When Puberty Occurs Early
Parents look forward to puberty with both trepidation and elation – trepidation at explaining all the adult things of the world and elation that their baby is growing up. But what happens when puberty occurs prematurely? What happens when your child is only 6 or 7 years old or even as young as 2 or 3?
Lisa White, a homeschooling mother of five from Bement, Ill., noticed that one of her 3-year-old daughter's breasts was larger than the other. Their pediatrician dismissed it as a hemangioma, or an abnormal buildup of blood vessels in the skin or internal organs, but the Whites knew it was more than that. They were referred to a specialist, who diagnosed their daughter as having premature thelarche (breast development) and told them to watch it closely. By age 6 they noticed she had body odor after playing and she began to use deodorant as part of her daily regimen.
"Sarah wasn't getting much taller, but suddenly, just after her 8th birthday, her breasts developed, waist nipped in and hips broadened and some secondary puberty symptoms appeared," White says. "We've run a gamut of emotions, from frustration just to get a doctor to hear us to restlessness over yet again being told wait and see, to incredible guilt on my part because I felt it was my genes causing this, therefore my fault." (Heredity does play a part in precocious puberty, but it is not the only part.)
Sharon Stidham, a mother from Springfield, Ill., understands that frustration all too well. Her daughter was barely 6 when she came to her and said, "Mommy, there's a nickel under my nipple."
"I quizzed her about what she was saying, and then took a very deep breath," Stidham says. "I was not in any way, shape or form prepared for this so soon. At that time, I told her I was proud of her for coming to me, and that we would discuss it with the doctor, and that she should tell me if anything changed."
Stidham's pediatrician told her that puberty could indeed happen at that young of an age and she should continue to keep the lines of communication open with her daughter and not to worry, she wasn't in it alone.
What Is Central Precocious Puberty?
Dr. Carol Wheeler, a board certified reproductive endocrinologist and director of the Pediatric and Adolescent Gynecology Clinic at Women & Infants Hospital in Providence, R.I., says central precocious puberty (CPP) is when the normal changes of puberty occur earlier than the expected time.
"For white girls, this would mean breast development prior to age 8," Dr. Wheeler says. "Since black girls tend to develop earlier, most would use prior to age 7. It is due to a problem where the brain triggers release of pituitary hormones (FSH, follicle stimulating hormone, and LH, luteinizing hormone), which then leads to the ovaries producing estrogen and progesterone. These ovarian hormones (estrogen and progesterone), then lead to breast development and ultimately can lead to menstrual bleeding."
According to Dr. Wheeler, there is no identifiable cause in 80 to 90 percent of the cases reported. A few possible causes are brain tumors, hydrocephalus (water on the brain) and prior x-ray treatment of the brain. Hypothyroidism (underactive thyroid) and high levels of male hormones may also lead to central precocious puberty. With overweight girls, puberty overall may be occurring slightly earlier, due to the fact that obese girls tend to start puberty earlier.
The Challenges of CPP
CPP can create many challenges for children, but especially young girls. Girls who develop early can have emotional issues because of teasing or inappropriate remarks. These early changes can make them very uncomfortable with their bodies. These early increased hormone levels will also cause the bones to stop growing too early. At first the girls will appear taller than average, but they will stop growing taller well before their peers and end up much shorter than average.
Dr. Lawrence Silverman, a pediatric endocrinologist at Morristown Memorial Hospital in Morristown, N.J., says there are serious risks associated with the condition. "CPP can cause growth acceleration and advancement of bone age, ultimately resulting in shorter stature," Dr. Silverman says. "Long-term studies have shown that girls who begin menstruation at an earlier age may have an increased risk of developing breast cancer as adults."
According to Dr. Silverman, CPP can also take a psychological toll on children. A child may feel that her emotional development should match her outward appearance and try to step into adulthood prematurely. Studies of teens have suggested that girls who develop early are more likely to be sexually active, have more problems in school and are more likely to smoke and use alcohol and drugs.
What Can You Do?
"CPP can be stopped through treatment with gonadotropin-releasing hormone (GnRH) agonists," Dr. Silverman says. "Patients have traditionally been treated with once-monthly intramuscular injections of GnRH agonists. The first new therapy for CPP in 25 years was approved in May 2007. A once-yearly subcutaneous implant, Supprelin LA continually releases the GnRH agonist histrelin over the course of 12 months, suppressing hormone levels over the period."
The goal of CPP treatment is to inhibit puberty, normalize bone growth or maturation and improve the psychological well-being of children living with CPP. Children are typically treated until they reach normal pubescent age.
Testing for Central Precocious Puberty
According to Dr. Silverman, children who exhibit signs of early puberty should be referred to a pediatric endocrinologist who will conduct a thorough review of a child's medical history and a physical examination. Further evaluation may include a series of lab tests and imaging tests to determine if a child has CPP and if there is an underlying cause for the condition.
Tests may include the following:
- Hand/wrist x-ray: To determine whether the bones are maturing early and the rate of progression.
- Blood tests: To check the levels of various hormones.
- GnRH stimulation test: To determine whether sex hormones in the child's body are at levels seen during puberty.
- Pelvic and adrenal ultrasound: To determine whether the ovaries, testicles or adrenals are normal.
- Magnetic resonance imaging (MRI) or computer assisted tomography (CAT) scan of the head: To determine whether the parts of the brain that produce hormones are all normal.