The Challenge of Early Onset (Precocious) Puberty

My child is showing signs of puberty in kindergarten. HELP!
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For most parents, few things give as much joy and satisfaction as seeing their children reach developmental milestones. Yet, as they get older, the milestones can become more bittersweet as they pass from the innocence of childhood to young adulthood. Of those, few are more dreaded by parents than their daughters or sons starting puberty. The idea of their sweet, innocent little girls and boys turning into moody, hormonal, snapchatting, car-driving teenagers is outright scary and causes many moms and dads to lose sleep.

What if your daughter or son, only in kindergarten or first grade, began showing signs of entering puberty? It’s not far-fetched and perhaps more common than you might think. This phenomenon of very early puberty, called precocious puberty, has become a reality for many American families and continues to increase. A study conducted by the American Academy of Pediatrics followed girls from various ethnic backgrounds and locations and found that by seven years of age, more than 10 percent of Caucasian girls, 23 percent of African-American girls and 15 percent of Latina girls showed signs of breast development, indicating the start of puberty. Breast development in 7- to 8-year-old girls is twice as common as it was in the late 1990s. 

From a medical standpoint, precocious puberty is defined as the onset of secondary sexual development before the age of 8 in girls and 9 in boys. Due to recent shifts toward earlier onset of puberty in general, some doctors do not call it precocious puberty unless breast development starts before age 7, as the definition of “normal” may be changing. In most populations, the average age that puberty begins is about 11, although slightly earlier in girls (10 1/2) and later in boys (11 1/2). 


How do you know?

Figuring out whether your daughter or son is really starting puberty is not as straightforward as it may seem. In girls, the usual order of changes as they enter puberty is breast development, pubic hair, underarm hair, followed by their first period.

In boys, the order is larger genitals, pubic hair, facial hair and then a deeper voice. However, the order can change and growth spurts may occur anytime throughout the process.

Emotionally, early puberty can lead to several difficulties, including low self-esteem, unnecessary risk-taking and bullying. A child who enters early puberty is also at greater risk of sexual contact or attention before he or she is mentally ready or prepared to handle it.

In addition to the psychosocial and emotional impacts, one of the biggest concerns with precocious puberty is its effects on long-term growth and eventual adult height. Most of a person’s adult height occurs during the growth spurts and precocious puberty can interfere with the growth plates in developing bones, causing growth to stop early.


What can you do?

Children with signs of early puberty should be evaluated by their pediatrician or primary care physician to rule out any underlying problems. In a very small number, the cause can be identified as a cyst or tumor of the ovary, testes or brain, which can affect the secretion of sex hormones.

Precocious puberty affects girls more than boys (87 percent versus 13 percent). In the vast majority of children, the cause of precocious puberty is not known and the most common type, central precocious puberty (CPP), has no identifiable cause in 80 to 90 percent of girls and up to 60 percent of boys. 

In children where early puberty poses serious physical, such as a growth disturbance or emotional problems, there are several medical treatments to delay the process until the child is older. Medications can be given to halt puberty by turning off the system in the brain responsible for signaling the hormone production that results in the transition to adulthood. As you might expect, parents who opt for puberty-suppressing treatment in their children may have a harder time deciding when to end treatment than knowing when to start it. Fortunately, research shows no long-term negative effects from this treatment.

Precocious puberty can be a stressful issue for parents and their children, but medical help and emotional support are available. If you have any concerns, reach out to your doctor.

Dr. Daniel Bambini is a board-certified Pediatric Surgeon with Pediatric Surgical Associates in Charlotte. For more information on keeping your child safe and well, visit www.pedsurgical.com.