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Early Puberty

Puberty typically begins around 10 years of age in girls and 12 years of age in boys. Precocious puberty (early puberty) is when the body’s changes toward sexual maturity start much sooner than usual: before girls are eight years old and before boys are nine years old.

Signs of Puberty

In the vast majority of children, early puberty is just a normal variation. Sometimes, though, it’s a sign of an underlying health problem. When a child starts experiencing early puberty, a visit with a pediatric endocrinologist is appropriate. Learn about the Division of Endocrinology

Endocrinologists can determine if there’s an underlying cause that needs medical attention. Treatment can help even if, as in most cases, the cause cannot be determined. The sexual changes can be stopped or reversed to limit the child’s social and emotional difficulties, and protect the child at risk of becoming a short adult. The child can mature comfortably alongside peers instead of early and alone. In the long run, the child may enjoy many psychological benefits and good health as a result.

Hormone Pathway

The hypothalamus, pituitary and gonads (ovaries in girls and testicles in boys) create a pathway for hormones activating the changes of puberty. When activated, the hormones increase estrogen in girls and testosterone in boys.

Causes

Usually, early puberty has no identifiable cause. It happens earlier in certain ethnic groups such as Afro-Caribbean and South Asian.

Being overweight or obese can contribute to early physical maturation. In rare instances, precocious puberty may be due to other conditions. For example:

  • A structural anomaly in the brain (such as an abnormal growth or mass)
  • Brain injury due to head trauma
  • An infection (such as meningitis or encephalitis)
  • A problem in the ovaries, testes, adrenal gland or thyroid gland
  • A genetic disease affecting endocrine organs, bones and skin
Girls usually have no underlying medical problem; they simply start puberty early for unknown reasons. In boys, early puberty is less common and more likely to be associated with an underlying medical problem. Talk to your child’s doctor if sexual development is happening too soon.

Precocious Puberty Types

  • Central (gonadotropin-dependent): The hypothalamus and pituitary activate hormones earlier than usual. This is the most common type of early puberty, especially in girls.
  • Peripheral (gonadotropin-independent): The hormones released by the hypothalamus and pituitary aren’t the problem. The gonads (ovaries or testes) or adrenals create hormones earlier than usual.

In both boys and girls, the adrenal glands make testosterone-like hormones that can be activated early. The adrenal glands are separate from the hypothalamus-pituitary-gonad pathway. Adrenal  hormones promote development of pubic and underarm hair, body odor and acne. When these changes happen early, it’s called premature adrenarche. Rare causes include an enzyme deficiency in the adrenal gland (congenital adrenal hyperplasia) and a mass in the adrenal gland.

Sometimes, just one feature of puberty starts early. The rest of puberty doesn’t begin until the usual time. One example of this “partial puberty” is when breasts start developing in a baby girl (a condition called thelarche).

Height Concerns — Now & Later

Being taller than peers can be a temporary problem with social implications. A very early growth spurt can also have a negative effect on adult height. When puberty begins very early, the child’s growth stops too soon and final height can be significantly less than it was meant to be. Treatment can prevent at-risk children from being short as an adult.

Social & Emotional Well-Being

Limiting the social and emotional difficulties is important in early sexual maturation. Difficulties can lead to both behavioral and medical problems. Our specialists help the child and family respond to issues.

On a personal level, the child may be unsettled about the physical changes. The mood swings in girls and greater aggressiveness and early sex drive in boys need to be recognized as part of the hormonal changes. Children are often reassured to hear that these physical and emotional changes are normal and will be experienced by peers, too.

Among peers, the child can be uncomfortable and isolated. The child may feel self-conscious and be talked about. Teasing is common and hard to endure. Dressing age appropriately and wearing looser clothing helps the child feel more comfortable.

Adults need to remember to have age-appropriate expectations for the more mature-looking child. Parents may need to discuss issues of sexuality earlier than expected. Children’s attitudes reflect parents’ attitudes, so appreciating qualities rather than physical features  is important. 

Our [psychologist?], nurses and endocrinologists are useful resources. We help parents explain the changes and behaviors the child is experiencing. We offer strategies and support to the child. We know that social-emotional problems and medical conditions, such as eating disorders, can be brought on when self-esteem and confidence are low. Fostering a healthy self-image and outlook is important. 

Diagnosis & Treatment

Diagnosis

Although early puberty can be upsetting to children and parents, the situation usually doesn’t need medical treatment. Looking for a cause is, however, important to safeguard the child’s health in case there’s an underlying problem. A thorough work-up by a pediatric endocrinologist should be done.

At your first visit, we listen to your concerns. The doctor learns your medical history and does a physical examination. Typically, a bone age x-ray and blood tests aid our diagnosis.

  • Patient and family history: We take a careful history. When did the mother and father start puberty? At what age did developments occur (pubic hair, acne, underarm hair, body odor, breast development or increase in testicular size)? Are there other medical conditions? Recent changes in weight or height?
  • Physical examination: The doctor looks for stages and signs of puberty and signs of any underlying problems. This thorough examination includes the genitalia (private areas) and breasts (for girls). Our doctors are always careful to conduct themselves with sensitivity and respect for the teen’s privacy and comfort.
  • Bone age: We can use this type of x-ray (of the hand and wrist) to see how mature the bones are. The bones’ “age” tells us, better than the child’s age, if it is time for puberty.
  • Morning blood tests: We learn the amount of hormones made in the brain and in the ovaries or testicles. Hormone levels are best checked in samples of blood collected in early morning (because hormone levels change throughout the day). So a blood draw is usually separate from your first visit.

If we find that certain hormones levels are high, we can do further studies to get more information. Imaging tests can help us rule out specific causes without exposing the child to radiation. Ultrasound lets us see the adrenal glands and ovaries. An MRI lets us see inside the brain. The MRI can show us a tumor or abnormality in the pituitary gland. Medicine lets the child sleep comfortably during the MRI scan.

If we need more information on the hormones involved, we can do stimulation tests. These need careful medical supervision. You come to the infusion center at the hospital, and a child life specialist helps your child through the experience. We usually administer a hormone or other stimulating agent and take blood samples at intervals for testing.

Treatment

For some children, the best course of treatment may be no treatment. Some questions to consider are these: Is the child too young to deal with the psychological aspects of early puberty? Are there behavioral problems or concerns about harmful psychological and medical consequences (for example, a focus on self-image that leads to an eating disorder). Is the child at risk for short stature as an adult?

Our specialists in the Division of Endocrinology can help families and patients discuss how the condition is affecting and may affect the child, and what treatment options may help.

  •  Central precocious puberty: Hormone therapy stops or reverses sexual development until a more appropriate time. It also stops the rapid growth and bone maturation that can lead to adult short stature. The medication lowers the level of sex hormones (gonadotropins) in the body. Counseling may also help.
  • Peripheral precocious puberty: Treatment is based on the cause — perhaps medication will help, or surgery for a tumor. If creams or cosmetics with estrogen or testosterone are the cause, the answer is to eliminate this exposure.
  • Individualized care: Your child is an important part of the care plan. We consider your child’s age, overall health and medical history; the extent of the condition and the child’s ability to tolerate the medications, procedures or therapies. Parent input is important, too.

Counseling may help the child cope with the emotional effects of early puberty.

Hormone therapy medication — a form of gonadotropin-releasing hormone (synthetic luteinizing-releasing hormone) —  can suppress or slow the signals from the hypothalamus and pituitary. Central precocious puberty can be effectively treated this way. The cost of hormone therapy is a concern to discuss with the doctor. The medication can be used until the child reaches a better age for puberty. It is generally safe, with mild side effects. Some side effects are most noticeable in the first few weeks. After a couple months of treatment, rapid growth slows and pubertal changes stop (some reverse). Usually, the options are these:

  • Injections: The child receives an injection every month or every six to ten weeks.
  • Implant:  A tube of medication is surgically placed under the skin. Over the course of a year, the implant slowly releases the medication.

Resources

Learn more about delayed puberty by visiting these physician-recommended websites:
Early Puberty

Overview
Puberty typically begins around 10 years of age in girls and 12 years of age in boys. Precocious puberty (early puberty) is when the body’s changes toward sexual maturity start much sooner than usual: before girls are eight years old and before boys are nine years old.

Signs of Puberty
ANNE WILL NEED TO CREATE GRAPHIC FOR THIS DATA

The table above lists key developments in puberty. In the vast majority of children, early puberty is just a normal variation. Sometimes, though, it’s a sign of an underlying health problem. When a child starts experiencing early puberty, a visit with a pediatric endocrinologist is appropriate.

Endocrinologists can determine if there’s an underlying cause that needs medical attention. Treatment can help even if, as in most cases, the cause cannot be determined. The sexual changes can be stopped or reversed to limit the child’s social and emotional difficulties, and protect the child at risk of becoming a short adult. The child can mature comfortably alongside peers instead of early and alone. In the long run, the child may enjoy many psychological benefits and good health as a result.

Hormone Pathway
ANNE WILL NEED TO CREATE GRAPHIC FOR THIS DATA
 
Causes
Usually, early puberty has no identifiable cause. It happens earlier in certain ethnic groups such as Afro-Caribbean and South Asian.

Being overweight or obese can contribute to early physical maturation. In rare instances, precocious puberty may be due to other conditions. For example:
•    A structural anomaly in the brain (such as an abnormal growth or mass)
•    Brain injury due to head trauma
•    An infection (such as meningitis or encephalitis)
•    A problem in the ovaries, testes, adrenal gland or thyroid gland
•    A genetic disease affecting endocrine organs, bones and skin

Girls usually have no underlying medical problem; they simply start puberty early for unknown reasons. In boys, early puberty is less common and more likely to be associated with an underlying medical problem. Talk to your child’s doctor if sexual development is happening too soon.

Precocious Puberty Types
•    Central (gonadotropin-dependent): The hypothalamus and pituitary activate hormones earlier than usual. This is the most common type of early puberty, especially in girls.
•    Peripheral (gonadotropin-independent): The hormones released by the hypothalamus and pituitary aren’t the problem. The gonads (ovaries or testes) or adrenals create hormones earlier than usual.

In both boys and girls, the adrenal glands make testosterone-like hormones that can be activated early. The adrenal glands are separate from the hypothalamus-pituitary-gonad pathway. Adrenal  hormones promote development of pubic and underarm hair, body odor and acne. When these changes happen early, it’s called premature adrenarche. Rare causes include an enzyme deficiency in the adrenal gland (congenital adrenal hyperplasia) and a mass in the adrenal gland.

Sometimes, just one feature of puberty starts early. The rest of puberty doesn’t begin until the usual time. One example of this “partial puberty” is when breasts start developing in a baby girl (a condition called thelarche).

Height Concerns — Now & Later
Being taller than peers can be a temporary problem with social implications. A very early growth spurt can also have a negative effect on adult height. When puberty begins very early, the child’s growth stops too soon and final height can be significantly less than it was meant to be. Treatment can prevent at-risk children from being short as an adult.

Social & Emotional Well-Being
Limiting the social and emotional difficulties is important in early sexual maturation. Difficulties can lead to both behavioral and medical problems. Our specialists help the child and family respond to issues.
On a personal level, the child may be unsettled about the physical changes. The mood swings in girls and greater aggressiveness and early sex drive in boys need to be recognized as part of the hormonal changes. Children are often reassured to hear that these physical and emotional changes are normal and will be experienced by peers, too.
Among peers, the child can be uncomfortable and isolated. The child may feel self-conscious and be talked about. Teasing is common and hard to endure. Dressing age appropriately and wearing looser clothing helps the child feel more comfortable.
Adults need to remember to have age-appropriate expectations for the more mature-looking child. Parents may need to discuss issues of sexuality earlier than expected. Children’s attitudes reflect parents’ attitudes, so appreciating qualities rather than physical features  is important.

Our [psychologist?], nurses and endocrinologists are useful resources. We help parents explain the changes and behaviors the child is experiencing. We offer strategies and support to the child. We know that social-emotional problems and medical conditions, such as eating disorders, can be brought on when self-esteem and confidence are low. Fostering a healthy self-image and outlook is important. 

Diagnosis & Treatment

Diagnosis
Although early puberty can be upsetting to children and parents, the situation usually doesn’t need medical treatment. Looking for a cause is, however, important to safeguard the child’s health in case there’s an underlying problem. A thorough work-up by a pediatric endocrinologist should be done.

At your first visit, we listen to your concerns. The doctor learns your medical history and does a physical examination. Typically, a bone age x-ray and blood tests aid our diagnosis.
•    Patient and family history: We take a careful history. When did the mother and father start puberty? At what age did developments occur (pubic hair, acne, underarm hair, body odor, breast development or increase in testicular size)? Are there other medical conditions? Recent changes in weight or height?
•    Physical examination: The doctor looks for stages and signs of puberty and signs of any underlying problems. This thorough examination includes the genitalia (private areas) and breasts (for girls). Our doctors are always careful to conduct themselves with sensitivity and respect for the teen’s privacy and comfort.
•    Bone age: We can use this type of x-ray (of the hand and wrist) to see how mature the bones are. The bones’ “age” tells us, better than the child’s age, if it is time for puberty.
•    Morning blood tests: We learn the amount of hormones made in the brain and in the ovaries or testicles. Hormone levels are best checked in samples of blood collected in early morning (because hormone levels change throughout the day). So a blood draw is usually separate from your first visit.
If we find that certain hormones levels are high, we can do further studies to get more information. Imaging tests can help us rule out specific causes without exposing the child to radiation. Ultrasound lets us see the adrenal glands and ovaries. An MRI lets us see inside the brain. The MRI can show us a tumor or abnormality in the pituitary gland. Medicine lets the child sleep comfortably during the MRI scan.
If we need more information on the hormones involved, we can do stimulation tests. These need careful medical supervision. You come to the infusion center at the hospital, and a child life specialist helps your child through the experience. We usually administer a hormone or other stimulating agent and take blood samples at intervals for testing.

Treatment
For some children, the best course of treatment may be no treatment. Some questions to consider are these: Is the child too young to deal with the psychological aspects of early puberty? Are there behavioral problems or concerns about harmful psychological and medical consequences (for example, a focus on self-image that leads to an eating disorder). Is the child at risk for short stature as an adult?

The doctor and family discuss how the condition is affecting and may affect the child and what treatment options may help.

•    Central precocious puberty: Hormone therapy stops or reverses sexual development until a more appropriate time. It also stops the rapid growth and bone maturation that can lead to adult short stature. The medication lowers the level of sex hormones (gonadotropins) in the body. Counseling may also help.
•    Peripheral precocious puberty: Treatment is based on the cause — perhaps medication will help, or surgery for a tumor. If creams or cosmetics with estrogen or testosterone are the cause, the answer is to eliminate this exposure.
•    Individualized care: Your child is an important part of the care plan. We consider your child’s age, overall health and medical history; the extent of the condition and the child’s ability to tolerate the medications, procedures or therapies. Parent input is important, too.

Counseling may help the child cope with the emotional effects of early puberty.

Hormone therapy medication — a form of gonadotropin-releasing hormone (synthetic luteinizing-releasing hormone) —  can suppress or slow the signals from the hypothalamus and pituitary. Central precocious puberty can be effectively treated this way. The cost of hormone therapy is a concern to discuss with the doctor. The medication can be used until the child reaches a better age for puberty. It is generally safe, with mild side effects. Some side effects are most noticeable in the first few weeks. After a couple months of treatment, rapid growth slows and pubertal changes stop (some reverse). Usually, the options are these:
•    Injections: The child receives an injection every month or every six to ten weeks.
•    Implant:  A tube of medication is surgically placed under the skin. Over the course of a year, the implant slowly releases the medication.

Resources
Learn more about delayed puberty by visiting these physician-recommended websites:
•    American Academy of Pediatrics (healthychildren.org)
•    Hormone Health Network
•    KidsHealth article on Precocious Puberty
•    National Institute of Child Health and Human Development  article on Puberty
•    You and Your Hormones website, from the Society for Endocrinology
•    The MAGIC Foundation for Children’s Growth