Understanding Early Puberty

"Normal" adolescent puberty occurs when a child is around 10 or 11 years old. However, there are children who start to physically and emotionally develop into young adults earlier. When this happens before the age of 7 or 8 years old (for girls) and age 9 (for boys), it is labeled precocious puberty, or early puberty. While this may seem innocuous, researchers have associated a number of health and psychological consequences of reaching puberty too early in life.

For girls, true precocious puberty includes the following signs before the age of 7 or 8 years:

• Development of breasts
• The growth of pubic or underarm hair
• Having a significant growth spurt in a short amount of time
• Starting menstruation
• Development of acne
• Body odor

For boys, precocious puberty includes the following signs before the age of 9 years:

• Enlargement of the testicles or penis
• The growth of pubic, underarm, or facial hair
• Having a significant growth spurt in a short amount of time
• Deepening of the voice
• Development of acne
• Body odor

There are many children that may show only some signs of early puberty. For example, some girls and boys may grow underarm hair or pubic hair at a very young age without any other sexual development.

The early hair growth may not be a sign of any underlying conditions and simply fall under "partial" precocious puberty. These children will show the other expected signs of puberty later on and at the usual age.

Although the exact reason behind starting puberty earlier than is the norm is uncertain, some instances of precocious puberty have been attributed to:

• Genetics (5 percent of boys and 1 percent of girls have inherited the condition)
• Early nutritional problems followed by obesity
• Environmental or chemical causes
• Structural problems in the brain or central nervous system injuries
• A problem in the ovaries or thyroid gland, such as a tumor

There are a number of physical, emotional, and social consequences of going through puberty early. Each child, of course, will experience this transition period differently.

A child that is going through puberty may at first be quite tall when compared with their peers. However, the child will stop growing when puberty ends. This means that a child with precocious puberty will not reach their full height potential because their skeleton matures and bone growth stops at an earlier age than it normally should.

For girls, irritability, emotional outbursts, and moodiness can accompany early puberty. Boys may experience an emergence of a sex-drive inappropriate for their age, along with aggressive behavior.

Young children may not notice or understand what is happening when someone of their same age is developing breasts or getting their period. Older children, however, typically notice if someone in a lower grade is physically developing ahead of them. Many younger children experiencing precocious puberty—girls in particular—report being teased or bullied by older children at school.

Children who experience early puberty have higher rates of depression and anxiety compared to their peers. This effect is found consistently in girls, but findings involving boys are less clear. Perhaps most disturbingly, the enhanced risk of depression and anxiety may stretch all the way into the college years.

Girls who mature early also tend to suffer from lower self-esteem and poorer body image than their friends who mature on time or late. Early-developing boys seem to avoid these negative effects.

Girls and boys who experience precocious puberty may also be at greater risk of abusing substances. Smoking, in particular, seems to be much more common among children who mature early compared to their on-time or late-maturing peers. Some studies indicate that increased substance abuse risk extends into the early twenties.

Reaching puberty early may also put a child at risk of earlier sexual activity compared to his or her peers. Some studies indicate that girls are also more sexually promiscuous when they develop early. Unfortunately, early sexual activity and promiscuity are associated with an increased risk of teen pregnancy. Teen pregnancy comes with its own host of concerns, including a higher drop-out rate, a potential for lower lifetime income, and an increased risk of having more children while still a teen.

Finally, some studies find that girls who experience early puberty do poorer in school compared to their peers. Their decreased academic achievement may extend through the high school years and possibly beyond. Like the self-esteem and body image findings, those related to academic outcomes seem to be restricted to girls; boys do just as well academically regardless of when they hit puberty.

Do not hesitate to talk to your child's doctor if you start to see signs of early puberty. Your pediatrician may order further testing for your child once they have performed a physical exam.

X-rays are ordered to check the bones of the hand and wrist to see if the bones are maturing too fast, and blood and urine tests are used to check for high levels of sex hormones.

To rule out tumors in the brain, ovaries or testicles, the pediatrician may also suggest a computed tomography (CT) scan or magnetic resonance imaging (MRI).

Your child may also be referred to a pediatric endocrinologist (a doctor who specializes in growth and hormonal disorders in children) for further evaluation and treatment.

Because, in most cases, there is no identifiable cause for precocious puberty, treatment is not always recommended.

If there is a diagnosis, the goal may either be to treat the underlying cause (i.e. a tumor) or provide hormone therapy to lower the production of sex hormones. These two approaches work to stop or reverse early sexual development and halt the bone maturation and rapid growth that comes with precocious puberty.

You can best care and support your child by giving simple and truthful explanations about what is happening to their body. You may want to provide guidance in the following way:

• Describe the types of changes that are happening and what to expect along the way.
• Explain that the changes they are experiencing are normal for older kids and teens.
• Keep your child informed about the treatment plan if there is one.

The goal of creating a supportive environment is to encourage your child to come to you if they are having a difficult time with any of the physical, emotional, or social difficulties of precocious puberty. Try not to comment on how your child's appearance is changing.

Since sports participation has been positively linked to higher self-esteem, encouraging your child to participate in sports or school activities may help to counter some of the negative effects of early puberty.

If you think your child may be having a hard time with this change, speak to her pediatrician and/or a therapist for more guidance.