EARLY PUBERTY – What is it?  What can be done? 

 Hylton I Lightman, MD, DCH (SA), FAAP

It’s the annual well visit.

As an aside, as much as you may bring your children to the doctor for sick visits, it’s the annual physical or well visit that provide us physicians with the best opportunity to identify conditions or concerns early in their course, and, in addition, where we can promote the value of the family and other relationships.

So it’s at an annual visit when Mom says, “Dr. Lightman.  I’m concerned that my 8-year old daughter may be showing signs of puberty. This is a big embarrassment to her, and a medical concern for my husband and me.  Is this something for which we should seek medical attention?”

For parents, discovering that your child is entering puberty early can be alarming.

Why is it happening?

Can your child really handle the effects — both physical and psychological?

These are big questions, often overwhelming for parent and child. We are here to help.

An important stage of development, both socially and culturally, the onset of puberty varies according to different population groups and environmental factors. On average, a girl starts between ages 8 to 13, and a boy between ages 9 to 14.  Girls who show significant signs of puberty and its progression before age 7 and boys before age 9 are considered to have precocious puberty.  About 1 out of 5,000 children are affected.

Some girls experience a delay of puberty because of chronic illness, prolonged physical and psychosocial stress, intensive exercise, or excessive weight loss. In contrast, others have an acceleration of the onset of puberty called “precocious puberty.”  Precocious puberty is the development of certain signs of puberty before the age of 10 in girls and boys (this depends on the population group).  While there may be a familial constitutional tendency towards early puberty, we nonetheless need to evaluate if a medical problem is causing these symptoms.

How do you know that you are dealing with signs of early puberty?

Signs of concern would be whether a girl has started breast development, auxiliary hair growth, and increased sweating and auxiliary odor, moderately severe acne, as well as perhaps menses. Similarly, a boy might have genitalia growth or his voice might start to change.  A more obvious signal is a rapid growth spurt, with acceleration of bone age, as documented by an x-ray of the wrist. Because bone maturity is quickened, children with precocious puberty are taller than their peers in the 4^th, 5^th, 6^th and 7^th grades.  However, their growth stops earlier and they end up shorter in stature in adulthood.

There are psychosocial concerns with precocious puberty.  Too early menses may mean a girl is too young to handle the emotional and physical effects of menses.  If he or she is taller than their peers, they may feel embarrassed or worse, be ostracized by them.   Further, when a child is perceived as older than their years, it leads to others having unrealistic expectations of them:  Their emotional maturity is often not a match for their physical maturity.

If you suspect precocious puberty, consult with your child’s pediatrician for an evaluation that would include a clinical exam, blood test for levels of hormones, and x-ray of the wrist bone.  An MRI may be ordered to rule out any brain tumors or abnormalities in the pituitary gland.   An important is the 17 Hydroxyprogesterone Level.  Many times, signs of precocious puberty, especially hair growth, can be coming from the adrenal gland, which is usually due to an enzyme deficiency.  Although this enzyme is measure at birth through a national screening, the deficiency may present later.

If problems show up in these tests, your pediatrician should refer you to an endocrinologist for follow up and further management. Some children require medical intervention to assist with proper growth, as well as control of hormonal issues.

You should seek a medical evaluation if you suspect your child might be experiencing precocious puberty.  It’s possible that proper medical treatment NOW can slow down the premature development of early puberty and its unfortunate consequences.  After all, we want each child to achieve their optimal adult height and overall human potential.

Make sure your children of all ages, from birth into young adulthood, have well visits regularly.

As always, daven.