Ages & Stages
Prenatal
First Trimester: Week 1 (conception) – Week 12
Physical and Emotional Changes a Woman May Experience
Hormonal changes will affect almost every organ in the body. Some signs of early pregnancy in many women include symptoms like:
Extreme fatigue
Tender, swollen breasts. Nipples may protrude.
Nausea with or without throwing up (morning sickness)
Cravings or aversion to certain foods
Mood swings
Constipation
Frequent urination
Headache
Heartburn
Weight gain or loss
Changes in a Woman’s Daily Routine
Some of the changes you experience in your first trimester may cause you to revise your daily routine. You may need to go to bed earlier or eat more frequent or smaller meals. Some women experience a lot of discomfort, and others may not feel any at all. Pregnant women experience pregnancy differently and even if they’ve been pregnant before. Pregnant women may feel completely differently with each subsequent pregnancy.
First Trimester: The Baby at 4 Weeks
At 4 weeks, your baby is developing:
The nervous system (brain and spinal cord) has begun to form.
The heart begins to form.
Arm and leg buds begin to develop.
Your baby is now an embryo and 1/25 of an inch long.
First Trimester: The Baby at 8 Weeks
At 8 weeks, the embryo begins to develop into a fetus. Fetal development is apparent:
All major organs have begun to form.
The baby’s heart begins to beat.
The arms and legs grow longer.
Fingers and toes have begun to form.
Sex organs begin to form.
The face begins to develop features.
The umbilical cord is clearly visible.
At the end of 8 weeks, your baby is a fetus, and is nearly 1 inch long, weighing less than ⅛ of an ounce.
First Trimester: The Baby at 12 Weeks
The end of the first trimester is at about week 12, at this point in your baby’s development:
The nerves and muscles begin to work together. Your baby can make a fist.
The external sex organs show if your baby is a boy or girl.
Eyelids close to protect the developing eyes. They will not open again until week 28.
Head growth has slowed, and your baby is about 3 inches long, and weighs almost an ounce.
Second trimester: Week 13 – Week 28
Second Trimester: Changes a Woman May Experience
Once you enter the second trimester you may find it easier than the first. Your nausea (morning sickness) and fatigue may lessen or go away completely. However, you will also notice more changes to your body. That “baby bump” will start to show as your abdomen expands with the growing baby. By the end of the second trimester you will even be able to feel your baby move!
Second Trimester: Physical and Emotional Changes in a Woman
Some changes you may notice in your body in the second trimester include:
Back, abdomen, groin, or thigh aches and pains
Stretch marks on your abdomen, breasts, thighs, or buttocks
Darkening of the skin around your nipples
A line on the skin running from belly button to pubic hairline (linea nigra)
Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. This is sometimes called the mask of pregnancy (melasma, or Chloasma facies).
Numb or tingling hands (carpal tunnel syndrome)
Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, yellowing of skin, or fatigue combined with itching. These can be signs of a liver problem.)
Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight quickly, call your doctor immediately. This could be a sign of a serious condition called preeclampsia.)
Second Trimester: The Baby at 16 Weeks
As your body changes in the second trimester, your baby continues to develop:
The musculoskeletal system continues to form.
Skin begins to form and is nearly translucent.
Meconium develops in your baby’s intestinal tract. This will be your baby’s first bowel movement.
Your baby begins sucking motions with the mouth (sucking reflex).
Your baby is about 4 to 5 inches long and weighs almost 3 ounces.
Second Trimester: The Baby at 20 Weeks
At about 20 weeks in the second trimester, your baby continues to develop:
Your baby is more active. You might feel movement or kicking.
Your baby is covered by fine, feathery hair called lanugo and a waxy protective coating called vernix.
Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself.
Your baby can hear and swallow.
Now halfway through your pregnancy, your baby is about 6 inches long and weighs about 9 ounces.
Second Trimester: The Baby at 24 Weeks
By 24 weeks, even more changes occur for your growing baby:
The baby’s bone marrow begins to make blood cells.
Taste buds form on your baby’s tongue.
Footprints and fingerprints have formed.
Hair begins to grow on your baby’s head.
The lungs are formed, but do not yet work.
Your baby has a regular sleep cycle.
If your baby is a boy, his testicles begin to descend into the scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs has formed in the ovaries.
Your baby stores fat and weighs about 1½ pounds, and is 12 inches long.
Third Trimester: Week 29 – Week 40 (birth)
Third Trimester: Changes a Woman May Experience
The third trimester is the final stage of pregnancy. Discomforts that started in the second trimester will likely continue, along with some new ones. As the baby grows and puts more pressure on your internal organs, you may find you have difficulty breathing and have to urinate more frequently. This is normal and once you give birth these problems should go away.
Third Trimester: Emotional and Physical Changes a Woman May Experience
In the third and final trimester you will notice more physical changes, including:
Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of a serious condition called preeclampsia.)
Hemorrhoids
Tender breasts, which may leak a watery pre-milk called colostrum
Your belly button may protrude
The baby “dropping,” or moving lower in your abdomen
Contractions, which can be a sign of real or false labor
Other symptoms you may notice in the third trimester include shortness of breath, heartburn, and difficulty sleeping
Third Trimester: Changes as the Due Date Approaches
Other changes are happening in your body during the third trimester that you can’t see. As your due date approaches, your cervix becomes thinner and softer in a process called effacement that helps the cervix open during childbirth. Your doctor will monitor the progress of your pregnancy with regular exams, especially as you near your due date.
Third Trimester: The Baby at 32 Weeks
At 32 weeks in the third trimester, your baby’s development continues:
Your baby’s bones are soft but fully formed.
Movements and kicking increase.
The eyes can open and close.
Lungs are not fully formed, but practice “breathing” movements occur.
Your baby’s body begins to store vital minerals, such as iron and calcium.
Lanugo (fine hair) begins to fall off.
Your baby is gaining about ½ pound a week, weighs about 4 to 4½ pounds, and is about 15 to 17 inches long.
Third Trimester: The Baby at 36 Weeks
At 36 weeks, as your due date approaches, your baby continues development:
The protective waxy coating (vernix) thickens.
Body fat increases.
Your baby is getting bigger and has less space to move around. Movements are less forceful, but you will still feel them.
Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.
Third Trimester: The baby at 37 to 40 Weeks
Finally, from 37 to 40 weeks the last stages of your baby’s development occur:
By the end of 37 weeks, your baby is considered full term.
Your baby’s organs are capable of functioning on their own.
As you near your due date, your baby may turn into a head-down position for birth.
Average birth weight is between 6 pounds 2 ounces to 9 pounds 2 ounces and average length is 19 to 21 inches long. Most full-term babies fall within these ranges, but healthy babies come in many different weights and sizes.
As the weeks and months pass leading up to your delivery date, you’re probably eagerly planning for the new addition to your family, and adjusting to what is going on in your own body.
During the third trimester, you’ll notice many changes that may affect how you feel:
You’ll gain weight, typically at a rate averaging about one pound a week during the last trimester.
As your baby grows in size and places pressure on nearby organs, you may experience episodes of shortness of breath and back pain.
You may urinate more frequently as pressure is placed on your bladder, and you might have episodes of incontinence.
You may find it harder to get comfortable, and sleep may become more difficult. You may prefer to sleep on your side.
You could experience more fatigue than usual.
You may have heartburn, swelling in your feet and ankles, back pain, and hemorrhoids.
You may have “false labor” contractions known as Braxton- Hicks contractions. These Braxton-Hicks contractions begin to soften and thin the cervix, preparing it for the delivery of the baby. But unlike true labor contractions, they are irregular, do not occur more often as time passes, and do not become stronger or more intense.
While you’re pregnant, you and your spouse/partner may be participating in childbirth education classes, which will give you information about labor and birth, provide the chance to meet other parents-to-be, and help you prepare for the birth. Several types of classes are available in many communities. The Lamaze method, for example, uses approaches such as focused breathing, massage, and labor support that can be used during the actual childbirth process.
The Bradley method emphasizes natural childbirth, and relies heavily on deep breathing techniques. Many childbirth education classes discuss a combination of these as well as other methods to teach expectant parents about the birth process and ways to make the delivery successful, comfortable, and enjoyable.
Whatever class you’re considering, ask in advance about the topics and methods of childbirth that will be emphasized, and whether the classes are primarily lectures or also involve your active participation. What is the instructor’s philosophy about pregnancy and birth? Is he or she certified? Will you learn proper methods for breathing and relaxation? What will the classes cost? Is there a limit on class size?
At the same time, consider signing up for other classes that can help prepare you for the parenting challenges ahead. Ask your doctor for referrals to breastfeeding classes, infant care programs, or instructional courses on cardiopulmonary resuscitation (CPR).
Some education classes encourage their participants to develop a “birth plan,” and may provide guidance in helping you do so. The birth plan is usually a written document for both you and your doctor in which you’ll record your own preferences for labor and delivery.
For example:
Where will you be delivering your baby?
Based on your doctor’s instructions, do you plan to go directly to the hospital when labor begins, or will you call the office first? What arrangements have you made for transportation to the hospital or birthing center? Do you have a doula or want to participate in a doula program? (A doula provides various forms of nonmedical support in the childbirth process.)
Who would you like to deliver your baby (an obstetrician or a nurse midwife)?
Who do you want to be present to support you during the childbirth experience?
What position would you prefer to be in during delivery?
What are your preferences for pain medication (if any is going to be used)?
What options would you consider if unexpected circumstances develop (e.g., the need for an episiotomy or a Cesarean section)?
If you deliver prematurely, does the facility have adequate resources to take care of your prematurely born infant?
Not only should you talk about and share this document with your doctor, but also let your family members and friends know of your decisions.
Baby
Your Baby Should Be Doing This. . .
Physical Skills:
Raises head & chest when on stomach
Stretches & kicks on back
Opens and shuts hands
Brings hand to mouth
Grasps and shakes toys
Social Skills:
Begins to develop social smile
Enjoys playing with people
More communicative
More expressive with face & body
Imitates some movements & expressions
Sensory Milestones:
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
Prefers sweet smells
Prefers soft to coarse sensations
Your Baby Should Be Doing These Things. . .
Physical Skills:
Rolls both ways
Sits with and without support of hands
Supports whole weight on legs
Reaches with one hand
Transfers object from hand to hand
Uses raking grasp
Social Skills:
Begins to develop social smile
Enjoys playing with people
More communicative
More expressive with face & body
Imitates some movements & expressions
Sensory Milestones:
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
Prefers sweet smells
Prefers soft to coarse sensations
Your Baby Should Be Doing This. . .
Physical Skills
Gets to sitting position without help
Crawls forward on belly
Assumes hands-and-knees positions
Gets from sitting to crawling position
Pulls self up to stand
Walks holding on to furniture
Social Skills
Shy or anxious with strangers
Cries when parents leave
Enjoys imitating people in play
Prefers certain people and toys
Tests parental response
Finger-feeds himself
Cognitive Thinking
Explores objects in different ways
Finds hidden objects easily
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly
Toddler
Your Toddler Should Be Doing This. . .
Physical Skills
Walks alone
Pulls toys behind when walking
Begins to run
Stands on tiptoe
Kicks a ball
Social Skills
Imitates behavior of others
Aware of herself as separate from others
Enthusiastic about company of other children
Cognitive Thinking
Finds objects even when hidden 2 or 3 levels deep
Sorts by shape and color
Plays make-believe
Preschool
4 Years Old – 5 Years Old
Your Preschooler Should be doing this. . .
Physical Skills
Climbs well
Walks up and down stairs, alternating feet
Kicks ball
Runs easily
Pedals tricycle
Bends over without falling
Social Skills
Imitates adults and playmates
Show affection for familiar playmates
Can take turns in games
Understands “mine” and “his / hers”
Cognitive Thinking
Makes mechanical toys work
Matches an object in hand to picture in book
Plays make believe
Sorts objects by shape and color
Completes 3 – 4 piece puzzles
Understands concept of “two”
Gradeschool
6 Years Old – 12 Years Old
What can my child do at these ages?
As your child grows, you’ll notice him or her developing new and exciting abilities.
A child age 6 to 7:
Enjoys many activities and stays busy
Likes to paint and draw
Practices skills in order to become better
Jumps rope
Rides a bike
A child age 8 to 9:
Is more graceful with movements and abilities
Jumps, skips, and chases
Dresses and grooms self completely
Can use tools, such as a hammer or screwdriver
A child age 10 to 12:
Likes to sew and paint
What does my child understand?
As children enter into school age, their skills and understanding of concepts continue to grow.
A child age 6 to 7:
Understands the concept of numbers
Knows daytime and nighttime
Knows right and left hands
Can copy complex shapes, such as a diamond
Can tell time
Understands commands that have 3 separate instructions
Can explain objects and their use
Can repeat 3 numbers backward
Can read age-appropriate books
A child age 8 to 9:
Can count backward
Knows the date
Reads more and enjoys reading
Understands fractions
Understands the concept of space
Draws and paints
Can name the months and days of the week, in order
Enjoys collecting objects
A child age 10 to 12:
Writes stories
Likes to write letters
Reads well
Enjoys using the telephone
How will my child interact with others?
An important part of growing up is learning to interact and socialize with others. During the school-age years, you’ll see a change in your child. He or she will move from playing alone to having multiple friends and social groups. Friendships become more important. But your child is still fond of you as parents, and likes being part of a family. Below are some of the common traits that your child may show at these ages.
A child age 6 to 7:
Cooperates and shares
Can be jealous of others and siblings
Likes to copy adults
Likes to play alone, but friends are becoming important
Plays with friends of the same gender
May sometimes have temper tantrums
Is modest about his or her body
Likes to play board games
A child age 8 to 9:
Likes competition and games
Starts to mix friends and play with children of the opposite gender
Is modest about his or her body
Enjoys clubs and groups, such as Boy Scouts or Girl Scouts
Is becoming interested in boy-girl relationships, but doesn’t admit it.
A child age 10 to 12:
Finds friends are very important and may have a best friend
Has increased interest in the opposite gender
Likes and respects parents
Enjoys talking to others
How can I encourage my child’s social abilities?
You can help boost your school-aged child’s social abilities by:
Setting limits, guidelines, and expectations and enforcing them with appropriate penalties
Modeling good behavior
Complimenting your child for being cooperative and for personal achievements
Helping your child choose activities that are suitable for his or her abilities
Encouraging your child to talk with you and be open with his or her feelings
Encouraging your child to read, and reading with your child
Encouraging your child to get involved with hobbies and other activities
Promoting physical activity
Encouraging self-discipline and expecting your child to follow rules that are set
Teaching your child to respect and listen to authority figures
Encouraging your child to talk about peer pressure and setting guidelines to deal with peer pressure
Spending uninterrupted time together and giving full attention to your child
Limiting screen time (TV, video, and computer)
Teen
How much will my teen grow?
The teenage years are also called adolescence. This is a time for growth spurts and puberty changes (sexual maturation). A teen may grow several inches in several months, followed by a time of very slow growth. Then they may have another growth spurt. Puberty changes may happen slowly. Or several changes may occur at the same time.
It’s important to remember that these changes will happen differently for each teen. Some teens may have these signs of maturity sooner or later than others. Each child goes through puberty at their own pace.
What changes will happen during puberty?
Sexual and other physical maturation that happens during puberty is due to hormonal changes.
Here’s a look at the changes for boys and girls.
In boys, it’s hard to know exactly when puberty is coming. There are changes that occur, but they happen slowly and over a period of time. It’s not just a single event.
Each male teen is different and may go through these changes differently. But these are average ages when puberty changes may happen:
Start of puberty. Between 9 ½ and 14 years old.
First puberty change . Enlargement of the testicles.
Penis enlargement. Begins about 1 year after the testicles begin enlarging.
Pubic hair appears. About 13 ½ years old.
Wet dreams (nocturnal emissions). About 14 years old.
Hair under the arms and on the face, voice change, and acne. About 15 years old.
Girls also experience puberty as a series of events. But their puberty changes often begin before boys of the same age. Each girl is different and may go through these changes differently.
These are average ages when puberty changes may happen:
Start of puberty. Between 8 and 13 years old.
First puberty change. Breast development.
Pubic hair appears. Shortly after breast development.
Hair under the arms. About 12 years old.
Menstrual periods. Between 10 and 16 ½ years old.
Both boys and girls go through certain stages of development when developing secondary sex characteristics. These are the physical characteristics of males and females that are not involved in reproduction. These include voice changes, body shape, pubic hair distribution, and facial hair.
Here’s a quick look at the changes that happen:
Boys. In boys, the first puberty change is the enlargement of the scrotum and testes. At this point, the penis does not enlarge. Then, as the testes and scrotum continue to enlarge, the penis gets longer. Next, the penis will continue to grow in both size and length.
Girls. In girls, the first puberty change is the development of breast buds. This is when the breast and nipple elevate. The dark area of skin that surrounds the nipple of the breast (the areola) gets larger at this time. The breasts then continue to enlarge. Over time, the nipples and the areolas will rise again. They then form another mound on the breasts. When a girl becomes an adult, only the nipple is raised above the rest of the breast tissue.
Both boys and girls. Pubic hair development is similar for both girls and boys. The first growth of hair produces long, soft hair that is only in a small area around the genitals. This hair then becomes darker and coarser as it continues to spread. Over time the pubic hair looks like adult hair, but in a smaller area. It may spread to the thighs. It sometimes goes up the stomach.
What does my teen understand?
The teenage years bring many changes. These are not only physical, but also mental and social changes. During these years, teens become more able to think abstractly. Over time they can make plans and set long-term goals. Each child may progress at a different rate and may have a different view of the world.
In general, these are some of the abilities you may see in your teen:
Develops the ability to think abstractly
Is concerned with philosophy, politics, and social issues
Thinks long-term
Sets goals
Compares himself or herself to their peers
As your teen starts to struggle for independence and control, many changes may happen.
Here are some of the issues that may affect your teen during these years:
Wants independence from parents
Peer influence and acceptance becomes very important
Romantic and sexual relationships become important
May be in love
Has long-term commitment in relationship
How to help your teen to develop socially
Here are some ways to help strengthen your teen’s social abilities:
Encourage your teen to take on new challenges.
Talk with your teen about not losing sight of one’s self in group relations.
Encourage your teen to talk with a trusted adult about problems or concerns, even if it is not you.
Talk about ways to manage and handle stress.
Provide consistent, loving discipline with limits, restrictions, and rewards.
Find ways to spend time together.
Young Adult
A young adult who goes away to a college or a job far from home has to build a social support system from the ground up. At the same time, he may have to acclimate himself to a drastically different environment.
Tips to Support Your Teen Graduating from High School
Graduating from high school is a time of excitement and adventure for many young people, but also a time filled with uncertainty. In addition, the end of high school means transitions to college, into jobs, into the military, or out of the foster care system. All of these situations bring up things to think about regarding general well-being, health concerns and diagnoses, and medications. Your child’s pediatrician can be a wonderful source of advice on helping your teen to transition successfully.
Advice for Parents & Caregivers:
Is your child headed to college? Know what to do to support your teen emotionally as he ventures out into the world and away from home base.
Make sure that your teen has medical coverage after high school and teach your teen how to access and use it. Many teens and young adults are covered under their parents’ health insurance through age 25.
If your teen is going to college, check into the health and mental health support services on campus, and make sure he is familiar with them.
In addition to making sure that the graduating patient has all of the vaccines and other preventive health care recommended for this stage of life, pediatricians also can help families to ensure they are preparing the way for their young adult’s continuing mental and emotional health.
If your teen has mental health needs, develop a plan of care in advance of your teen moving away from home. For college, this can take several weeks or months to develop.
Does your child have a mental health diagnosis, such as ADHD, depression, eating disorder, etc? Be sure to ask the health center staff what kind of medical information they will need related to your teen, and how to set up prescription refills if needed.
With your teen, communicate with college or university staff about their accommodations for teens with ADHD and other diagnoses. In addition, consider contacting the college’s Disabilities Office, Academic Advising Office, or Student Affairs Office to determine what accommodations are available for ADHD and other diagnoses.
Once your teen is settled into the college routine, keep in close contact and try to get frequent readings about how he is doing academically and socially. This is especially important during the first month or so while teens are still trying to settle in and may not have made friends yet.
Do you have a child in foster care who is “graduating” out of the system? Depending on state laws, children in foster care are covered under Medicaid until age 18 or 21 and may need to transition to a different provider. Some may need to transition even earlier to an adult or Transitional Aged Youth mental health provider. Young adults transitioning out of the foster care system need help in identifying caring adults—related or not—from whom they can seek advice, support, and reassurance. See Health Insurance for Young Adults Previously in Foster Care for more information.
Is your teen going straight to work rather than college? Even though she may be remaining at home for a time, her life will change dramatically from when she was in the structured environment of high school, having daily contact with friends. Be sure to give her extra space as a young adult, but realize that she may need help navigating adult responsibilities like bill paying, taking on her own health care, etc. She may be missing her high school life and friends who have moved on. Encourage her to keep up her friendships and to form new ones through work or other interesting activities.
Alcohol, drugs and sexual activity may become more accessible at this time. Be clear about your expectations regarding drug and alcohol use are even though your child may not be living at home. Be sure your teen knows where to go—whether on campus or locally—for reproductive health care. Continue to have conversations about peer pressure, good decisions, and consequences.
Once your teen turns 18, you’ll no longer have legal access to his academic or health records. After he moves on from high school to college or work, have frequent, one-on-one conversations with your teen as a means of staying in touch.
It’s normal for young people starting at college or moving to a new place to have days when they feel sad, homesick, or a bit lost. If these feelings persist or interfere with their ability to work, they should seek help and know that it is normal to do so. Watch for warning signs and be prepared to act.
Advice for Your Teen:
Graduating from high school is such an exciting time. For some, this may mean transitioning to a full time job. For others, it may mean heading off to college. Whatever this next stage in life brings, it’s important to be in charge of your own health.
Here are some tips for you to consider.
Participate in activities to promote your overall health. Eating right, getting enough sleep (at least 8-10 hours), and being active will keep you feeling energized and can reduce stress.
Talk with your pediatrician about when to start seeing an adult doctor. Many young adults see their pediatricians until they turn 21. Your pediatrician can provide you with guidance about choosing an adult health provider.
If you have a health care problem, know the facts. When going to a new doctor or clinic, you will need to provide information about your diagnosis and how you treat it.
If you are taking medication to treat a health care problem, know the name of the medication, how is it taken, side effects, and if you cannot have certain foods or drinks while taking the medication. Also know how and where you will go to refill prescriptions.
If you will no longer be living at home, know where you will go if you are having a health problem. What hospitals or clinics are close by? Is there a student health center? Talk with your parents about how your family’s health insurance works, and be sure you have a card from the health plan.
Tips for the New College Student:
Be sure you are familiar with the local or campus health center and counseling center (hours of operation, services offered, fees, location) and what to do if the Center is closed (nights and weekends). Make sure you have your insurance card and know how to use it (For example, some insurance companies may only allow certain labs or may require pre-authorization for referrals.)
If you have a chronic health condition, make sure roommates or someone close to you know about your health condition, signs of problems, and what to do in an emergency situation. Consider having your treating physician send a report with your current status and treatment report to the Health Center. If your problem is particularly complex or challenging, consider talking with or meeting with a health center staff member before the academic year starts.
Studies have shown that the majority of students on campus don’t use drugs and either don’t drink or do so in so moderation. So you don’t need to do either one to fit in. Drinking excessively can open you up to significant health risks (accidents, fights, date rape/sexual assault).
Find out what resources are available to support you. Often there are support groups and student services available to help address the transition to work or college. And don’t forget about your family…they want to hear how you are doing!
It’s normal for someone starting at college or moving to a new place to have days when they feel sad, homesick, or a bit lost. If these feelings last for more than a week or so or are interfering with your ability to work or enjoy your college experience, seek help. The health center or counseling center is the best place to start.
Depression or Mental Health Warning Signs:
Changes in sleep patterns
Unexpected weeping or excessive moodiness
Eating habits that result in noticeable weight loss or gain
Expressions of hopelessness or worthlessness
Paranoia and excessive secrecy
Self-mutilation, or mention of hurting himself or herself
Obsessive body-image concerns
Excessive isolation
Abandonment of friends, social groups, and favorite pastimes
Unexpected and dramatic decline in academic performance
Drinking excessively or using other drugs to feel better or help with sleep
