Ask nine to twelve-year-olds about their daydreams and they gleefully give pie-in-the-sky replies. Four out of five imagine being rich and the same number would lavish their funds on foreign travel. Three-quarters of so-called “tweens” imagine being smarter, more popular, famous or beautiful. Quiz this group about their worries, however, and the answers verge on grown up: families separating, the future, getting a serious disease, not having enough money.

Welcome to tween life, away station between childhood and the teen years. These kids are an energetic bundle of contradictions – the same child that giggles like a kindergartner wants to know when she can start wearing makeup to school. Children mature physically and emotionally during these years, sometimes dramatically, but they’re not ready to be their own bosses yet. Parents play an important role in promoting wellness, lending an experienced ear, and fostering healthy independence.

Checking in for Check-Ups
Though routine physicals taper off a bit as kids grow, moms and dads should continue to regularly visit pediatricians with tweens in tow. It's hard to wedge well-visits into packed sports schedules and budding social lives, but the American Academy of Pediatrics recommends check-ups at ages 10, 11 and 12. Physicians often administer a combined tetanus and diphtheria vaccine now, one that recently incorporated pertussis protection. This new booster for older children helps head off the recent increase in pertussis, or whooping cough, occurring in adolescents and adults.

Eleven-year-olds also may receive Menactra, which guards against potentially lethal viral meningitis. “The incidence of meningitis increases as kids get older, but younger children aren’t immune,” explains Doylestown Hospital pediatrician Joseph Werner, MD. “Studies are exploring giving this vaccine at earlier ages.” Dr.Werner also recommends blood work for kids with a family history of heart disease. Screening now detects elevated cholesterol levels before they temporarily drop during the teens.

Nutrition and exercise also merit discussion. An average of 4.8 hours in front of the TV every day leaves little room for playing outside and exposes tweens to more than 500 commercials a week, much of it plugging fast food. It’s no wonder that fewer than 25 percent of tweens get enough fruits and vegetables.

“I recommend that parents limit sugary drinks, ensure good calcium intake, encourage healthy foods rather than forbidding unhealthy ones, and curb TV and computer time,” advises Margery Schonfeld, MD, another pediatrician affiliated with Doylestown Hospital. She tells kids that their bodies seem invincible now, but must last for decades.

Bodies and Minds Are Changing
“Don’t judge a book by its cover” is an axiom tailor-made for tween girls, whose physical development spans a wide spectrum. One ten-year-old may begin menstruation while her twelve-year- old friend still sports a child’s slighter, straighter frame. “Girls are very aware of looks and that can lead to over-emphasizing and being embarrassed about their appearance,” says Dr. Schonfeld, who adds that boys usually enter puberty after age 12.

Providing age-appropriate information about puberty helps assure precocious kids that they’re normal and gives them correct facts. “Help kids see that their worth comes from within,” Schonfeld also counsels. Girls in particular are bombarded with misleading social messages that beauty and agreeability equal high esteem. Now is a great time to play up accomplishments like good grades, athletic prowess, and musical skills rather than appearances.

Tweens may look mature, but their brains won’t be full-grown for years. Young brains are works in progress,with the emotional pilot – the pre-frontal cortex – still practicing at the controls, a fact that helps explain moodiness and defiance. Decision-making areas also are inexperienced, a bit of information that may help parents who are left scratching their heads over tween choices. Further, it seems that what young brains do guides what older brains prefer; playing outside rather than being a couch potato probably does lead to a more active adulthood.

Stepping Out Solo
Good communication now lays a solid foundation for tackling contentious teen issues later. “Kids have more information these days, but don’t assume they have the facts and know what to do with them, even if they insist they do,” Dr. Schonfeld comments. Information, she notes, doesn’t equal insight at this age. Active listening is a valuable tool. Even if parents can’t fix troubles, providing empathy, reassurance, and gentle suggestions supports coping skills and improves youthful decision-making.

Tweens are also beginning to make personal declarations of independence. Allowing more freedom incrementally – responsible behavior during small excursions earns expanded privileges – is a comforting approach to both parents and youngsters. Still, parents inevitably make unpopular decisions. Become resigned to being the bad guy, say pediatricians. Firm parents may provide a much needed out. Sometimes it’s easier to say, “My mom would flip” than admit, “I’m not comfortable with that.”

Children in this age group also need to hear parental views about risks like tobacco, drugs, alcohol, the on-line community, and sex. There’s strong motivation for forging ahead despite rolling eyes and suddenly recalled prior engagements; research finds, for example, that kids experiment with tobacco as early as fifth grade and alcohol as early as age 12. Even if these issues aren’t front and center now, they will almost certainly arise in the future.

Enjoying Family Time
Kids this age relish new experiences, branch out socially, challenge limits and make bigger choices, but they still embody the lightness and enthusiasm of childhood. Dr. Werner views these years as joyful for many families and often sends tween parents out his door with this parting advice: “Listen, love unconditionally, show affection, and share your feelings.” The rest, he says, follows naturally.

Dr. Joseph Werner is with Valley Pediatrics in Warrington. Dr. Margery Schonfeld is with Central Bucks Pediatrics in Doylestown.