Puberty occurring at an unusually early age

Children who develop earlier than their peers may feel embarrassed or self-conscious. — Unsplash

Sara was only seven when her mother noticed something unusual – her daughter had started developing breasts and even had her first period.

This caught the family by surprise. Isn’t puberty supposed to start later?

Worried, they came to see me.

Sara’s story is one many parents might find unfamiliar but is important to understand.

When children start puberty too early – before age eight in girls and before age nine in boys – it’s called precocious puberty.

What happens during puberty?

Puberty is a time of big changes.

The brain tells the body to start producing hormones that help children grow taller, develop breasts or testicles, grow body hair, and eventually become capable of reproduction.

The main hormone messenger in this process is a chemical in the brain called gonadotropin-releasing hormone (GnRH).

It signals the pituitary gland (a small gland at the base of the brain) to release two key hormones: luteinising hormone (LH) and follicle-stimulating hormone (FSH).

These in turn stimulate the ovaries in girls and the testes in boys to produce estrogen and testosterone, the hormones responsible for the visible changes of puberty.

Normally, girls start puberty between eight and 13 years, while boys begin between nine and 14 years.

But when this process begins too soon, children face unique physical and emotional challenges.

When precocious puberty strikes, boys might feel pressured to behave in a more mature way than they’re ready for. — Pixabay

Signs to watch for

How do you know if your child may be entering puberty early?

Here are some common signs:

In girls:

> Breast development before the age of eight

> Menstrual bleeding before the age of 10

> Rapid growth or “growth spurts”

> Pubic or underarm hair

> Acne or oily skin

> Body odour similar to that of a teenager.

In boys:

> Enlargement of the testicles or penis before age nine

> Deepening of the voice

> Muscle growth

> Facial, underarm, or pubic hair

> Acne and body odour.

In both boys and girls, a noticeable increase in height over a short period may be one of the first signs parents pick up on.

Sometimes these signs can be subtle at first. If you’re unsure, speak to your child’s doctor.

Why does early puberty happen?

In most girls, early puberty is due to the brain starting the hormone process too early.

This is called central precocious puberty (CPP), and in many cases, there is no identifiable cause – it just happens.

However, if the onset is very young before six years or in boys, it is likely to be caused by a medical issue, such as a problem in the brain, a tumour, or another hormonal disorder.

Less commonly, precocious puberty can be peripheral – meaning the hormone changes start outside the brain.

This could be due to problems with the adrenal glands, ovaries, or testes, and is not triggered by the usual brain hormones.

Other known factors that may play a role in triggering early puberty include:

> Brain abnormalities or tumours, especially in very young children

> Previous radiation or trauma to the brain

> Congenital conditions, such as hypothalamic hamartoma

> Obesity, which is increasingly recognised as a contributing factor

> Family history of early puberty

> Environmental exposures to hormone-disrupting chemicals.

What are endocrine disruptors?

Parents should be aware of endocrine-disrupting chemicals (EDCs).

These are substances that can interfere with the body’s hormone systems.

Some are found in plastics especially bisphenol A (BPA), cosmetics, fragrances, pesticides and even some foods e,g, plant-based estrogen known as phytoestrogen.

For example, certain essential oils like lavender and tea tree oil have been linked – though not conclusively – to hormone effects in children.

Creams or supplements bought over the counter or online may also contain undisclosed hormones.

While the science and evidence is still evolving, it’s best to reduce unnecessary exposure to products that may contain hormones or hormone-like compounds, especially in young children.

How is early puberty evaluated?

If your child is showing early signs of puberty, the next step is to consult a paediatric endocrinologist – a doctor who specialises in hormone issues in children.

Here’s what you can expect during an evaluation:

> A detailed medical and family history, including growth patterns, timing of puberty in parents and any medications or exposures

> A physical examination to assess the stage of puberty and growth rate

> Blood tests to measure hormone levels (LH, FSH, estrogen or testosterone, and other related hormones)

> Bone age X-ray of the left hand and wrist to see how much a child’s bones have matured

> Pelvic ultrasound in some girls to assess the uterus and ovaries, or testicular ultrasound in boys if needed

> Pituitary MRI in certain cases (especially in boys or girls under six years, or those with rapid progression) to look for brain abnormalities.

What problems can early puberty cause?

One major concern with precocious puberty is shorter adult height.

Children grow quickly at first, but their bones also mature faster. This can lead to the growth plates closing earlier than usual, limiting final height.

There are also emotional and psychological challenges.

Children who develop earlier than peers may feel different, embarrassed or self-conscious.

Girls may struggle with body image or unwanted attention.

Boys might feel pressured to behave in a more mature way than they’re ready for.

These feelings can affect self-esteem, social development and even school performance.

Can early puberty be treated?

Yes! The good news is that precocious puberty can be managed effectively.

The main treatment for central precocious puberty is with GnRH analogues – medications that “switch off” the puberty hormones by blocking the signals from the brain.

These medications are usually given as intramuscular injections, typically once a month or every three to six months, depending on the preparation used.

These medications are generally safe and well-tolerated, and once they are stopped (usually around the normal age of puberty), the body resumes puberty naturally.

Side effects such as sterile abscess at the injection sites are reported but uncommonly.

Treatment helps preserve height potential and gives children more time to grow physically and emotionally before entering adolescence.

Any underlying causes or contributing factors must also be addressed.

A paediatric endocrinologist considers treatment based on:

> The child’s age

> How fast the puberty is progressing

> Bone age and predicted adult height

> The child’s emotional readiness and how they’re coping.

Sara’s journey

Sara began treatment soon after her diagnosis.

Her hormone levels were consistent with early puberty, and her bone age showed advanced maturity compared to her actual age.

With three-monthly injections and regular follow-up, her puberty progression slowed, and her growth pattern stabilised.

More importantly, she had the time to adjust emotionally and her confidence returned.

With the support of her family, Sara started feeling like a kid again.

So, if you suspect your child might be going through puberty too early, trust your instincts.

Seek medical advice early – because early diagnosis can make a big difference in your child’s growth, emotional health and long-term well-being.

Remember:

> Not all early signs mean your child has precocious puberty or needs treatment, but it’s worth getting checked

> Treatment is available and effective

> Support from parents and clear information can help your child feel safe and understood.

And finally, be mindful of the products your child is exposed to – avoid unnecessary fragrances, creams, oils or supplements that may contain hormone-like substances.

With awareness, early action, and the right care, children with precocious puberty can go on to thrive – just like Sara.

Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. 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.