Early Bloomers
Timely education, school nurse intervention prepare young girls for puberty

By Megan Flaherty
Photo: Digital Stock
September 2, 1999

Concerned that school-based puberty education is a history lesson rather than a preview of what's to come for many girls, school nurses have been working to prepare female students sooner for their physical transformation to adulthood.

The average starting age of puberty for girls has declined since the start of the century-due in large part to better nutrition-and is now somewhere between 8 and 13, according to the American Academy of Pediatrics. A 1997 study by the AAP found that 48 percent of African-American girls and 15 percent of white girls started developing breasts, pubic hair, or both by age 8. Menstruation typically begins about two or three years after breasts or pubic hair appear.

Puberty education is often "too little, too late," said Beverly Bradley, PhD, RN, president of the American School Health Association. Students commonly learn about basic anatomy and reproductive health in fifth grade, when they are 10 years old. In response to the trend toward early puberty, however, some schools have moved puberty programs for girls to fourth grade, and many schools encourage school nurses to meet with early bloomers in small groups or one-on-one. In addition, school nurses frequently contact parents to make sure these girls are receiving the information they need.

Taking puberty in stride

Presenting straightforward puberty information to girls helps them come to terms with their bodies, school nurses say. "It's a matter of making girls aware of what to expect as their bodies develop so they can accept the changes as normal," said Judy Robinson, PhD, RN, executive director of the National Association of School Nurses. "When students are taught about their reproductive systems in the same manner as they're taught about their respiratory or digestive systems, they are better able to handle those changes."

Armed with the right information, girls often adapt to their physical changes surprisingly well, although early bloomers are sometimes vulnerable to teasing, school nurses say. "Kids deal with things very matter-of-factly. Often they're looking forward to changes in their bodies," Bradley said.

On the other hand, parents and school board members are often wary of puberty education, especially before the fifth or sixth grade. "We have parents who think sixth grade is too young," said Frances Brown, RN, school nurse for the Hamilton Independent School District in West Central Texas and president of the Texas Association of School Nurses. "Imagine how upset parents would be if we said we were doing it in third grade."

According to Robinson, "School nurses and teachers have to be sensitive to parental wishes and community norms when they deliver their messages."

Celebrating maturity

During the 20 years Brown has worked as a school nurse, she has noticed a big shift in girls' attitudes toward puberty, especially their first periods. Young girls today will recite maxi-pad commercials and ask for brand-name products, while in the past they wouldn't even recognize a product or know how to use it, she said.

But some girls still come in scared and upset when they begin menstruating, thinking they have hurt themselves or are sick. When an 8-year-old began menstruating for the first time, Brown calmed her and called her mother. In addition, teachers have alerted Brown to second-graders who are starting to develop breasts and need to wear another layer of clothing or a bra under their T-shirts. "I usually talk to their parents and explain the situation. They usually say they've noticed, but didn't think anyone else would," Brown said.

School nurses can help girls not only accept puberty, but embrace it. Nancy Gordon, PHN, RN, a school nurse in the Panama-Buena Vista Union School District in Bakersfield, Calif., encourages girls who
come to her when they begin menstruating to celebrate their first step toward adulthood. She even gives girls a cupcake decorated with a candle to commemorate the event. A week later, she checks back with the girls to make sure they feel good about themselves. Sometimes, mothers will call Gordon and ask her to talk with their daughters about menstruation. Aunts, grandparents, or other guardians may also request that a school nurse broach sensitive subjects relating to puberty, Gordon said.

"A school nurse is seen as a person who you can talk to easily and who won't make you feel like you're silly," said Susan Lordi, MS, PNP, RN, an independent consultant and former director of student and community services for the Los Angeles County Office of Education. "The key is that school nurses take kids' and parents' concerns seriously. There are no frivolous concerns to school nurses, and that builds trust," she said.

School nurses are "very in tune to the growth and developmental needs of young girls," making them an invaluable resource for parents, Robinson said. "They deal with [puberty] like a normal body function, which is exactly what it is."