Eleven and Twelve Year Visit

A child’s eleventh and twelfth years are a time of transition into early adolescence, often called the “tween” years, accompanied by emotional, social, physical, and cognitive changes.  These changes can provide not only challenges, but many opportunities to grow for both children and their parents.

This time can be stressful for pre-adolescents as they go through physical changes and are preoccupied by how their peers perceive them.  Some pre-adolescents will try to change their appearance by dieting and over exercising.  It is important to reassure them that their development is normal and that the media and their peers often make young people have an inappropriate and even dangerous perceptions of what is a normal body.  Encourage nutritious snacks and meals, limiting foods with high fat and sugar content.  As far as exercise goes, do what you can to make sensible, enjoyable exercise a part of their lives.

The AAP recommends vitamin D supplementation for all infants, children, and adolescents.    After reviewing the literature, it certainly looks like many children may benefit from vitamin D, although not everyone necessarily needs it.   Some children are more at risk for vitamin D deficiency than others.  Risk factors for vitamin D deficiency include dark skin (African-americans, Indians, Hispanics), time spent indoors and not out in the sunlight (particularly in the winter months), low amount of milk consumption (less than 16 oz a day), and obesity.  The recommended dose is 400 IU (international units) once daily.  This can be bought over the counter in either liquid, chewable, or pill form.  Another option would be a multivitamin (i.e. Flintstones Gummies Complete ).   Read the label carefully when dosing this to your child.  Too much vitamin D can be harmful.

During these years, your pre-adolescent is trying to achieve more independence and individualization.  Peer relationships assume top priority.  They will want to do things their friends do.  While it is important to allow your adolescent some choices to learn independence and decision making, talk with them about the dangers of drug use, alcohol use, smoking and sexual relations.

The two most common causes of adolescent mortality are violence and motor vehicle accidents.  Teach them that decisions they make today may affect them for years to come.  Some specific decisions that pre-adolescents make involving smoking, TV viewing, sports, extracurricular activities, and internet usage.

Your role as parent should be to discuss these issues openly, trying to avoid “preaching”.  Be aware that a significant number of children start smoking as early as twelve years of age.  In addition to reducing physical activity (leading to obesity), TV viewing and internet usage expose children to many undesirable influences.  Therefore, limitation of time spent in front of the screen and encouragement of sports, both team and informal, activities is desirable.

It is important to understand that your pre-adolescent may be suddenly challenging parental authority.  This is normal as the importance of peer relations and independence increases.  Your pre-adolescent needs to be allowed some autonomy, at the same time, it is also important to establish realistic expectations and rules.  Working out ground rules together in advance with your child will make decisions easier for everyone.

Parents must not abandon their roles as guides and authority figures.  Respect your child’s need for privacy and try to minimize criticism and praise them for positive behavior.  This will help keep the lines of communication open between you and your pre-adolescent and will make this time of transition easier for the whole family.


A Tdap is required for entry into sixth grade and we also administer the meningitis vaccine, Menactra, at the eleven year physical.  Other immunizations that will be given during the next several years will be chicken pox booster, Hepatitis A series if not given already(2 shots given 6 months apart) and the HPV vaccine (3 shots are in the series).