Between ages 11 and 13, your child will grow and change a lot. It's important to keep having yearly checkups so the doctor can track this progress. As your child enters puberty, they may become more embarrassed about having a checkup. Reassure your child that the exam is normal and necessary. Be aware that the doctor may ask to talk with the child without you in the exam room.

Here are some topics you, your child, and the doctor may want to discuss during this visit:

• School performance. How is your child doing in school? Is homework finished on time? Does your child stay organized? These are skills you can help with. Keep in mind that a drop in school performance can be a sign of other problems.
• Friendships. Do you like your child's friends? Do the friendships seem healthy? Make sure to talk to your child about who their friends are and how they spend time together. This is the age when peer pressure can start to be a problem.
• Life at home. How is your child's behavior? Do they get along with others in the family? Are they respectful of you, other adults, and authority? Does your child participate in family events, or do they withdraw from other family members?
• Risky behaviors. It's not too early to start talking to your child about drugs, alcohol, smoking, and sex. Make sure your child understands that these are not activities they should do, even if friends are. Answer your child's questions, and don't be afraid to ask questions of your own. Make sure your child knows they can always come to you for help. If you're not sure how to approach these topics, talk to the doctor for advice.
• Emotional health. Experts advise screening children ages 8 to 18 for anxiety. They also advise screening for depression in children ages 12 to 18 years. Your child's doctor may advise other screenings as needed. Talk with your child's doctor if you have any concerns about how your child is coping.

Puberty is the stage when a child begins to develop sexually into an adult. It usually starts between 9 and 14 for girls, and between 12 and 16 for boys. Here is some of what you can expect when puberty begins:

• Acne and body odor. Hormones that increase during puberty can cause acne (pimples) on the face and body. Hormones can also increase sweating and cause a stronger body odor. At this age, your child should begin to shower or bathe daily. Encourage your child to use deodorant and acne products as needed.
• Female body changes. Early in puberty, breasts begin to develop. One breast often starts to grow before the other. This is normal. Hair begins to grow in the pubic area, under the arms, and on the legs. Around 2 years after breasts begin to grow, monthly periods (menstruation) will start. To help prepare your child for this change, talk with them about periods, what to expect, and how to use feminine products.
• Male body changes. At the start of puberty, the testicles drop lower, and the scrotum darkens and becomes looser. Hair begins to grow in the pubic area, under the arms, and on the legs, chest, and face. The voice changes, becoming lower and deeper. As the penis grows and matures, erections and “wet dreams” begin to happen. Reassure your child that this is normal.
• Emotional changes. Along with these physical changes, you'll likely notice changes in your child's personality. You may notice your child developing an interest in dating and becoming “more than friends” with others. Also, many kids become moody and develop an attitude around puberty. This can be frustrating, but it is very normal. Try to be patient and consistent. Encourage conversations, even when your child doesn't seem to want to talk. No matter how your child acts, they still need a parent.

Today, kids are less active and eat more junk food than ever before. Your child is starting to make choices about what to eat and how active to be. You can't always have the final say, but you can help your child develop healthy habits. Here are some tips:

• Help your child get at least 60 minutes of activity every day. The time can be broken up throughout the day. If the weather's bad or you're worried about safety, find supervised indoor activities.
• Make a family media plan that works for your child and your family. Think about how much screen time your child needs for school or other tasks, how old and responsible they are, and what matters most to your family. Screen time includes time spent watching TV, playing video games, and using the computer, tablet, or cell phone.
• Limit sugary drinks. Soda, juice, and sports drinks lead to unhealthy weight gain and tooth decay. Water and low-fat or nonfat milk are best to drink. In moderation (no more than 8 ounces daily), 100% fruit juice is OK. Save soda and other sugary drinks for special occasions.
• Have at least 1 family meal together each day. Busy schedules often limit time for sitting and talking. Sitting and eating together allows for family time. It also lets you see what and how your child eats.
• Pay attention to portions. Serve portions that make sense for your kids. Let them stop eating when they're full—don't make them clean their plates. Be aware that many kids' appetites increase during puberty. If your child is still hungry after a meal, offer seconds of vegetables or fruit.
• Serve and encourage healthy foods. Your child is making more food decisions on their own. All foods have a place in a balanced diet. Fruits, vegetables, lean meats, and whole grains should be eaten every day. Save less healthy foods—like french fries, candy, and chips—for a special occasion. When your child does choose to eat junk food, consider making the child buy it with their own money. Ask your child to tell you when they buy junk food or swap food with friends.
• Bring your child to the dentist at least twice a year for teeth cleaning and a checkup.

At this age, your child needs about 10 hours of sleep each night. Here are some tips:

• Set a bedtime and make sure your child follows it each night.
• TV, computer, and video games can agitate a child and make it hard to calm down for the night. Turn them off at least an hour before bed. Instead, encourage your child to read before bed.
• If your child has a cell phone, make sure it's turned off at night.
• Don't let your child go to sleep very late or sleep in on weekends. This can disrupt sleep patterns and make it harder to sleep on school nights.
• Remind your child to brush and floss their teeth before bed. Briefly supervise your child's dental self-care once a week to make sure of correct method.

Recommendations for keeping your child safe include the following:

• When riding a bike, roller-skating, or using a scooter or skateboard, your child should wear a helmet with the strap fastened. When your child is using roller skates, a scooter, or a skateboard, it is also a good idea for them to wear wrist guards, elbow pads, and knee pads.
• In the car, all children younger than 13 should sit in the back seat. Children shorter than 4 feet 9 inches (57 inches) should continue to use a booster seat to correctly position the seat belt.
• If your child has a cell phone or portable music player, make sure these are used safely and responsibly. Do not allow your child to talk on the phone, text, or listen to music with headphones while they are riding a bike or walking outdoors. Remind your child to pay special attention when crossing the street.
• Constant loud music can cause hearing damage, so keep track of the volume on your child's music player. Many players let you set a limit for how loud the volume can be turned up. Check the directions for details.
• At this age, kids may start taking risks that could be dangerous to their health or well-being. Sometimes bad decisions stem from peer pressure. Other times, kids just don't think ahead about what could happen. Teach your child the importance of making good decisions. Talk about how to recognize peer pressure and come up with strategies for coping with it.
• Sudden changes in your child's mood, behavior, friendships, or activities can be warning signs of problems at school or in other aspects of your child's life. If you notice signs like these, talk to your child and to the staff at your child's school. The doctor may also be able to offer advice.

At this visit your child may receive vaccines, such as:

• Human papillomavirus (ages 11 to 12).
• Influenza (annually).
• Meningococcal (ages 11 to 12).
• Tetanus, diphtheria, and pertussis (ages 11 to 12).
• COVID-19.

Ask your child's doctor which vaccines are advised at this visit.

In this wired age, kids are much more “connected” with friends—possibly some they've never met in person. To teach your child how to use social media responsibly:

• Set limits for the use of cell phones, the computer, and the internet. Remind your child that you can check the web browser history and cell phone logs to know how these devices are being used. Use parental controls and passwords to block access to inappropriate websites. Use privacy settings on websites so only your child's friends can view their profile.
• Explain to your child the dangers of giving out personal information online. Teach your child not to share their phone number, address, picture, or other personal details with online friends without your permission.
• Make sure your child understands that things they “say” on the internet are never private. Posts made on websites like Facebook, TikTok, and Instagram can be seen by people they weren't intended for. Posts can easily be misunderstood and can even cause trouble for you or your child. Supervise your child's use of social networks, chat rooms, and email.