- Dr. Lewis First
It's often said that kids grow up fast these days. Turns out, it's true. Researchers have found that over the last century, the average age of puberty for boys and girls — once in the late teens — has decreased significantly. And with this new normal, some children go through puberty at an even younger age, experiencing what's known in the medical world as "precocious puberty." It's a condition that can influence a child's psychological and developmental well-being.
This month, Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, explains precocious puberty and what to do if it's affecting your child.
KVT: To start, what exactly is puberty?
LEWIS FIRST: Puberty is the process of physical change during which a child becomes sexually mature. Hormones begin to be released in the brain's hypothalamus, which send a message to the pituitary gland (also in the brain) to turn on the ovaries or testes.
KIDS VT: What is precocious puberty?
LF: Precocious puberty is when sexual maturation begins at an earlier-than-average age. It's now defined as girls who begin to develop breasts before age 8, and boys who grow pubic hair and show genital development before age 9. In the past 25 years, 20 percent of girls have undergone puberty before age 8; for boys, this disorder is 10 times less common. The reason for the difference is unclear and continues to be studied.
KVT: How much has the average age of puberty dropped, and why?
LF: If you look back to the early 1900s, girls got their first period at an average age of 16. In the past 25 years, puberty has decreased to younger than 13 for girls and happens anywhere from six months to two years earlier than in the past for boys, depending on what study you read. Two factors that have changed in that time period, and may be playing a role in the onset of precocious puberty, are diet — leading to increased obesity in children — and environmental stress. While we can't prove cause and effect, obesity can prompt increased estrogen production. Sixty percent of girls who experience precocious puberty are overweight. Environmental stressors such as poverty, food insecurity, substance abuse, neglect, and physical or sexual abuse may stress the brain and cause it to release hormones earlier, triggering puberty. Studies also implicate pesticides, phthalates, PCBs and other compounds in the environment that are considered "endocrine disruptors" as contributing to the increased prevalence of precocious puberty, especially in girls.
KVT: What should parents do if they suspect their child is experiencing precocious puberty?
LF: If parents see that their daughter is developing breasts before age 8, or their son's penis and testicles have enlarged before age 9, they should have their child evaluated by a doctor. They may also need to be referred to a pediatric endocrinologist for special hormonal testing to see if there is a specific cause.
KVT: Does precocious puberty have developmental consequences?
LF: There's no question that most children who experience precocious puberty will be bothered by it. They can experience a significant amount of emotional difficulty. Remember, you basically have the brain of a child in the body of a young adult. They can be teased or bullied by their peers who have not yet started puberty. Boys who are teased can become more aggressive. Oftentimes it's assumed that because some kids look older than their peers, they're being held back in school. Precocious puberty can also be associated with increased risk-taking behaviors such as earlier initiation of sexual activity, drug abuse, tobacco use, loss of peer relationships, etc., if parents or health professionals don't teach kids with this disorder how to deal with the emotional consequences of maturing early.
KVT: Are there physiological concerns?
LF: Kids with precocious puberty may get earlier growth spurts, but their bones may not continue to grow for as long as they would if they were to develop at an older age. Some parents, in consultation with an endocrinologist, may choose to slow the early pubertal process to maximize their child's height potential and prevent some emotional distress. One way to slow down early puberty is the use of a synthetic hormone that basically delays puberty for several years. For a child who displays gender dysphoria — an emotional or psychological gender identity different from the one assigned at birth — parents may also choose to stop puberty, not because it is coming early but to allow the child to mature and decide at a later age what to do about their gender identity.
KVT: Are there risks involved with synthetic hormones?
LF: These compounds may come with side effects including hot flashes or vaginal bleeding, which can be scary for a child. Also, these compounds cost an average of $15,000 a year, and may not be covered by insurance.
KVT: How can parents support a child experiencing precocious puberty?
LF: Watch for a drop in grades, problems at school, a loss of interest in friends, even depression. Parents need to create a supportive parent-child relationship. Parents also need to set clear rules and expectations, perhaps earlier than they might have expected, around sexual behavior. Parents need to play up their child's strengths — build their child's self-esteem — so kids don't succumb to acting older than their true age. The good news is, with good parental support and education, most kids who experience precocious puberty do just fine.