PRECOCIOUS PUBERTY|
What you should know

Imagine a first-grader getting her period at recess, a toddler’s budding breasts obvious through her shirt, a 5-year-old mystified by her underarm hair and adult body odor. These are among the symptoms of a condition called early pubertal development, or precocious puberty, which effects about 4-5 percent of all girls. Although boys may also exhibit symptoms of early physical maturation, experts say that girls are five to eight times more likely than boys to experience precocious puberty.

Who, what, when, and why

According to Siobhan Pittock, M.D., a pediatric endocrinologist at the Mayo Clinic, “Precocious puberty occurs when physical and hormonal signs of pubertal development are present before age 7 for African-American girls and age 8 for Caucasians and/or girls of other races.” Girls who are overweight are at risk for precocious puberty, says Pittock, and there may be genetic causes as well. Girls who were adopted internationally are overrepresented among those with the condition; some experts have speculated that this is due to poor prenatal and early childhood nutrition.

After a child has been diagnosed with precocious puberty, it is especially important to determine the cause, says Pittock, adding, “Precocious puberty can have a physical cause, but most often it is idiopathic [of unknown cause].” Though there’s been much speculation about the chemicals in our food causing precocious puberty, Pittock doubts that the growth hormone in cow’s milk or the pesticides used to grow broccoli can cause your daughter to experience precocious puberty. She thinks it’s more likely that other factors are at play. For example, Pittock says, some cases of precocious puberty are caused by a child’s accidental exposure to estrogen or testosterone creams, and children who have had radiation therapy are also at high risk. Rarer but more serious causes of precocious puberty include tumors, cysts, or hormonal imbalances. In general, the earlier the onset of precocious puberty, the more likely its cause is a serious one, though this is not always the case.

Diagnosis and treatment

Pittock advises parents who believe their children are experiencing early pubertal development to seek treatment from a pediatric endocrinologist. If there is an underlying cause, treatment is essential to the child’s physical health. Even if there appears to be no serious reason for precocious puberty, treatment can be important for several reasons.

One obvious reason for arresting, or slowing or stopping, too-early puberty is the psychological and social effects it can have on a young child. A kindergartener who gets her period on a regular basis is likely to experience depression, low self-esteem, feelings of isolation, and difficulty coping with the changes her body is experiencing. She may experience an increased libido and is more likely to become involved in sexual activity at a younger age.

A permanent result of precocious puberty can be stunted growth. The younger the girl is, the more likely it is that early puberty will influence her adult height. “Growth is part of puberty, and when a girl goes through puberty at a rapid pace, the growth plates close at an earlier age,” says Pittock. As a result, about one-third of the girls who experience rapidly progressive premature puberty will reach a full adult height of five feet or less. Girls who experience early puberty are also at higher risk for breast cancer, probably because of prolonged exposure to estrogen.

While precocious puberty can be alarming to parents and difficult for children, treatment is available. A pediatric endocrinologist can determine through testing whether a girl is likely to benefit from treatment to stop the advance of puberty. In cases where there is no apparent cause of precocious puberty, the endocrinologist may prescribe regular hormone injections and regular monitoring through the age of 11 or 12. While the injections may be painful, they are often successful in arresting puberty and even returning the body to a normal prepubescent state, and decreasing the child’s risk factors for related complications.