Early Signs of Puberty Usually Normal, AAP Report States


A new report from a leading group of US pediatricians has found that although children who develop particular signs of puberty at an earlier age than is common are frequently referred to specialists for examination, usually there is nothing to be concerned about, reports Amy Norton of HealthDay News.

Dr. Paul Kaplowitz, the lead author of the American Academy of Pediatrics report, says certain traits associated with puberty, such as some pubic hair, underarm hair, and beginning signs of breast development, are not abnormal for young people. He added that early signs of sexual maturation often lead to pediatricians referring children to pediatric endocrinologists, physicians who specialize in hormonal disorders.

Kaplowitz, an endocrinologist at Children’s National Medical Center in Washington, D.C., added that a majority of the children sent to a specialist do not have what is called “precocious puberty,” or puberty that begins at an abnormally early age. For girls that would mean eight years or below, and for boys that would mean nine years or below.

The hypothalamus sets off a hormonal shower that causes the production of estrogen and testosterone, which is called puberty. For girls, breast growth is triggered, and testicular enlargement occurs in boys, according to Dr. Brenda Kohn, director of pediatric endocrinology at NYU Langone Medical Center in New York City, who was not involved in the report by the Academy.

The secondary component to puberty is known as “adrenarche,” when the adrenal glands, which are on top of the kidneys, begin to produce small amounts of “male” hormones that can make a child begin to develop some pubic and underarm hair and body odor. When those adrenal gland changes occur, they may not be connected to “true” puberty.

Kaplowitz says early pubic hair development can even happen in infants and is usually an uncomplicated event, especially if it is not accompanied by genital enlargement or abnormal body growth. He adds that the rising rate of obesity in children, girls are more often being evaluated for what seems to be breast tissue, but often it is excess body fat. The report was published on December 14 in the journal Pediatrics.

Precocious puberty can be caused, in rare cases, by a brain tumor. Children with true precocious puberty should have an MRI of the brain. Most often, precocious puberty is unexplained. One of the concerns that accompanies the early onset of puberty is that children’s adult height will be affected because rapid early development can cause bones’ growth plates to fuse too quickly. Kaplowitz said only 10% of the children he evaluates have true precocious puberty.

The trend toward a decrease in the age of puberty onset stabilized in the 1950s, but ethnicity and body weight can cause significant variations. Black girls tend to enter puberty earlier than white girls, for example, writes Tara Haelle for Clinical Endocrinology News.

“The typical evaluation includes obtaining a family history, because CPP (central precocious puberty) is occasionally inherited from the parents; menarche in the mother at 10 years or younger or a growth spurt in the father before 12 years of age are suggestive of autosomal-dominant inheritance,” the researchers noted.

Families should be queried as to the child’s exposure to birth control pills, transdermal estrogen creams, or testosterone gels. Also, certain essential oils, such as lavender and tea tree oil, and other potential exogenous sources of sex steroids, can be a cause.

Kristen Fischer, reporting for Healthline, says the report explains that the onset of breast and pubic hair development are beginning earlier than they have in the past.

A study led by Dr. Imogen Rogers from the University of Brighton in 2010 reported that girls who ate more protein and meat when they were 3- and 7-years-old were more likely to start their periods at 12 1/2- years-old than those who ate less meat and protein.

Kaplowitz says, however, there is no hard data to show us that children are indeed showing signs of puberty sooner than they did in the past.