Pre-Adolescent

(10-13 Years)

Adolescence is a time of significant physical, emotional, and social change. For young teens with an ostomy, these normal developmental challenges can be compounded by additional considerations related to their medical condition.

During this time, young teens experience a myriad of physical, emotional, and social changes at different speeds and times. Hormones begin to change at around 10-11 years for girls and 11-12 for boys. It is normal to start puberty in the range of 8-13 years for girls and 9-14 years for boys. During this time, the beginning of facial hair, breast development, pubic hair and menses begins. These changes can bring about fear and anxiety about what others think. If puberty is beginning later, the Young Teen may feel anxious and or worried. Peer pressure to use alcohol, drugs, tobacco products and have sex. Other challenges might be school, eating disorders and depression and family issues. During this time, young teens begin to make their own decisions about friends, school, sports. Although parents are important, Young Teens become more independent showing their own personalities and interests.

How to talk to your Young Teen
about Puberty:

Factual Explanations
Young teens need factual explanations using the right terms for body parts.
Reinforcement
Reinforce that “physical changes happen differently for everyone~ some are early and some later”.
Reassurance
Reassure them that puberty is an important and exciting life stage.
Avoid Certain Words
Avoid using words like “right or wrong” when talking about development~ everyone is different.
Avoid Comparison
Do not compare your child to others, even if you have other children in the home.

General FAQ’s About Your Pre-Adolescent

Identity Development and Self-Perception

In all cultures, adolescents work to develop their identity, including how they perceive themselves. Young teens with an ostomy may face additional questions about body image and identity. Similarly, there are young teens who may identify themselves different from the sex they were given at birth. As a parent, you might think this decision was sudden, when in fact, your Young Teen has most likely thought about this for a long time and may have been trying to figure out how to tell you.

Whether your teen is navigating gender identity or adjusting to life with an ostomy, it is important to reassure your Young Teen in this conversation just as you would in any other conversation about an issue. Open, non-judgmental communication creates a foundation of trust where teens feel comfortable discussing sensitive topics, whether related to their ostomy care or other aspects of their identity.

Emotional/Social Changes:

Young teens have concrete black and white thinking which means things are either right or wrong. For teens with an ostomy, this cognitive pattern can create unique challenges. They may view their body as either “normal” or “different,” without recognizing the spectrum of human experiences. Parents and healthcare providers can help by emphasizing that having an ostomy doesn’t define them and is just one aspect of who they are.

Their thinking is centered on self (often referred to as “egocentrism”). Young teens with ostomies may believe everyone is noticing their ostomy appliance or focusing on their condition, even when others aren’t aware of it. This self-centered thinking can heighten anxiety about their ostomy during social interactions.

Due to all the physical changes, Young Teens are often self-conscious about their appearance and may feel as if they are constantly being judged by peers. They want to “fit in.” This desire for conformity can be particularly intense for teens with ostomies, who may worry about ostomy sounds, odors, or visible outlines of their appliance under clothing. Providing strategies for discreetly managing their ostomy in social settings and connecting them with other teens who have ostomies can help normalize their experience.

One might see Young Teens moving towards more independence from the family. For teens with ostomies, this developmental push for autonomy should include gradually taking ownership of their ostomy care. Parents can support this transition by teaching self-care skills while remaining available for assistance when needed.

Boundaries and limits may be tested. Young teens with ostomies may resist medical recommendations or skip necessary care routines as a way of asserting control. Setting clear expectations about ostomy care while allowing choices in other aspects of management (such as selecting appliance styles or scheduling care times) helps balance their need for independence with medical necessities.

Expressing emotions can be difficult at this age. Having an ostomy can add layers of complex feelings, frustration, embarrassment, anger, or grief—that teens may struggle to articulate. Let your teen know that emotions are not right or wrong, they are feelings, and that what is wrong is how we behave. Stating something like “I can see that you are angry about having to change your ostomy appliance right before the party, and it’s not acceptable to kick the door. Let’s figure out a solution together that helps you attend the event and still take care of your health needs.

Thinking/Learning:

Young teens have the ability for complex thought and are better able to express their feelings by talking. For teens with ostomies, this cognitive development creates an opportunity for more nuanced discussions about their medical condition. They can better understand the physiological aspects of their ostomy and engage in deeper conversations about how it impacts their life. Parents might notice that questions or concerns about their ostomy arise during quiet moments such as late nights.

Talking sometimes happens at off hours, such as late nights. This can be due to scheduling of activities and thoughts expressed when the Young Teen has some “down time.” Be receptive to these moments when your teen with an ostomy wants to discuss concerns, frustrations, or even practical aspects of ostomy management. These late-night talks might reveal anxieties about overnight leaks, sleepovers with friends, or broader questions about how their ostomy will affect future relationships.

They also develop a stronger sense of right and wrong. Teens with ostomies may begin questioning why this happened to them or develop personal philosophies about fairness and resilience. This moral development can be channeled into advocacy or peer support for others with similar conditions.

This is a transition time to middle school or junior high. Oftentimes there is a new school, new teachers, and a new routine. For teens with ostomies, this transition includes planning for ostomy care in a new environment. Help them be organized and flexible as they navigate this new experience by collaboratively creating strategies for bathroom access, emergency supply storage at school, and communication with relevant staff about their medical needs.

Because the Young Teen is beginning to think on their own, they should be able to take responsibility for their schoolwork (homework). Similarly, they can take increasing responsibility for their ostomy care. Here is where assisting in organizing assignments can be of great help—the same organizational skills apply to managing ostomy supplies, tracking patterns, and maintaining a care schedule alongside academic responsibilities. Ask about what is happening in classes, ask to look at homework, and praise your Young Teen when they do something well, including taking initiative with their ostomy management.

It is also good for your Young Teen to see that you as a parent struggle too. Admit your own mistakes in front of your children and apologize when you are wrong. This models resilience and adaptability—qualities are essential for teens with ostomies who will face occasional challenges with their appliances or care routines. Showing that difficulties can be handled with grace helps normalize the occasional ostomy-related mishap and builds confidence in their ability to manage unexpected situations.

What about bullying?

Bullying can increase and has the potential to become serious during this period of growth. For young teens with an ostomy, the risk of being targeted may be heightened due to differences in bathroom habits, physical limitations, or visible medical equipment. Bullies might focus on ostomy-related issues such as sounds, odors, or appliance visibility through clothing.

Bullying can be physical and or emotional via in-person or social media. Young teens with ostomies may face traditional bullying in locker rooms or bathrooms or encounter hurtful comments online about their medical condition. Some teens might experience exclusion from activities or gossip related to their ostomy.

Monitor cell phones and social media, be alert for signs of bullying, and talk to your Young Teen about how things are at school. Watch for warning signs that may indicate your teen is being bullied about their ostomy, such as:

Sudden reluctance to attend school or participate in activities
Avoiding the bathroom at school
Refusing to eat during school hours to minimize ostomy output
Anxiety about changing for physical education
Decreased confidence in managing their ostomy care

Create a safe space for your teen to discuss any negative interactions related to their ostomy. Ask specific questions about how peers respond when they need to use the bathroom or if anyone has made comments about their ostomy. Validate their feelings while helping them develop appropriate responses to questions or comments from peers.

If you are concerned, reach out to healthcare providers for assistance as well as the school. School nurses, counselors, and administrators can help create accommodations that protects your teen’s privacy while ensuring necessary access to bathrooms and medical supplies. Healthcare providers can connect your family with support groups where your teen can learn coping strategies from others who have successfully navigated similar challenges.

Consider working with your teens’ healthcare team to develop age-appropriate language they can use to explain their ostomy to close friends, potentially preventing misunderstandings that could lead to bullying. Some teens find that selective disclosure to trusted peers creates a supportive network that can help buffer against potential bullying.

Safety:

To promote safety, have direct conversations about concerns (drugs, alcohol, tobacco, sex, safety gear) and how these might affect their ostomy. Don’t assume knowledge about either these topics or all aspects of ostomy management in different situations.

Ask specific questions about their day and occasionally include how they’re handling ostomy care at school. Get to know their friends and their families and consider sharing basic information with parents of close friends who might need to assist during social activities.

Teach good decision-making for both general safety and ostomy management when you’re not present. Ensure they always have necessary ostomy supplies and a plan for discreet management when away from home. Listen for both spoken and unspoken concerns about their ostomy.

When setting goals or expectations, include ostomy self-care in these discussions. When they’re home alone, make sure they can handle basic ostomy-related problems independently, and incorporate ostomy-specific scenarios when teaching them how to handle various emergencies.

Sexting is considered a common practice amongst adolescents. Sexting is when adolescents text sexually explicit videos, photos, photographs or messages via a mobile phone or some other digital device. Laws differ from state to state~ when a minor is involved there are legal consequences. In many states, sexting is considered a sexual crime and a felony. Depending on the circumstances, prosecution can occur even with possessing nude photos of oneself. Remember that when digital files are created and shared, the digital media no longer is secure. Technology also makes it easy to not reveal one’s true identity, age and intentions. An adolescent may unknowingly correspond with an adult or a peer with harmful intentions. The pressure for peer acceptance and sexual exploration can be enormous which can lead the adolescent to engage in situations that they may lack the emotional maturity to manage. Talk to your adolescent about sexting. Be curious about their digital information~ let them know you are curious ~ and ask questions.

Alcohol, and drug use~ drinking can reduce self-control and increase risky behaviors such as unsafe driving and sex. Cannabis is the most widely used psychoactive drug which can lead to behavioral, emotional, social, and school problems.

Tobacco and vaping (E-cigarettes) ~~ these are electronic devices that come in all shapes and sizes and heat a liquid and produce an aerosol or mix of small particles in the air. Other names are “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).” For more information check out Quick Facts on the Risks of E-Cigarettes for Kids and Teens and Young Adults

Health:

Seek regular medical and dental checkups, including specialized ostomy care assessments to monitor stoma health and appliance fit as their body grows. It is important to have good nutrition and rest, particularly for teens with ostomies who may have specific dietary considerations or absorption issues.

Choose healthy foods/snacks that work well with your teen’s ostomy, noting which foods cause increased output or gas. Since your Young Teen is growing rapidly, consider a multivitamin and extra calcium, especially if their ostomy affects nutrient absorption. Be creative by having breakfast foods at dinner time or vice versa or having your Young Teen suggest a new recipe or food that accommodates their ostomy needs. Ask their opinion on meals or restaurants, helping them learn to navigate food choices that keep them comfortable with their ostomy.

Television/Computers/social media:

Young Teens are exposed to a multitude of media that may be violent, have inappropriate sexual messages or inappropriate content. Be aware that teens with ostomies might also encounter inaccurate or negative portrayals of ostomies that could affect their self-image.

Time with the television/computer/social media is time away from the family and other duties/responsibilities, including proper ostomy care routines. Sharing the physical effects of sitting for long periods of time is important. Information such as sitting can cause high amounts of stress on the spine, neck, and lower back. This can contribute to headaches and backaches. For teens with ostomies, extended sitting can also lead to skin irritation under the appliance or output issues.

As much as your Young Teen may not like it, limit computer time and plan for other activities such as reading, board games and/or walking/bike riding. Encourage physical activities that are compatible with their ostomy, helping them build confidence in being active while managing their appliance.

It is best not to have a TV in one’s bedroom for sleeping. Place computers/screen in central locations so everyone can see and have access. Monitor internet sites/email accounts, phone calls/text messages and remind your Young Teen not to share personal information on the internet, including details about their medical condition except in appropriate support forums. Be aware that some cell phones receive unwanted pornographic material without a request.

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P.O. Box 2293
Biddeford, ME 04005-2293

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Please understand that UOAA is a private, nonprofit, advocacy and informational organization. We are not a medical facility and we do not have medical or legal professionals on staff. Therefore, UOAA does not provide Medical, Mental Health, Insurance or Legal Advice. Visit UOAA Virtual Ostomy Clinic provided by The Wound Company for non-emergency, virtual ostomy support.

Pre-Adolescent

How to talk to your Young Teen about Puberty:

General FAQ’s About Your Pre-Adolescent

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How to talk to your Young Teen
about Puberty: