have received the following vaccines and no immunizations are usually given at this age:   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 2 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) A Td (tetanus-diphtheria) booster is recommended every 10 years and is usually given at the 14 or 16 year checkup. Annual flu vaccines for children with chronic illnesses like asthma and heart defects. Check with your doctor. Vision and hearing, as well as blood and urine, are usually checked at this visit. Other screening done at this age may include a tuberculin test (if indicated) and blood pressure. 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 your adolescent’s height and weight. Determine the body mass index (BMI) If an adolescent has a BMI greater than the 95th percentile for age and gender, or less than the 5th percentile, refer for dietary assessment and counseling. Adolescents with a BMI between the 85th and 95th percentile need initial evaluation and counseling for obesity. Special referrals should be considered at age 16 for: (1) Adolescent boys who have not begun pubertal development should be evaluated for pubertal delay (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 - those who do not belong to a peer group at age 16 are considered loners and frequently are depressed, at risk for suicide, involved in truancy or are taking drugs. (5) The promiscuous teenager - this may be a sign of difficulties in the adolescent's life caused by poor self-esteem, parental hostility, rebellion, self-destruction, or a teen in search of comfort and love. The physician and his or her staff, as well as the parents, should respect the child's privacy by using appropriate draping during the 16-year examination. Sexuality for the Adolescent Identify a supportive adult who can give you accurate information about sex. Get accurate information about birth control and sexually transmitted diseases and learn to recognize the signs. Having sexual feelings is normal, but having sex should be a well thought out decision. Do not have sex if you do not want to. 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 are engaging in sexual activity, including intercourse, ask the health professional for an examination and discuss methods of birth control. Learn about safer sex. Practice safer sex. Limit the number of partners, and use latex condoms and other barriers correctly. If you are confused or concerned about your sexual feelings (for the same sex or opposite sex), talk to a trusted adult or a health professional. 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, find out about smoking cessation programs. If you use drugs or alcohol, ask for help (e.g., a substance abuse treatment program). Avoid situations where drugs or alcohol are easily available. Support your friends who choose not to use tobacco, alcohol, drugs, steroids or diet pills. Become a peer counselor to prevent substance abuse. Safety Advice for the Adolescent Wear a seat belt while driving or riding in the car. If you are driving, insist that your passengers wear seat belts. Follow the speed limit. Learn how to swim. Do not drink alcohol, especially while driving, boating or swimming. Plan to have a designated driver if drinking. Protect yourself from skin cancer by putting sunscreen on before you go outside for long periods of time. Avoid tanning salons. Test smoke detectors in your home to ensure they work properly. Change batteries yearly. Always wear a helmet when on a motorcycle, in an all-terrain vehicle or riding a bicycle. Even with a helmet, motorcycles and ATVs are very dangerous. Wear protective sports gear such as a mouth guard or a face protector. Wear appropriate protective gear at work and follow job safety procedures. Avoid high noise levels, especially in music headsets. Do not carry or use a weapon of any kind. Develop skills in conflict resolution, negotiation and dealing with anger constructively. Learn techniques to protect yourself from physical, emotional and sexual abuse, including rape by strangers or acquaintances. Seek help if you are physically or sexually abused or fear you are in danger. Health Promotion Get adequate sleep. Exercise vigorously at least three times per week. Encourage friends and family members to exercise. Discuss with your health professional or coach about athletic conditioning, weight training, fluids and weight gain or loss. Limit television viewing to an average of one hour per day. 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 05-14-07

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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.