Approaching puberty in girls with special needs

It is challenging for any parent to understand the best way to educate their daughter about the changes that come with the onset of puberty in her life. It becomes even harder when the child has special needs, owing to either physical, emotional or cognitive challenges. There are multiple challenges with menstruation for a special needs child.

This article is based on an informative presentation compiled by Dr. Kavya Priya Vazrala, a gynaecologist and a parent to a child on the autism spectrum. 

Understanding Puberty

Every child will undergo changes – physically, emotionally –  upon puberty. It is important for parents to acknowledge this and prepare themselves and their children ahead of time.

The most apparent change will be bodily changes that your child will undergo. In girls, prominent changes can be:

• Presence of body hair 
• Development of breasts
• Menarche or the child’s first period
• Associated hormonal changes such as acne, monthly Premenstrual Syndrome (PMS), irritability and tiredness.

Onset of Puberty and Menstruation

In most girls, the onset of menstruation can be expected between the ages of 10 and 16 years of age. It is observed that menstruation starts later in girls with developmental delays than in neurotypical children.

However, it is important to note that lifestyle changes and the presence of hormone mimicking pollutants in food, there is a growing trend of early onset of puberty among children nowadays.

How can we help?

Start early

• Help familiarise your child with their body from an early age. Teach them the names and functions of their private parts as you would teach any other concept.
• Introduce the concept of privacy, with importance on the 2Cs:
  • Closing doors while changing
  • Covering private parts when in public

Encourage confidence

• Every child – neurodiverse or neurotypical – can thrive with respect and a sense of self-worth. It is therefore important to support their sense of self.
• Recognise and appreciate the behaviour you want to see, this will encourage and motivate them.
• Allow them to voice their thoughts and opinions freely.

Self expressions through grooming 

• Allow them to dress and groom themselves in clothes, hairstyle or makeup that they like. 
• Allowing and encouraging self expression will boost and encourage their self esteem.

Step back a little 

Every parent’s goal is to ensure their child’s independence and self-reliance. This can be achieved only when they are allowed to:

• Perform self care tasks and Activities of Daily Living (ADLs) like brushing teeth, having a bath.
• Clean themselves after using the bathroom. It is important for their hygiene to teach them to clean their private parts thoroughly after using the bathroom.
• Clearly communicate their likes and dislikes.

Self-protection

Being in a safe environment is every child’s right – with or without disability, whether a boy or a girl. It is therefore crucial to teach your children:

• Physical/ bodily boundaries 
  • Good/safe touch and bad/unsafe touch
  • It should be made clear that they do not need to allow any kind of touch that makes them uncomfortable.
  • Build trust and encourage them to approach you as soon as something/someone makes them feel uncomfortable.
• Emotional/social boundaries 
  • Abuse is not always physical, it may be verbal as well. 
  • Help children understand not to engage in conversations that are not comfortable.
  • Be vigilant, identify and understand how to help your non-speaking child to express their feelings and discomfort.

Visual aids

Create and use visual tools to help teach children different activities and steps involved in self care and ADLs.

Support in situations

Occasionally there might be situations where there may be excessive bleeding or menorrhagia. Such conditions may lead to discomfort to the child. There are a few effective non medical ways to deal with it and support the child during that time. 

• Maintaining an exercising routine and keeping a healthy body weight
• Hydrating regularly
• Avoiding salty / sugary food, maintaining a balanced diet

In case of severe pain and discomfort, consult a gynaecologist for further guidance.

Acknowledging the physical changes that come with puberty is essential. At the same time educating and reassuring special children becomes a daunting task for parents. This slideshow addresses some common challenges with menstruation for a special needs child. It also includes concerns that several parents face before and during their special girl-child’s journey into puberty.

Every girl has the right to experience puberty irrespective of special needs. When the going gets tough here’s how you approach it. 

Acknowledgement: We would like to thank Dr. Kavya Priya Vazrala for her valuable inputs. We also extend our heartfelt gratitude to Ms. Hemanta Nijhawan for volunteering her time and effort with us towards the translation of this presentation from English to Hindi.

Have questions about Autism, Down Syndrome, ADHD, or other intellectual disabilities, or have concerns about developmental delays in a child? The Nayi Disha team is here to help. For any questions or queries, please contact our FREE Helpline at 844-844-8996. You can call or what’s app us. Our counselors speak different languages including English, Hindi, Malayalam, Gujarati, Marathi, Telugu, and Bengali.

DISCLAIMER: Please note that this guide is for information purposes only. Hence, please consult a qualified health practitioner for safe management.