There is such a balance between having conversations with kids before they are ready and waiting too long, giving them too little information, or missing the opportunity to prepare them for something. It can feel as if you can’t time it right. The advice I give is that if you think you need to have the conversation with your kids, you might even be a little late, so go ahead and start.

There are many different parent-child dynamics. Some are positive, and some are not. But I see communication style and love between a parent and child as totally different. A parent and a child can be poor communicators or they can struggle with how to ask and answer questions between the two of them, but they can still have a tight bond and love each other. I try to remind parents who feel disconnected from their kids because their kids don’t want to talk to them that talking is not a measure of their child’s love.

I know families who pass a journal back and forth. The child will ask the questions and the parents can write the answers. Parents will sometimes write a question and the child will answer, and that works for them.

I’ve seen families where a child is brave enough to ask a question, but the parent struggles with the answer. Either they’re embarrassed because they weren’t raised in a home where this stuff was talked about or they don’t know how to explain it, so they turn to good content. They use the internet or videos to help them answer—they use an expert, so to speak. That’s going to give a good answer. It can take parents a while to find that content, but that’s a good technique.

If it’s the opposite and the child doesn’t know how to ask or it’s not in their nature to bring it up but they have questions and worries, it may be good for the parent to present something other than a verbal question—a way to draw the concern out of their kid. It can be a show, a movie, or a video clip. Sometimes, around the house, I’ll leave a magazine or a newspaper open to the article that I want my kids to read. It is not subtle. They know exactly what is happening. Then if they move it away, I’ll text it to them. Sometimes you just want to get information in front of your kids without lecturing them. You don’t want to tell them what they need to know. You want them to hear it or read it from a different source.

If your kid’s not ready, you’ll know, because either your child will say, “I’m not ready for this,” which a lot of them do, or they’ll get up and leave, which is them showing you they’re not ready for the conversation yet—and this is totally fine! You do not need to feel badly. You do need to try again sometime soon.

The hardest part is knowing how to have anticipatory conversations. I’ll use porn as a good example. Free porn is extraordinarily accessible online, and all of our kids are online. If you think there’s no chance that they’re going to stumble across it, you’re wrong.

Giving your child the tools to manage what they see is the most important step. When you’re ready to start handing a device to your kid, that’s when you should be saying, “If you see images that seem inappropriate or scare you, just tell me, and I’ll help you out because there’s stuff online you might not be ready to see.” Instead of getting your child in trouble for seeing something, you’re giving them permission to come to you and tell you that they stumbled onto something that they didn’t want to see.

When it comes to sex, you want your child to be able to get there in a healthy way, not in a way that pornographers are telling them to get there. You want them to see the sex you want them to have. You want them to have healthy relationships and be able to make their own paths. Telling them that resonates, especially with older kids.

I don’t think so. For one, there’s no reason that everyone shouldn’t understand what’s happening inside of everyone else’s body—why should that knowledge be split? We have fallen into this pattern, but the vast majority of the transformation through puberty is not about reproductive organs. It’s about physical changes, like growth, height, and body, and also changes in interests and friendships, plus emotional swings. And each of these giant categories is impacted by hormones. Plus, everyone has at least a little of each hormone. For all of these reasons, there is so much more experiential overlap than people think there is.

One of the biggest distinctions between girl and boy puberty has nothing to do with sex or anatomy: It’s the cultural attitudes we have toward gender. It’s that girl puberty has become something we talk about in our society, while boy puberty is still something that parents and boys get quiet about.

It’s important for parents to realize that their kids are going through puberty earlier. It’s especially helpful to know this is happening because the hormones in charge of transforming the body—estrogen and testosterone—don’t circulate just below the neck. They circulate up in the brain as well. And they have profound effects on the way kids think and feel. If we don’t recognize that these hormones are circulating through their bodies, essentially acting as drugs, and that the way kids feel and think is shifting, then we can’t parent them as effectively.

One of the amazing features of early puberty is that you start to see that a child is grappling with a new hormone. We call it a mood swing, but a mood swing is really a kid acclimating to a shift in hormone level. They’re trying to figure out why they feel that way—and they’re riding their feelings. I always use classic girl mood swings as the most obvious example. During early puberty, many girls will start giggling hysterically or crying dramatically, sometimes even inappropriately. Parents see this in their eight-, nine-, and ten-year-old girls and they don’t understand what’s happening. Yet when pediatricians ask girls that age if they’ve felt these kinds of mood swings, the girls often say yes, and when they are asked if they like how this feels, almost every one of them says, “No, because it feels a little bit out of control.” That’s the girl’s experience of learning how to modulate these new chemicals floating through her body and the brain.

Boys go through it, too. The classic emotions that we associate with testosterone surges are rage and aggression, but boys becoming quiet is probably dictated by testosterone swings, too. There are no studies proving the connection, but when boys enter puberty, they tend to go quiet and often retreat from the world. Kids appreciate when you explain that there are these new drugs essentially floating around their bodies, and it’s okay and they’re healthy, but their brain is going to need some time to get used to the surges of these chemicals.

With early puberty, though, it’s important for parents to remember not to treat their kids as if they are older just because their bodies are changing sooner. There exists a humongous dyssynchrony between brain and body development: Kids are entering puberty at increasingly young ages, but their ability to make smart, consequential decisions has not sped up.

If they know it’s coming and they understand that it’s hormonal, then they have the power to take steps to shift their behavior so that they’re not as reactive. When I ask if they want to learn some ways to get ahead of an upcoming emotional swing, they all say yes. They want to learn simple techniques like counting to ten or square breathing—when you inhale to a count of four, hold to a count of four, exhale to a count of four, and hold to a count of four.

Doing those things resets the brain chemistry long enough for them to control anger, frustration, or sadness. When you allow a kid to articulate what they’re feeling instead of just acting on what they’re feeling, they love that control. It empowers them.

In girls, physical development and estrogen surges tend to start at around the same time, because when their estrogen levels start to rise, certain physical changes start, like their breasts budding or their hips widening. This is when girls start getting the classic womanly features of secondary sex characteristics that are going to take their body to be the shape of a woman’s body.

In males, testosterone is produced in the testicles. The first thing that happens, which can take a year or two for some boys, is that the testosterone in the testicles makes the testicles bigger. Then the testicles can make more testosterone, and it becomes a feedback loop. Initially, that’s the only noticeable physical change. Most boys become more private around that age and are covered up, so parents can be pretty clueless.

There’s this saying in pediatrics, a warning really, that we should not think of kids as mini adults. They are physiologically different, in the ways their bodies process foods and medicines and in the ways their brains process information and make decisions. So why do we shrink down our adult-size products for them when their needs are utterly different? Take bras: When the training bra was the most popular product for young girls, it was just a shrunken-down women’s bra with bows sewn on it. Today, these have been replaced by two-ply bras with bulky pads stuffed into the material to make a cup. The goal was understandable: conceal those pointy breast buds. But this design only made a young girl’s boobs look more prominent. As breast development started appearing sooner in young girls, the solution of two big pads poking out of the T-shirts of seven- and eight-year-olds looked more and more absurd. Then sports bras became more favored in an effort to smash down the breast buds and make everything disappear.

None of the solutions that were created for growing boobs worked, because no one thought about the unique needs of tweens and teens. I was clueless, too—I wrote books about managing early boobs for years before it dawned on me that I could be part of the solution. When my own daughter was experiencing it, my friend Julie and I put our heads together and created the OOMBRA. It’s a super soft bra for skin that’s not used to having material strapped to it all day, and it’s slightly compressive to make tender boobs more comfortable but not binding because growing tissue needs space.

There are a lot of features we associate with going through puberty that are not controlled by estrogen or testosterone. When we see them happening, we think kids are entering puberty—things like bad body odor or when they start growing hair: pubic hair, axillary hair, or mustache hair. Hair growth and body odor are tied to the hormones that are released from the adrenal glands, which are glands that sit on top of the kidney.

Those hormones do not impact your reproductive system. Yes, kids may look and smell older, but they’re not any further down the path toward reproductive ability because of those features. Those hormones are called adrenal androgens and they are on a separate pathway. They govern adrenarche, which is a set of changes that also contributes to looking womanly or manly, but adrenarche is not puberty.

For as long as I’ve been a pediatrician, my fellow doctors and I have all pushed back against screen time and technology, but the pandemic has changed the landscape. It has forced pediatricians, like me, to do a better job of listening to the people who have been espousing the positives of online social connection for a long time. It has pushed us into a new position where we recognize that the screen is not the enemy; it’s how you use your screen that matters.

When kids have been isolated from one another in their homes—not going to school, not seeing their friends—that is not socially or developmentally normal, and their way of staying connected is often through a screen. It may be video chat, social media, or texting. There are lots of different avenues, and those avenues have become lifelines.

It doesn’t take away any of the negatives that we used to talk about. I still worry about bullying online. I still worry about all the body image issues that come up because of the idealized images being put online. All the same things that used to keep me up at night as a pediatrician—like an addiction to gaming and the inability to get a good night’s sleep because the device is in the room dinging constantly—they still worry me, but I have a much healthier balance in my approach to screens with my own kids.

It’s helping kids understand that what they see isn’t always reality; it can be a cry for help. It’s helping them understand the difference between being a bystander versus an upstander on a screen.

When you’re going through puberty, everything around you is transforming: your body, brain, friends, world, and your relationships with your family. A lot of parents feared the online interactions that they couldn’t see because it felt beyond their control. I still feel that fear a little bit, but the balance is knowing that there’s a community out there that Gen Z kids know how to access in a way that we don’t. I think the net result is that kids accessing their community and building relationships is as important to them now as it was when we did it in person in decades past. They’re just doing it both in person and virtually now.