Understanding Early Puberty in Children: What Parents Need to Know

Medically Reviewed by KLE Doctor

Written by KIE Editorial Contributors

What is Puberty?

Puberty is when a child's body begins to develop and change transitioning into adulthood, resulting in the achievement of adult height and body proportions as well as the development of the genitalia and capacity to reproduce.

Timing of Puberty

In healthy children, the normal age of pubertal onset in girls is 8-13 years, and in boys is 9- 14 years. The timing of onset may be affected by Environmental (secular trends, exposure to oestrogenic Endocrine disrupting Chemicals/EDCs), Nutritional (BMI), and Constitutional (genetics, ethnicity) factors.

Precocious (Early) Puberty

Precocious/Early Puberty is defined as the onset of physical signs of puberty before the age of 8 years in girls and 9 years in boys.

What signs or symptoms suggest that your child may have precocious puberty?

Mostly in girls, the first sign of precocious puberty is the development of breast buds, tender lumps felt in the area under the nipples before they turn 8 years old. For boys, the first sign of precocious puberty is the enlargement of testicles before they turn 9 years old. Other changes during puberty include the following: Girls: growth spurt, vaginal discharge, pubic and armpit hair growth, body odor, menstruation Boys: growth spurt, pubic and armpit hair growth, growing genitals, acne, body odor, and the crackling of the voice later on

Causes of Precocious(Early) Puberty

The onset of puberty is normally triggered by the hypothalamus. This area of the brain signals the pituitary gland (a pea-sized gland near the base of the brain) to release hormones that stimulate the ovaries (in girls) or testicles (in boys) to make sex hormones, estrogen and testosterone respectively. Most commonly, especially in girls, precocious puberty is due to the brain sending signals earlier than it should. There is no other underlying medical problem or trigger. This also can often run in families. Precocious puberty is less common in boys, and more likely to be related to another medical problem. For about 5% of boys, the condition is inherited. Less often, precocious puberty stems from a more serious problem, such as a problem in the brain (tumor, injury, or infection), thyroid gland, adrenal gland, or ovarian/testicular problems.

Major Concerns of Precocious Puberty

• Short Adult Height
  • In the beginning, children with precocious puberty often experience a growth spurt, making them appear to grow taller faster than same-age peers (who have not started puberty). Then sex hormones can cause advanced bone age and early closure of growth plates. As a result, they stop growing taller earlier than their peers and eventually become adults of short stature due to the shorter period of development compared to their peers.
• Social and Emotional
  • Early puberty can cause feelings of isolation or embarrassment due to looking and feeling older than their peers.
  • The emotions and behavior of kids going through precocious puberty may also be affected. Girls can become moody and irritable, while boys can become more aggressive and develop a sex drive earlier than they should.

How Is Precocious Puberty Diagnosed?

Your child's Paediatric Endocrinologist (a specialist in growth and hormonal disorders in children) will order:

• Blood tests to check hormone levels.
• X-rays of the hand, called a bone age X-ray, to see if the bones are growing too fast.
• Other tests such as CT scans, magnetic resonance imaging (MRI), and ultrasounds to look for tumors, abnormal growths, or other problems, if suggestive based on the initial investigations

Treatment

The goal of treatment is to stop or reverse early puberty. This is so your child can grow to their full adult height and delay puberty until the right age. The type of treatment depends on what is causing the problem. The goal is to make sure development doesn’t happen too early so that the child does not feel different from his/her peers and uncomfortable in dealing with a body that is older than they are emotionally. Your child may need:

•  Medicines to stop the pituitary from releasing hormones, which will delay sexual development.
•  Treatments to correct other problems causing the hormone imbalance.
•  Sometimes no treatment is needed.

Caring for Your Child

Using simple and honest words, talk to your child about what is happening. Tell them that signs of puberty are normal for older children and teens, but their body has started developing a little too early. Focus on their success in school, sports, and other activities rather than on their appearance. Watch for signs of emotional stress, teasing by others, or depression leading to poor grades, problems at school, or loss of interest in daily activities.

Dr Meenakshi B R

Consultant Paediatric & Adolescent Endocrinologist