Sex Education for Youth in Foster Care

By Dr. Cara Natterson

When I was growing up, puberty was generally considered a moment of temporary physical change: acne, curves, growth spurts, moustaches, periods. But then, the phase was done. Today, puberty is seen quite differently. It’s an entire stage of life, occupying several years of body and brain changes. Understanding what happens when, in what order, and why can help make sense of a situation that feels almost universally awkward and out of control. This is especially true for foster parents who are navigating puberty with kids whose lives have already been marked by unpredictability and transition.

What Happens and When

A checklist of events happen during puberty. Each of these things is caused by surges of the hormones, responsible for reproductive maturity. The goal of puberty is to prepare the body for its contribution to the making of a baby. The most frustrating part of puberty is that each of these changes happens in a different order and at different ages — and none of it happens at the same time for everyone.

In general, children enter puberty about two years earlier than when I was growing up. Today, girls tend to enter puberty between ages 8-9; for boys, the average age is 9-10. However, there are a lot of kids who notice changes even earlier or much later than predicted. There are also many kids who don’t notice any of these changes at all, even though they are happening. All of this creates complication: it can be hard to tell when a child has entered puberty.

Some basic information about the process: In biological females, puberty begins when the hormones estrogen and progesterone are produced by the ovaries. These hormones then cause the body to shift and change, but slowly! The most common early sign of estrogen is the development of breasts.

Another early sign is moodiness, the result of hormones circulating in the brain and changing the way the neurons (brain cells) communicate. Eventually, the overall shape of the body shifts, most notably with hips widening. Girls will then get their periods, a sign that their ovaries are able to produce mature eggs. The average age for a first period is about 12½, though depending on genetics it’s considered normal as young as 8 and as old as 16. Once a period begins, it may return every month or be completely irregular for a couple of years.

Hair will grow under the armpits and in the pubic region; it will also thicken on the arms and legs. But this hair growth is controlled by its own set of hormones called the adrenal androgens — these are separate from estrogen and progesterone, which is why sometimes girls will have hair growth well before they experience any other body changes. The adrenal androgens also cause increased sweating, which can lead to body odor, and they also shift the amount of oil production in the skin, which can lead to acne.

In biological males, puberty is ruled by the hormone testosterone. The impact of testosterone is more invisible at first, because initially it only causes growth in the penis and testicles.

Eventually, testosterone makes its presence known in other ways: it causes the voice to drop and the shoulders to broaden and lean muscle mass to increase. Like estrogen, testosterone also circulates in the brain and impacts moods. And another similarity across the genders is the impact of the adrenal androgens on sweat, oil and hair production.

Puberty is More Than Body Changes.

The hormones that surge through the body during puberty deeply impact the brain. This can result in mood swings, especially when hormone levels are particularly high (or low) — and it’s important to remember here that hormones don’t just slowly rise and stay at the same level, but they surge and then drop. We have all felt moody or rattled because of hormonal highs and lows; it can be hard to remember sometimes that tweens and teens are just getting used to these ups and downs. For kids in foster care, it can be particularly helpful to offer a sounding board: worries about things like family stability, friends, school and after-school activities can be magnified by the ups and downs of hormones.

It takes confidence — plus time — to get used to what is happening. Weight gain, growth (or no growth), zits, smells, hair appearing in new places … each of these things can make anyone feel self-conscious. While the changes are different for biological males and females, the fact change is universal. It’s a time of transformation in so many obvious and hidden ways, internal and external. Having resources with good information becomes critical for everyone involved: the kids experiencing puberty and the adults who care for them.

The Unique Experience for Foster Families.

It’s tricky enough to give parenting advice about puberty since the experience is so different for each child. Foster parents face a few unique challenges. Here’s my advice as someone who has worked in pediatrics for more than two decades and spent countless hours talking to kids from a wide range of backgrounds:

  • Talk. This is the number one piece of advice I give all parents (and kids), regardless of their home set-up. Open lines of communication help establish trust. Good information allows kids to make smart choices. Some foster parents have long and deep relationships with their kids, which can make talking a little easier. But even in a relatively new relationship, offer to talk and then do your best to mostly listen.
  • Identify Good Resources. Help kids find the best books, websites or people around them to answer questions as they arise. And you need good resources for yourself as well! The internet is an incredible thing, but it is not excellent at giving tweens and teens the best puberty information available. In fact, many searches about body changes can result in links to sites filled with misinformation or pornography. When kids go looking for answers to explain what’s happening to them, it’s not their fault when they get pulled down an internet rabbit hole filled with myths or graphic visuals. Help them avoid this by identifying resources ahead of time. And if this has happened, help them by asking about it without any judgment or shame.
  • Make Them Comfy. Find clothes or products that make them feel good in their transforming bodies. Go shopping for cleansers and sunscreens together. Buy bras that boost confidence and actually feel good — you can find tween/teen specific brands online or you can go together to a local store.
  • Remind Them That This is All Normal. It’s normal to feel uncomfortable about a changing body. It’s normal to wish you could know where you were going to land — how tall you will be or when the zits will go away. It’s normal to feel moody sometimes. It’s also normal to feel happy, confident and silly, too.
  • Remind Yourself You Don’t Have to be Perfect. We all make mistakes as we raise kids, even with a deep desire to get everything right. Give yourself a break if a conversation doesn’t go well — just try again soon. Take a deep breath if your rules are broken — then explain why you made the rule in the first place. Anger doesn’t help; neither does shutting down. Just as kids need forgiveness for making mistakes along the way, so do we. But keep your own resources close — make sure you have a friend to talk to, a healthcare provider to lean on and a great set of books or websites to turn to when you are in over your head.


Dr. Cara Natterson is a renowned pediatrician and New York Times best-selling author of multiple books regarding puberty, including “The Care and the Keeping of You” series. Inspired by her daughter’s adolescent experiences, Natterson co-founded puberty brand OOMLA to address the important physical, mental and emotional sensitivities tweens and teens face as they enter and make the journey through puberty. 

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