EARLY PUBERTY: WHY IS IT BECOMING MORE COMMON?

Written by: Caroline Meyer

Puberty usually starts anything from 8 years old in girls and 9 years old in boys with the average being around 10 for girls and 11 for boys. Puberty is the when kids start developing and maturing towards becoming adults both emotionally and physically.  For some children, puberty can start really early, from 4 to 5 years old. This is known as precocious puberty and is used to describe puberty that starts before 8 years in girls and before 9 in boys.  Precocious puberty can be a sign of a health problem in some children. It can also be quite difficult physically and emotionally for younger children to deal with. 

WHAT ARE THE SIGNS OF PRECOCIOUS PUBERTY? 

In girls, precocious puberty can include breast development, growth of underarm and pubic hair, start of menstruation (period), acne, rapid growth in height, and change in body odour. In boys, early puberty may present with acne, enlargement of the penis and testicles, growth of underarm, pubic and facial hair, rapid growth in height, deepening of the voice and a change in body odour. 

Some children may show some or all of the signs. Some children undergo a partial puberty at an early age such as developing breasts which then stop growing until actual puberty or only 1 change without any other signs of the onset of puberty.  Some girls and boys may only develop hair under the arms and in the pubic region, with no other changes until later in life.  Most children who only undergo only a partial precocious puberty, should still be checked by their doctor to ensure there are no underlying issues causing the change, but generally do not require further treatment. They will usually go on to a normal puberty at the usual ages. 

THE EFFECTS OF PRECOCIOUS PUBERTY  

For most people, once puberty end, the horizontal growth does too. Children who start puberty early usually end early as well and their skeletal growth matures faster. This means they stop growing at a younger age and are unlikely to be as tall as they would have been had their puberty happened at the usual age. They will generally be taller than other children their age while undergoing precocious puberty, but they stop growing much earlier and will often be much shorter than expected. 

One of the biggest effects on these children is socially and emotionally. The growth of breasts, hair and genitals can be embarrassing and confusing to them. It can also see them being bullied or teased for being different. On top of this, take the puberty hormones in to account and you end up with irritability, mood swings and aggression. Boys may also develop an inappropriate sex drive for their age. 

WHAT CAUSES PRECOCIOUS PUBERTY? 

Puberty is governed by the hypothalamus. This is the part of the brain involved in sending signals to the pituitary gland. This is the gland that releases the hormones in to the blood steam which stimulates the testicles in boys and the ovaries in girls to start producing hormones which kick start puberty. This can be caused through problems in the brain such as an injury, infection or tumour. It can also be caused from issues with the thyroid gland or ovaries such as tumours or cysts. In boys, the cells that manufacture sperm or testosterone may have a tumour, causing the early release of hormones in to the child’s body. 

 For most children who undergo early puberty, there does not seem to be any particular medical cause. In boys it appears to possibly be an inherited issue in around 5% of the cases while less than 1% of girls may be due to hereditary.  

Other causes can include radiation to the spinal cord or brain. Congenital adrenal hyperplasia and hypothyroidism as well as a defect in the brain at birth, such as hydrocephalus which is a fluid build-up in the brain cavity are a potential cause in some children. Tumours in the pituitary and adrenal glands causing a release of testosterone or oestrogen can also bring on early puberty.  

Exposure to ointments or creams containing testosterone or oestrogen may be a factor as well. Rare genetic disorders such as McCune-Albright syndrome causes hormonal problems but includes symptoms such as bone issues and skin colour problems. A very rare disorder known as gonadotropin-independent familial sexual precocity results in extremely early testosterone production in boys, often between 1 and 4 years old, due to a gene defect. 

WHAT CAN YOU DO? 

The first step is to discuss the issue with your doctor if you feel your child may be experiencing precocious puberty. Most of the physical changes should be easy for a doctor to note. He will, however, more than likely require urine and blood tests to make a clear diagnosis. High levels of sex hormones in the blood is a clear indication of early puberty. Your doctor may also x-ray the hand and wrist to determine whether or not the skeletal structure is maturing more rapidly than it should. Your doctor may also order MRI’s, Ultrasounds and CT scans to rule out tumours as a cause for the early onset of puberty in your child. He may also refer you to an endocrinologist to assess and evaluate whether there may be a hormonal disorder which can then be treated.  

The main aim in treating precocious puberty is to stall it to allow the bones and skeletal structure to grow normally and allow the child to reach their full height potential eventually. Underlying conditions, if any, will be treated first to see if this resolves the problem. The next step is to reduce the levels of sex hormones to stop further sexual development until a later time. This is done via hormone therapy. In most cases, this resolves the issue and allows the child to develop at a normal rate. 

You need to explain to your child what their body is experiencing in an age appropriate way. You can let them know that it is something that usually happens later when they start getting closer to their teens. You can also help them understand the interventions that are done and that it is to help them develop normally.  

Stay alert for signs of teasing and bullying that can be detrimental to your child’s emotional development. Look for signs such as depression, bad grades, and problems at school, fighting with others or a general loss of interest in activities. Avoid comments on your child’s appearance as you also don’t want self-image or self-esteem issues, especially at such a young age. Encourage normal participation in activities and at school. Support them as much as possible without dwelling on the physical changes. Precocious puberty can be treated in almost all cases. The sooner it is diagnosed, the better for your child and the sooner the hormones can be brought under control.