Growth Milestones - 18 Years

"Leaving the Nest" At the age of 18, adolescents begin to recognize that parents can be their best friends. This is the time when parents can help their son or daughter more by being a good sounding board for them rather than making their decisions. As Mark Twain once noted, "18 year olds are sometimes amazed at how much their parents have grown on so little knowledge and how much they have learned in the past few years!" The peer group becomes less important to the late adolescent and is replaced by a few good friends. The young adult's interests now focuses on education or a vocational future. He or she attempts to answer the question frequently asked when he or she was younger: ".......and what do you want to be when you grow up?" The unrealistic fantasies of early adolescence are now replaced by more realistic educational and vocational plans. The mature adolescent is able to understand his or her strengths and applies them to a potential career. Separation from parents is a necessary part of growing up. We expect children to become independent adults. This independence does not mean there cannot be close family relationships, but this relationship should be based on mutual respect. In other words, parents need to recognize that their child has grown up and has come to terms with their sense of loss as the child "leaves the nest." Parenting and Behavioral The role of parents during this phase in their child's development should be one of support. Parents will usually find that their teenager has a better relationship with them now than he or she did in the early teen years. The adolescent may even seek out your advice! The most common mistake most parents make at this age is being overprotective. Many parents feel their young person will make a serious mistake with career choice or spouse selection. Parents should resist the impulse to make choices for their son or daughter and allow the youngster to come to that conclusion on his or her own. This is mostly true concerning spouse selection when many parents feel their young person has chosen a spouse who would not be right for him or her. In many cases, parents are correct, but it will do no good to impose that feeling upon your adolescent. Your young adult will interpret this as being unjust or unfair, and will push him or her further into the disliked relationship. Late adolescence is less of a struggle between parent and child than it was in earlier years. By the end of this period, most parents will find they like and enjoy their offspring as an emerging young adult. As older adolescents become more comfortable with themselves and their emotional independence, their relationships with family members become more accepting and harmonious. Most 18 year olds have decided whether they will go on to college, join the work force or enter the military. While late adolescence should be a time of choice it can also bring intense frustration to youth with restricted options. Those who have not concentrated on academic performance now confront severely curtailed choices. High unemployment rates among youth—especially those who are unskilled or belong to minority groups—underscore the fact that vocational options are limited. This harsh reality diminishes the young person’s sense of hope for the future unless some positive intervention is offered. Establish realistic expectations for family rules, with increasing autonomy and responsibility given to the adolescent. Enhance the adolescent’s self-esteem by providing praise and recognizing positive behavior and achievements. Minimize criticism, nagging, derogatory comments, and other belittling or demeaning messages. Spend time with your adolescent. Respect your adolescent’s need for privacy. Teach your young adult techniques for resisting peer pressure. Discuss with the adolescent possible contingency plans in the event that a car trip is necessary and the person who is driving is drunk or has taken drugs. Parents should learn the signs of adolescent depression: Making statements like "I want to die" or "I feel dead inside." Previous suicide attempts. Abuse of alcohol or drugs. Giving away prized possessions, writing a will or making other "final" arrangements. Preoccupation with themes of death or expression of suicidal thoughts. Changes in sleeping patterns (too much or too little), withdrawal from friends or family, or other major behavioral changes. Changes in school performance (lower grades, cutting classes, dropping out of activities). Frequent complaints of physical symptoms such as stomachaches, headaches or fatigue. Sudden and extreme changes in eating habits, or loss or gain of unusual amounts of weight. Sudden cheerfulness after a prolonged period of depression. Traits of the Adolescent Who may be Expected to do Well: Is in good health and has good food habits.SMALL> Believes he or she will do well. Has self-confidence and a sense of pride and competence. Enjoys close interactions with peers of both sexes. Takes advantage of recreational outlets. Recognizes the need for rules and fair play. Is energetic, enthusiastic and idealistic. Has plans for the future and has identified some life goals. Recognizes the consequences of his or her actions. Feels responsible for his or her health. Generally cooperative, understanding and considerate of parents. Has dramatic, artistic or musical talents. Does well in school and/or work. Takes appropriate responsibility for homework with little prodding. Is comfortable in asking parents questions. Generally cooperative and considerate, although at times is inconsistent and unpredictable. Has experienced an intimate relationship and has a firm self-identity. Traits of an Adolescent to be Concerned About: Has a low self-esteem or lack of friends. Does not communicate well with parents. Does poorly in school or has dropped out of school. Extremely worried to the point of panic concerning what he or she is going to do with his or her life. Delinquent behavior and has been in trouble with the law. Physically inactive. Anxious or fearful; displays aggressive or acting out behavior (lying, defiance, stealing, temper, vandalism, animal cruelty). Compulsive behaviors, fears, depression and without initiative. Has no marketable skills and cannot find or keep a job. Has no life goals. Is overly dependent on parents. Life Style Issues Youth 18–24 years of age are the most infrequent users of health care services. They are also the age group most likely to be uninsured. Many are no longer covered by their parents’ insurance plan, and those who work often have entry-level jobs that offer no health insurance benefits. Emphasize to your adolescent the importance of exercise. On the other hand, the dangers of overexercise should also be explained. The older adolescent is usually more receptive to information regarding good nutrition. Preaching to adolescence is generally ineffective, but supplying him or her with good factual information about nutrition and being a good role model are worthwhile. Maintains an appropriate weight. Brushes and flosses teeth regularly. Practices routine dental care. Is familiar and does self-examination of breasts and testes. Drives responsibly by always wearing a seat belt and shoulder harness, drives defensively, never drives when drinking or under the influence of drugs or when angry. Never rides in a car whose driver (including parent) has been drinking. Alcohol and Smoking- Older adolescents who live away from home may need to be reminded about the dangers of smoking and drinking. Those adolescents who have chosen not to begin smoking should be constantly commended for their decision and reminded that being in a room with others who smoke is harmful to their lungs. Mental Health: Take on new challenges that will increase your self-confidence. Continue to develop your sense of identity, clarifying your values and beliefs. Accept who you are and enjoy both the adult and the child. Trust your own feelings as well as feedback from friends and adults. Seek help if you often feel angry, depressed or hopeless. Learn how to deal with stress. Set reasonable but challenging goals. Understand the importance of your spiritual and religious needs and try to fulfill them. Nutrition for the Adolescent Eat three meals per day. Breakfast is especially important. Eat meals with your 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 your diet. Select a nutritious meal from the school cafeteria or pack a balanced lunch. Achieve and maintain a healthy weight. Manage weight through appropriate eating habits and regular exercise. Many girls develop anemia during this time. They need sufficient iron in their diet to replace menstrual loss. Sleep You may think that your 18-year- old "sleeps" his or her life away (especially on weekends), but many youngsters this age are actually sleep-deprived. Adolescents this age need 9-10 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 adolescents at age 18 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. 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 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. Sexuality for the Late Adolescent Educate yourself about birth control, sexually transmitted diseases, gay and lesbian issues, celibacy and other issues related to sexuality. Having sexual intercourse 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 ways to negotiate safer sex and to share your feelings about sexuality with your partner. 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 the 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 Late 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 that you are in danger. 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-`5-07

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.