PRECOCIOUS PUBERTY - Attention parents: Is your child starting puberty too young?
For a child, puberty is an important, though often stressful, process on the way to adulthood. But when the process begins too soon, precocious puberty can be a more difficult experience, which also has important health consequences.
Puberty is a natural process that every child goes through. But in recent years, an increasing number of children are experiencing the onset of puberty too soon. Children experiencing precocious puberty can suffer from unhealthy changes in their normal growth along with greater emotional and behavioral problems that are magnified by their young age. Parents can easily miss some of the early signs and symptoms, so having a greater awareness of the condition can help ensure their child receives the proper care
For expert insight into this fairly rare condition, Better Health sought the advice of Dr. Anuttara Pothikamjorn, a board certified physician specializing in pediatric endocrinology and diabetes who has extensive experience treating children with precocious puberty.
How young is precocious?
Puberty is considered precocious when it begins before the normal age range. Girls typically enter puberty between the ages of eight and 13. The most common changes associated with puberty in girls include:
- Development of breast tissue, sometimes beginning in only one breast;
- Growth of armpit and pubic hair;
- Growth spurt;
- Presence of acne and body odor.
Puberty in boys typically begins a year later – between the ages of nine and 14 – with the most apparent physical changes including:
- Growth of the penis, testicles and scrotum;
- Growth of armpit and pubic hair;
- Growth spurt;
- Deepening voice;
- Presence of acne and body odor.
Along with physical changes, the onset of puberty triggers the production of hormones which can cause changes in a child’s behavior – they become angry more easily, are less emotionally stable, and are more prone to suffer depression.
While research hasn’t yet determined the precise cause of precocious puberty, studies have shown that girls are much more likely than boys to experience the condition, and there is evidence of a link between childhood obesity in girls and the early onset of puberty. “The number of precocious puberty cases has been increasing in Thailand and around the world,” explains Dr. Anuttara. “And the growing number of children suffering from precocious puberty closely tracks the rise in overweight and obese children. Research has also shown that overweight children tend to go through puberty faster than normal-weight children.”
Precocious puberty is one of many childhood health risks that parents need to know about. While not life threatening, it can have a harmful effect on a child’s “bone age”; precocious puberty causes bones to mature faster, with a child’s growth cycle ending at a younger age and resulting in shorter height once growth stops.
It’s important for parents to pay attention to their child’s behavior and emotional well-being for signs of potential problems, as the physical differences among children with precocious puberty make them more susceptible to being teased or bullied by other children.
This can harm a child’s self confidence and magnify feelings of confusion about their body being different from ‘normal’ kids. Emotional difficulties can be especially pronounced among girls dealing with early menstruation. “In some cases, the very early onset of puberty can make a child more vulnerable to sexual abuse,” Dr. Anuttara cautions, “as the child isn’t mature enough to deal with an unwanted advance.”
In rare cases, precocious puberty can be caused by a tumor or other medical condition. “If the symptoms are caused by tumors, genetic conditions or other illnesses,” says Dr. Anuttara, “there are health risks that may result from those conditions.”
Diagnosis and treatment
The following tests and procedures are widely used to help confirm a diagnosis of precocious puberty:
- X-ray imaging: Since bones age more rapidly during precocious puberty, X-ray imaging is used to assess the extent of bone maturity. Doctors consider the test results when deciding whether to prescribe hormone treatment to slow the pace of the puberty process;
- Hormonal blood testing: Puberty affects the levels of certain hormones – testosterone in boys and estradiol in girls – so this test will confirm whether puberty has already begun.MRI and ultrasound imaging: These procedures give doctors detailed images that can reveal the presence of tumors in the brain and ovaries, either of which can cause precocious puberty in a very small number of cases.
Once precocious puberty is confirmed, and the possibility of a brain tumor or other illness has been ruled out, the doctor may recommend treating the child with hormone control medication to slow the pace of the child’s puberty. The treatment typically involves injections of medication about once a month, continuing until the child’s chronological age “catches up” with his “bone age.”
For girls, treatment usually continues until they reach the normal age for beginning menstruation, around the age of 12.
A precocious puberty diagnosis doesn’t automatically call for medical treatment. “Doctors usually recommend the treatment in cases where the condition is affecting the child’s physical growth and mental or emotional well-being,” Dr. Anuttara explains. “While many parents worry that their child won’t grow to reach normal height, the most widely used medications for treating precocious puberty don’t actually affect the body’s growth.”
Parents and precocious puberty
Parents should be open in discussing precocious puberty with their child. “After the precocious puberty diagnosis is confirmed, parents should give their child a simple, straightforward explanation about what's happening,” Dr. Anuttara advises.
“Explain to your child that these changes are normal for older kids, but that his or her body has begun maturing a bit too early. Keep your child informed about the possibility of treatment and other things they should expect along the way. And watch for any indication that your child is being teased or picked on by other children.”
Proper sex education also gives children important skills to handle puberty’s physical and emotional changes. “Many parents are uncomfortable talking about these things,” notes Dr. Anuttara. “That can leave a child without the coping skills they need, even at the age of 12 or older. Many girls have a difficult time coping with their first period; they often feel as if there’s something strange or different about themselves. By preparing for puberty ahead of time, parents can give their children the tools they’ll need to deal more successfully with the changes to come.”
Particularly for girls, the best way to lower a young child’s risk for precocious puberty is to teach healthy eating habits and make sure they get plenty of exercise. This will benefit their overall health and keep their weight under control.
The obesity connection
It’s fairly common for some parents to suspect that their child’s early puberty is the result of chemicals or hormones contained in popular food items. But extensive research has shown that for young girls, obesity may be the most important factor behind the growing rate of precocious puberty.
According to the journal Pediatrics, among the more than 350 obese girls who participated in a 2007 research study, nearly half (48 percent) experienced the onset of puberty by the age of nine, with six percent beginning to menstruate by the age of 11.
The study also cited the importance of the hormones estrogen and leptin, both of which are involved in the female body’s production of fat cells. Obese girls were shown to have higher levels of leptin than non-obese girls. Scientists believe that leptin may help stimulate the production of other hormones in the brain, a process that in turn promotes estrogen production that supports the body’s growth and development.
For boys, obesity apparently does not play a role in causing precocious puberty. In fact, overweight or obese boys tend to enter puberty later than non-obese boys. Ongoing research is exploring the relationship between fat cells and puberty, and it’s hoped this will eventually lead to more effective treatments for precocious puberty.
For now, one of the best things parents can do is to help their children develop and stick to good nutrition and lifestyle habits.