Growth and Development, Ages 15 to 18 Years

Topic Overview

How do teenagers grow and develop during ages 15 to 18?

The ages from 15 to 18 are an exciting time of life. But these years can be challenging for teens and their parents. Emotions can change quickly as teens learn to deal with school, their friends, and adult expectations. Teen self-esteem is affected by success in sports, school, and friendships. Teens tend to compare themselves with others, and they might form false ideas about their body image. The influence of TV, magazines, and the Internet can add to a teen's poor body image.

For parents, the teen years are a time to get to know their teenager. While teens are maturing, they still need a parent's love and guidance. Most do just fine as they face the challenges of being a teen. But it is still important for teens to have good support from their parents so that they can get through these years with as few problems as possible.

There are four basic areas of teenage development:

• Physical development. Most teens enter puberty by age 15. Girls go through a time of rapid growth right before their first menstrual period. And by age 15, girls are near their adult height. Boys usually continue to grow taller and gain weight through their teen years.
• Cognitive development. As they mature, teens are more able to think about and understand abstract ideas such as morality. They also begin to understand other people better. Even though they have a certain amount of empathy and can understand that others have different ideas, they often strongly believe that their own ideas are the most true.
• Emotional and social development. Much of teens' emotional and social growth is about finding their place in the world. They are trying to figure out 'Who am I?' and 'How do I fit in?' So it is normal for their emotions to change from day to day.
• Sensory and motor development. Boys continue to get stronger and more agile even after puberty. Girls tend to level out. Getting plenty of exercise helps improve strength and coordination in boys and girls.

When are routine medical visits needed?

Teenagers should see their doctor for a routine checkup each year. The doctor will ask your teen questions about his or her life and activities. This helps the doctor check on your teen's mental and physical health. It's a good idea to give your teen some time alone with the doctor during these visits to talk in private. Your teen will also get any needed shots (immunizations) at each checkup.

Teens should also see the dentist each year.

When should you call your doctor?

Call your doctor if you have questions or concerns about your teen's physical or emotional health, such as:

• Delayed growth.
• Changes in appetite.
• Body image problems.
• Behavior changes.
• Skipping school or other problems with school.
• Alcohol and drug use.

Also call your doctor if you notice changes in your teen's friendships or relationships or if you need help talking with your teen.

How can you help your teenager during these years?

Even though teens don't always welcome your help, they still need it. Your being available and involved in your teen's life can help your teen avoid risky behavior. It also helps your teen grow and develop into a healthy adult. Here are some things you can do:

• Encourage your teen to get enough sleep.
• Talk about body image and self worth.
• Encourage your teen to eat healthy foods and be active.
• Talk with your teen about drugs and alcohol.
• Be ready to address your teen's concerns and problems.
• Involve your teen in setting household rules and schedules.
• Continue talking to your teen about dating and sex.
• Encourage community involvement (volunteering).
• Set rules about Internet use.

Teens really want to know that they can talk honestly and openly with you about their feelings and actions. It is very important for teens to know that you love them no matter what.

Frequently Asked Questions

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What to Expect

Teens grow and develop at different rates. But general teen growth and development patterns can be grouped into four main categories.

• Physical development. By age 15, most teens have entered puberty. Most girls are close to their adult height and have completed the phase of rapid growth that precedes the first menstrual period. Boys often continue to grow taller and gain weight. The growth spurt in boys tends to start about 2 years after puberty begins and reaches its peak about 1½ years later. Also, gender characteristics continue to develop in both girls and boys.
• Cognitive development, which is the ability to think, learn, reason, and remember. Teens gradually develop the ability to think in more sophisticated, abstract ways. They begin to perceive issues in shades of gray instead of black and white, as they gain a better understanding of concepts like morality, consequence, objectivity, and empathy. Although they may understand that people can see the same issue in different ways, they often are convinced their personal view is the one that is most correct.
• Emotional and social development. Attempts to answer the questions, "Who am I?" and "How do I fit in?" guide much of teens' emotional and social development. This can be a painful process full of anxiety. In response, teens may behave unpredictably as emotions fluctuate seemingly at random. At times teens may seem mature. Other times, they may act as if they are still in elementary school, especially with parents and other close family members. Socially, teens form new friendships, often with members of the opposite sex.
• Sensory and motor development. After puberty, boys' strength and agility naturally continues to develop, while that of teen girls tends to level out. Both girls and boys can increase strength, coordination, and athletic skill through regular physical activity.

Growth and development does not always occur evenly among different categories. For example, your teen may have a tremendous growth spurt and look almost like an adult, but may seem socially and emotionally young for his or her age. Eventually, most teens mature in all areas of growth and development, especially if given the right tools and parental guidance.

Common Concerns

The word "teenager" to many people brings up an image of a wild and reckless young person whose main purpose in life is to rebel against his or her parents. Most teenagers do not fit this description. Of course, there are times when any teenager may be hard to deal with. But many teenagers are trying their best to please parents while they work toward some level of independence.

Parents of teenagers between ages 15 and 18 are often most concerned about whether the teen will be able to make good decisions. Parents know that the choices children make during the teen years can impact much of their adult lives. It is normal to worry. Even if your child has momentary lapses in judgment, the chances are that he or she is going to be okay.

Know that you are not alone in these types of concerns. For example, many parents worry about whether their teenager will:

• Resist using or abusing alcohol and drugs (including prescription drugs and supplements such as anabolic steroids). Many teens are exposed to these and other substances throughout their teen years. Offer strategies to avoid tobacco, drugs, and alcohol. Set firm, fair, and consistent limits for your teen. Talk about the immediate and long-lasting results of substance use, such as falling grades and poor health during adulthood. Help your teen practice how to respond when a harmful substance is offered, such as stating "No, thanks" and moving on to another subject. Look for community programs led by teens (peer education). And talk to your teen right away if you see signs of substance use.
• Focus enough on doing well in school. Typically, teenagers have many distractions. Friends, clubs, sports, and jobs can all compete for time that could be spent completing homework. Show your teenager how to set goals. For example, talk about and write down a goal for the week, month, and year. Help your teen think about the steps that need to be taken to reach the goal. Work with your teen to make a schedule for when to do each step and set rewards for when the goal is achieved.
• Drive safely. You can help teach your teen about safe driving. But what a teen does when parents are not around is the unknown. Remind your child often that driving is a huge responsibility that should not be taken lightly.
• Feel pressured to have sex. Talk about dating and sex early, before the information is needed. Focus on what makes a relationship healthy, such as trust and respect for each other. Also, kids have easy access to many Web sites with sexual or pornographic content. Keep the computer in a shared area where you can see what your teen is doing online.

Try to understand the issues your teen faces. Although you may remember some struggles from your own teen years, the issues your teen faces are likely quite different. Stay involved in your teen's life, such as by going to school events and encouraging your teen to bring friends to your house while you are home. You can better see the world from his or her perspective when you are familiar with it. Also, learn to recognize your teen's stress triggers and offer guidance on how to manage the anxiety they may cause. But be careful not to get too caught up in your teen's world. If you try to take too much control, it will likely only make things harder for him or her.

Promoting Healthy Growth and Development

You can help your teen between the ages of 15 and 18 years by using basic parenting strategies. These include offering open, positive communication while providing clear and fair rules and consistent guidance. Support your teen in developing healthy habits and attitudes, help him or her make wise choices, and offer guidance in how to balance responsibilities.

The following are examples of ways to promote healthy growth and development in specific areas. But remember that many growth and development issues overlap. For example, having a healthy body image is important for physical development and emotional development. Use these ideas as a starting point to help your teen make good choices that will help him or her grow into a healthy and happy adult.

Promote your teen's physical development by doing the following:

• Be aware of changing sleep patterns. Rapidly growing and busy teens need a lot of sleep. The natural sleeping pattern for many teens is to go to bed later at night and sleep in. This can make it hard to get up for school. To help your teen get enough rest, discourage phone and computer use and TV watching after a certain evening hour.
• Help your teen manage acne, if it is a concern. Most young people get at least mild acne. Keeping the skin clean helps control acne. Also, your teen should avoid skin products that clog skin pores. Look for products that say "noncomedogenic" on the label. Suggest that your teen wash his or her skin once or twice a day with a gentle soap or acne wash. Discourage scrubbing or picking at pimples, which makes them worse and can lead to scarring. If your teen has a few pimples, an acne cream you can buy without a prescription may work. Look for one that has benzoyl peroxide or salicylic acid. These work best when used just the way the label says. If your teen's pimples are really bothersome or are scarring the skin, see a doctor. A prescription gel or cream for the skin may be all he or she needs. For more information, see the topic Acne Vulgaris.
• Talk about body image. What teens think about their bodies greatly influences their feelings of self-worth. Stress that healthy eating and exercise habits are most important for the short and long term. Help your teen recognize that television and other media often produce unrealistic images of the ideal body that are not healthy. For more information, see the topic Anorexia Nervosa, Binge Eating Disorder, or Depression in Children and Teens.
• Offer strategies to avoid tobacco, drugs, and alcohol. Set firm, fair, and consistent limits for your child. Help him or her understand the immediate and long-lasting results of substance use, such as falling grades and poor health during adulthood. Practice how to respond when a harmful substance is offered, such as simply stating "No, thanks" and moving on to another subject. If you believe your teenager is using drugs or alcohol, it is important to talk about it. Discuss how he or she gets the alcohol, tobacco, or drugs and in what kind of setting it is used. Seek advice from a doctor if the behavior continues. For more information on tobacco, drugs, or alcohol problems, see the topic Teen Alcohol and Drug Abuse.

  Dealing with teen substance use

Promote your teen's healthy emotional and social development by doing the following:

• Address problems and concerns. Build trust gradually so your teen will feel safe talking with you about sensitive subjects. When you want to talk with your teen about problems or concerns, schedule a "date" in a private and quiet place. Knowing when and how to interfere in a teen's life is a major ongoing challenge of parenthood. Parents walk a fine line between respecting a teen's need for independence and privacy and making sure that teens do not make mistakes that have lifelong consequences.
• Understand the confusion about sexual orientation. Hormones, cultural and peer pressures, and fear of being different can cause many teens to question themselves in many areas, including sexual orientation. It is normal during the teen years to develop same-sex "crushes." Consider mentioning to your teen that having such an attraction does not mean that he or she is destined to be a homosexual. But it is helpful to acknowledge that in some cases, these feelings grow stronger over time rather than fade.
• Encourage community service. Both your teen and community members are helped when your teen volunteers. Your teen gets the chance to explore how he or she connects with others. While helping peers, adults, and other people, your teen can gain new skills and new ways of looking at things. He or she can also develop and express personal values and explore career options. Your teen can benefit most by thinking back on the service experience and figuring out what he or she learned from it.
• Help your child build a strong sense of self-worth to help him or her act responsibly, cooperate well with others, and have the confidence to try new things. For more information, see:

  Growth and development: Helping your child build self-esteem.

Promote your teen's mental (cognitive) development by doing the following:

• Encourage mature ways of thinking. Involve your teen in setting household rules and schedules. Talk about current issues together, whether it be school projects or world affairs. Listen to your teen's opinions and thoughts. Brainstorm different ways to solve problems, and discuss their possible outcomes. Stress that these years provide many opportunities to reinvent and improve themselves.
• Offer to help your teen set work and school priorities. Make sure your teen understands the need to schedule enough rest, carve out study time, eat nourishing foods, and get regular physical activity.
• Be goal-oriented instead of style-oriented. Your teen may not complete a task the way you would-this is okay. What is important is that the task gets done. Let your teen decide how to complete work, and always assume that he or she wants to do a good job.
• Continue to enjoy music, art, reading, and creative writing with your teen. For example, encourage your teen to listen to a variety of music, play a musical instrument, draw, or write a story. These types of activities can help teens learn to think and express themselves in new ways. Teens may discover a new or stronger interest, which may help their self-esteem. Remind your teen that he or she doesn't need to be an expert. Simply learning about and experimenting with art can help your teen think in more abstract ways and pull different concepts together.

Promote your teen's sensory and motor development by doing the following:

• Encourage daily exercise. Vigorous exercise, such as running, biking, or playing soccer or basketball, helps your teen to stay lean and to have a healthy heart.¹ Vigorous exercise also helps your teen feel good. If your child is not used to exercise, be careful about expecting too much too soon. Overdoing it at first can make your teen feel tired or discouraged or can even cause injury. Help your teen to build up an exercise routine slowly. For example, plan a short daily walk to start. This approach can help your teen gain confidence and make him or her more likely to keep exercising. For more information on exercise, see the topic Fitness.

Violence and teens

• Prevent teen violence by being a good role model. For example, talk calmly during a disagreement with someone else. Help your teen come up with ways to defuse potentially violent situations, such as making a joke or acknowledging another person's point of view. Praise him or her for avoiding a confrontation. You might say, "I'm proud of you for staying calm." Closely supervise the Web sites and computer games that your child uses. For more information on teen violence, see the topic Bullying or Anger, Hostility, and Violent Behavior.
• Reduce the risk of teen suicide and recognize the warning signs. If your teen shows signs of depression, such as withdrawing from others and being sad much of the time, try to get him or her to talk about it. Call your doctor if your teen ever mentions suicide or if you are concerned for his or her safety.

When to Call a Doctor

Call a doctor if your teen has health problems or issues that may need treatment, including:

• A significant delay in physical or sexual development-for example, if sexual development has not begun by age 15.
• Becoming sexually active. Teens who are sexually active need to be educated about birth control and sexually transmitted diseases (STDs). Also, girls will usually have a Pap test.
• Being overweight. A doctor can help guide weight loss and proper nutrition.
• Severe acne that may be helped by medicine. For more information, see the topic Acne Vulgaris.
• Problems with attention or learning.

Call a doctor or a mental health professional if your teen develops behavioral problems or signs of mental health problems. These may include:

• Expressing a lack of self-worth or talking about suicide.
• Acting physically aggressive.
• Regularly experiencing severe mood swings, such as being happy and excited one minute and sad and depressed the next.
• A significant change in appetite or weight. These may signal an eating disorder.
• Dropping out of school or failing classes.
• Having serious relationship problems with friends and family that affect home or school life.
• Showing a lack of interest in normal activities and withdrawing from other people.
• Seeking and having sex with multiple partners.

For more information, see the topics Depression in Children and Teens, Anorexia Nervosa, Binge Eating Disorder, or Teen Alcohol and Drug Abuse.

Routine Checkups

Your teen needs routine yearly checkups. These checkups are important for detecting problems and for making sure your teen is growing and developing normally. The doctor will do a physical exam and ask questions about your teen's social, academic, relationship, and mental health status. Your teen's immunization record will be reviewed, and needed immunizations should be given at this time. For more information on immunizations, see the topic Immunizations or the childhood immunization schedule.

Beginning in adolescence, most doctors like to spend some time alone with your child during the visit. Although many state laws are vague about teens' rights to medical confidentiality, most doctors will clarify expectations. Ideally, you will all agree that anything your teen discusses privately with the doctor will remain confidential, with few exceptions. This gives your teen an opportunity talk to the doctor about any issue he or she may not feel comfortable sharing with you.

Teens also need to have regular dental checkups and need to be encouraged to brush and floss regularly. For more information about dental checkups, see the topic Basic Dental Care.

Other Places To Get Help

Online Resources

Organizations

Related Information

• Acne Vulgaris
• Anabolic Steroid Abuse
• Anger, Hostility, and Violent Behavior
• Anorexia Nervosa
• Attention Deficit Hyperactivity Disorder (ADHD)
• Binge Eating Disorder
• Body Piercing Problems
• Bulimia Nervosa
• Depression in Children and Teens
• Domestic Violence
• Dyslexia
• Early Disease Detection
• Exposure to Sexually Transmitted Diseases
• Family Life Cycle
• Feeling Depressed
• Fitness
• Growth and Development, Ages 11 to 14 Years
• Healthy Eating for Children
• Normal Menstrual Cycle
• Protecting Your Skin From the Sun
• Stress Management
• Suicidal Thoughts or Threats
• Teen Alcohol and Drug Abuse

References

Citations

1. Gutin B, et al. (2005). Relations of moderate and vigorous physical activity to fitness and fatness in adolescents. American Journal of Clinical Nutrition, 81(4): 746-750.

Other Works Consulted

• Bashe P (2003). American Academy of Pediatrics: Caring for Your Teenager. New York: Bantam.

• American Cancer Society (2007). Child and teen tobacco use. Available online: http://www.cancer.org/docroot/PED/content/PED_10_2X_Child_and_Teen_Tobacco_Use.asp.

• Dalton R (2007). Sexual behavior. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 65-70. Philadelphia: Saunders Elsevier.

• DiClemente RJ, et al. (2001). Parental monitoring: Association with adolescents' risk behaviors. Pediatrics, 107(6): 1363-1368.

• Dixon SD, Stein MT (2006). Encounters With Children: Pediatric Behavior and Development, 4th ed. Philadelphia: Mosby Elsevier.

• Friedman RA (2006). The changing face of teenage drug abuse-The trend toward prescription drugs. New England Journal of Medicine, 354(14): 1448-1450.

• Kaul P, Stevens-Simon C (2007). Substance abuse. In WW Hay Jr et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 144-162. New York: McGraw-Hill.

• Kuperminc GP, et al. (2001). Volunteering and community service in adolescence. Adolescent Medicine: State of the Art Reviews, 12(3): 445-457.

• Maehr J, Felice ME (2006). Fifteen to seventeen years: Mid-adolescence-Redefining self. In SD Dixon, MT Stein, eds., Encounters With Children, 4th ed., pp. 565-598. Philadelphia: Mosby Elsevier.

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