Which findings in an 11-year-old male patients medical report indicate normal development

The tween years are upon you, and with them, some opportunities and challenges arise as a parent. Hanging out with your 11-year-old can be really fun as they’re starting to understand the world and converse like mini-adults.

However, the intensity and the drama of a pre-teen can be frustrating and difficult for a parent to handle. From the complex social dynamics at school to the physical changes that can confuse and embarrass a tween, here’s what to expect from an 11-year-old.

There are numerous language and cognitive milestones that your 11-year-old will reach within the year. Younger children tend to live in the moment and focus on what affects them right here and right now. Around age 11, they start to realize that the choices they make now could have longer-term effects.

“Tweens are only beginning to develop the ability to anticipate and plan for the future, such as understanding the benefits of studying ahead for a test,” explains Mark Bertin, MD, a board-certified developmental-behavioral pediatrician and assistant professor of pediatrics at New York Medical College. However, since child development is a bell curve, some will figure this out sooner than others.

Eleven-year-olds are also beginning to realize that there are multiple ways to look at a piece of information, situation, or issue, and they start to understand that there is a gray area where there was previously only black and white. “Cognitively, children nearing middle school mature in their abilities to think through problems, plan, and organize; they also learn to think less concretely and more flexibly about how the world works,” says Dr. Bertin. 

Some of this progress comes down to the development of your 11-year-old’s executive function skills, which are a combination of the cognitive, communication, motor, and sensory skills that will continue to mature into your child’s 20s. “They start to understand more fully the consequences of their actions, can be more responsible with chores, and can better empathize and understand the perspectives of other people,” says Dr. Bertin.

Any speech issues that appeared in a child’s past are typically resolved by this time. If you still notice speech difficulties—the “r” sound is the most common lingerer—you can sign them up for speech therapy to help.

• Begin to develop self-regulation skills 
• Understands that thoughts are private
• Experiences a greater sense of responsibility
• Exhibits an increased attention span, but changes interests often
  

Age 11 often means big physical changes. For girls, puberty may have already started. “In many girls, physical changes of puberty start around 11,” says Rolanda Gott, MD, a developmental-behavioral pediatrician at UCLA Health in Southern California. “These changes are breast development, axillary and pubic hair, body odor, acne, and growth spurts."

For girls, the arrival of puberty can also mean increased body fat, widening hips and oilier skin and hair, and the first menstrual period.

Boys often enter puberty later (around age 12), but it’s not unheard of for them to start it by 11. The physical changes of puberty in boys include testicle and penis growth and a darkening scrotum, explains Dr. Gott. Additional physical changes in boys might also include larger muscles, vocal changes, oilier hair and skin, and the beginning of underarm, facial and pubic hair.

Like girls, boys' sweat glands begin to get active at age 11, so you might start to smell unexpected odors from your child around this time. Remind your kid about the importance of regular bathing and putting on deodorant every day, but try to tread gently. “These physical changes can lead to kids feeling awkward for a while,” explains Dr. Bertin.

• Shows signs of puberty
• Shows improved handwriting and an improved ability to use a variety of tools
• Experiences growth spurts and accompanying growth pains and cramps
• Increased need to both sleep and eat more

Get ready for a wild ride with your 11-year-old's emotions. Once your child hits puberty, you can generally expect moodiness and a roller coaster of both distress and happiness. "Due to hormonal changes and additional challenges, this age group shows mood swings, low self-esteem, depression, and aggression," says Dr. Gott.

While many 11-year-olds still accept family beliefs and recognize adults as authority figures, this is also the time that they begin to question that authority and might have their first introduction to risky behaviors such as drinking, smoking, or self-harm.

“Social-emotional development at this age is a transition towards adolescence, which means an increased focus on their social world, and on who they are as individuals,” says Dr. Bertin.

While friendship has long been important to your child, this time is when it becomes vital, for better and for worse. The idea of a "group identity" starts to play a role, and tight-knit cliques can form. Peer pressure ​starts to influence your child into doing things that they probably wouldn’t do on their own. “The child is torn between family rules and peer pressure and the desire to be obedient or to be 'cool' and challenge authority,” explains Dr. Gott.

This is also the age that your child will likely push for more independence from you. “There is a gradual distancing from family while getting closer to a best friend,” says Dr. Gott. At 11, spending time with friends will look less like the playdates of their younger years and more like typical teenage behavior, such as sleepovers or group outings to the movies.

• Develops better decision-making skills
• Starts to resist physical affection from parents
• Forms strong and complex friendships
• Explores identity through hair, clothing, hobbies, and friends
• Dedicates more time to hobbies
  

Your 11-year-old may soon start middle school, which can be a challenging time for some children. "School becomes more demanding with more long-term projects and complex homework," says Dr. Gott. "As a result, some children may show signs of ADHD and anxiety."

This is an age when children need to start studying more but may need your help to show them how. "When approaching any new activity, it’s useful to gauge how much your child knows and give them a chance—but also provide direct instruction that provides them with a strong set of skills to get started," advises Dr. Bertin.

If you haven't already, now is a great time to engage your child in sports, volunteering, and other recreational activities. As your pre-teen starts to dedicate more time and energy to their hobbies, a competitive spark will likely emerge—particularly when playing sports.

There are many ways you as a parent can help your child grow at this age. Although your 11-year-old is starting to develop their own personality among a social group, they haven’t yet resisted the concept of “family time.” Make participation in family activities, such as going to church or dinner with grandparents, and responsibilities like chores part of the standard daily routine.

“Most children at this age are still pretty engaged with their family, so take advantage and enjoy that connection,” advises Dr. Bertin. “Strong, emotionally consistent adult relationships are a foundation of resilience and well-being, so prioritizing family meals, fun activities together, and valuing whatever your child enjoys all will make things easier for them as they transition into adolescence."

On the flip side, your tween might begin to test boundaries and push back on rules (if they haven’t already), often due to their friend group's influence. “Make clear rules and expectations as well as ensure consistency between all caregivers [with enforcing rules], and use a frequent reward system to recognize the child’s success,” says Dr. Gott. This is also the time to pick your battles. Good grades and avoiding drugs, alcohol, and cigarettes are the battles you want to choose, while clothing and hairstyle choices can be a good way to give your tween some freedom. 

You can encourage your pre-teen's desire for independence at this time by giving them more responsibilities, such as helping out with cooking and cleaning. But giving your child their independence doesn't have to mean giving them free rein to make all their own decisions. "You can preserve the child's self-esteem and provide some sense of independence by providing good options for the child to choose from," advises Dr. Gott.

One thing that isn't an option is school attendance. Students can begin to lose interest in school and learning around this age. Continue to engage their curiosity, and help make learning exciting. At the same time, resist overscheduling your tween. They need downtime, as well as time to focus on homework. Pick just a couple of activities together, and focus on commitment to those choices.

Staying alert for school and their activities is one key to success. Sleep is important to your 11-year-old (the AAP recommends that tweens get between nine and 12 hours of sleep each night). However, it might be difficult for your child to see how their daily routines can affect their emotional well-being and ability to learn. "Modeling a healthy family lifestyle, and making sure kids get a good amount of exercise and sleep still falls on parents at this age," says Dr. Bertin. "Making sure kids sleep well and exercise often starts with screen time. Family routines like having a household ‘tech bedtime’ go a long way in supporting children’s health."

Kids' safety doesn't just end with wearing a helmet while biking. Many 11-year-olds begin experiencing brain changes that help them foster their independence. But their developing frontal cortex and need for acceptance, however, can lead to increased risk-taking behavior. Preventable injury is the leading cause of death for this age range. "The child tries to be more independent and to make decisions without reaching full maturity of judgment," explains Dr. Gott.

As much as they want to be fully independent, it is important to remember that your pre-teen is still a child and will frequently need adult help to sort through challenges. "Like much of parenting, that all means finding a sense of balance by letting them try things and learn from their own mistakes while stepping in to support them when needed, too," says Dr. Bertin.

Don’t be surprised if your 11-year-old makes some impulsive choices or poor decisions at times. While you don’t want to shrug it off and let them off the hook, understanding why you might be seeing some interesting behavior choices can help you better respond.

If they don't have one already, your child will likely express interest in owning a smartphone around this age. Tackle inappropriate internet use head-on by limiting the websites your pre-teen can access, while also monitoring how much screen time they are getting. "Talk to your children a lot about how to use a phone safely once they have one—it’s like giving them the keys to drive the car: They need to show that they are responsible if they want to keep driving," warns Dr. Bertin.

As they develop and grow, it is normal for your child to feel awkward about their changing body. However, stay vigilant for any signs that they feel negatively towards how they look. "Some children may have a poor body image and develop eating disorders with high risk for both overweight and underweight," says Dr. Gott. The majority of people with an eating disorder are between the ages of 12 and 25.

Carving out regular quality time with your child, expressing interest in their new hobbies, and allowing them to talk to you about what's on their mind will all pay off. "Talk to your child and be ready to listen, provide guidance and support in reaching decisions," concludes Dr. Gott.

Each child develops at a different pace, so milestones are meant more like guidelines for what to expect rather than deadlines for shifts to occur. You don’t need to be overly worried if your 11-year-old isn’t displaying “typical” tween behavior, nor do you have to be concerned if puberty doesn’t begin during this year (if it doesn’t begin by age 14, then it’s time to talk to their healthcare provider).

You can be concerned, however, if you think that your pre-teen is falling into some worrying behavior patterns. "Poor sleep habits with short sleep duration and increased use of electronics even late at night can increase the risk for anxiety, depression, and poor attention in school," warns Dr. Gott. General moodiness is common at this age, but if your child seems unhappy, anxious, or isn't thriving socially or academically, reach out to their pediatrician.

"[Their pediatrician] can typically connect you with other resources in the community, whether that means an academic evaluation or working with a counselor for a while," says Dr. Bertin. Regardless of how, it's important to get your child the help they need.

All kids develop at a slightly different pace. Kids who lack social and emotional maturity, however, may become targets for bullies or they may struggle with loneliness and isolation.

It’s important to help your child sharpen their skills when you notice deficits. And if you’re concerned about potential developmental delays, talk to your child’s pediatrician. It’s important to address any problems now before your child enters the teen years.