There is a general perception that children are entering puberty earlier compared to few decades ago.
Further research in Malaysia is required to confirm the notion, but precocious or early puberty is an actual rare condition in children.
Precocious puberty is not simply when a child experiences puberty slightly earlier than their peers.
It is a medical condition when a child’s body begins changing into an adult’s body too soon, specifically before the age of eight years for girls and before the age of nine years for boys.
These transformations include changes in body shape and size, rapid bone and muscle growth, and development of sexual and reproductive functions.
In general, the prevalence is higher in girls than boys.
For example, a study on central precocious puberty in Denmark found a mean incidence of 9.2 per 10,000 in girls, compared to 0.9 per 10,000 in boys.
Causes for concern
Puberty typically starts when the pituitary gland at the base of the brain releases hormones called gonadotropins.
These gonadotropins in turn stimulate the ovaries (in girls) or testicles (in boys) to produce sex hormones (e.g. oestrogen or testosterone) that trigger the physical changes seen during puberty.
There are two types of precocious puberty depending on the possible causes:
This type of precocious puberty is more common.
The process is similar to normal puberty; the only difference is that it starts earlier.
In girls, often, there’s no underlying medical condition or identifiable cause.
However, in boys, up to 38% of cases may be due to defects or physical trauma of the brain/spinal cord caused by a tumour or injury, and also, rare genetic diseases.
It is less common and does not involve the early release of gonadotropins.
It is caused by the release of sex hormones due to problems such as tumours/growths (on the ovaries, testicles or adrenal glands) and rare genetic diseases.
Another possibility is over-exposure to sex hormones in medical, or even aesthetic products, e.g. creams, ointments, pills and essential oils (e.g. lavender oil and tea tree oil).
Adverse outcomes
Precocious puberty can cause physical and emotional issues in children if left untreated.
These include:
Children experiencing precocious puberty will grow quicker and become taller than their peers.
However, as they mature earlier, they will also stop growing earlier.
Hence, as adults, they may end up being shorter than average.
Their peers may treat them differently due to the changes.
They may feel awkward, confused or stressed.
Hence, this could affect their self-esteem or increase the risk of depression or substance abuse.
They may become more moody, irritable or aggressive due to the hormones.
They may also develop an early sex drive inappropriate for their age.
What can be done?
If your child is showing signs of precocious puberty, please consult a paediatrician or paediatric endocrinologist.
Your child’s doctor may advise these treatments:
This is a monthly or three-monthly injection of a medication to halt pubertal progression.
It has to be taken until they reach the normal age of puberty.
An implant on the inside of the upper arm that also delays sexual development.
It lasts for a year, so it may be more convenient compared to monthly shots.
However, this is not commonly used in children.
Treating the condition will usually also stop precocious puberty, e.g. by surgically removing the tumour that’s causing the release of hormones.
For girls with early puberty, i.e. breast development between eight to nine years of age, please bring them for a medical check-up.
If the puberty process is not rapidly progressing, explain to them what is happening to their body and assure them that everything will be alright.
Help them by promoting their self- esteem and positive body image.
It is always difficult to determine precocious puberty in boys.
More often than not, they are diagnosed late, i.e. when there is deepening of their voice.
Be mindful that rapid height gain, presence of pubic hair/acne or deepening of voice all occur at the late stage of puberty in boys.
Boys with rapid height gain at a much earlier age than their peers should get a medical check-up by their paediatrician/paediatric endocrinologist.
Their doctors must determine the testicular size based on the standard Prader orchidometer.
Puberty is part of growing up, but precocious puberty may not be what you expect your child to go through.
If you see signs of precocious puberty in your child, please bring them to see a doctor to determine the real problem.
But don’t worry! With the right treatment, most children with precocious puberty will do fine, medically, psychologically and socially.
Professor Dr Muhammad Yazid Jalaludin is a senior consultant paediatrician and paediatric endocrinologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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