Do parents need to be worried if puberty doesn't come on time?

Precocious puberty in boys occurs when they start to undergo puberty before the age of nine. — Positive Parenting

Puberty is a pivotal milestone in a child’s life, marking the onset of the physical and emotional transition towards adulthood.

For parents and healthcare professionals, understanding of what is normal and what to expect during this important transformative phase is crucial for providing appropriate guidance.

Although the timing of puberty varies, there are typical patterns of progression for both genders.

Girls usually begin puberty between eight and 13 years old with breast development as the initial sign.

Menstruation usually occurs two to three years after the start of breast development.

Boys typically start puberty between ages nine and 14, marked by testicular enlargement and production of the male hormone testosterone.

They also experience voice changes, facial hair growth and an increase in muscle mass, giving them a more muscular appearance.

Other signs of puberty in both boys and girls are a growth spurt, pubic and armpit hair growth, as well as the development of body odour and acne.

Hormonal changes can lead to mood swings, increased emotional sensitivity and changes in behaviour as well.

Precocious puberty

Early or precocious puberty refers to when puberty starts at a younger age than what is considered typical.

Early puberty is a general term and treatment is not necessarily indicated if it progresses slowly with a normal sequence.

Precocious puberty is a medical term referring to early puberty that has a rapid progression, resulting in a faster bone maturation and earlier fusion of the growth plates, which adversely affects the child’s final height.

The signs and symptoms of early or precocious puberty include:

• Breast development before the age of eight years or menses/period before the age of 10 years in girls.
• Enlargement of testes or penis before the age of nine years in boys.
• Other signs of puberty as described above occurring earlier than expected.

It is usually activated by the pituitary gland in the brain sending hormones earlier than it should to stimulate the ovaries (in girls) and testes (in boys) to make sex hormones.

For most girls, there is often no underlying cause for this early activation (medically known as idiopathic).

For boys, early puberty is uncommon and is usually related to another medical problem that needs to be investigated promptly.

Rare medical conditions that may cause precocious puberty include a tumour or defect in the brain, radiation or injury to the brain, other tumours (e.g. testicular, ovarian or adrenal), severe hypothyroidism (a condition where the thyroid gland does not produce enough thyroid hormones) and McCune Albright Syndrome.

Environmental factors such as certain food intake and exposure to endocrine disruptors have also been suggested.

Endocrine disruptors are chemicals that disrupt the level of hormones in the body.

They can be found in a wide range of products, including pesticides, plastics and fragrances.

The risk factors for early puberty include:

• Being a girl
• Being from certain ethnic groups
• Obesity
• Exposure to sex hormones, e.g. from creams, supplements or substances in the environment that contain testosterone or oestrogen, or that act similarly to these sex hormones
• Radiation therapy to the brain
• Being born small for gestational age.

Early puberty can lead to an initial growth acceleration, but a final short height, as bones mature and fuse faster due to the effects of hormones.

Some children may experience low self-esteem and difficulties coping with the physical and emotional changes of puberty.

They may also be treated inappropriately by adults for their age because of their mature appearance.

Delayed puberty

Late or delayed puberty refers to when puberty doesn’t begin by the typical age.

For girls, this means that there has been no breast development by the age of 13 years, no menses by the age of 15, and/or their menses do not start within three years after breast development.

For boys, it means that there has been no enlargement of the testes by the age of 14 years, and/or no appropriate genital/penile enlargement four years from the start of testes enlargement.

Some children develop later than others (known as late bloomers), especially boys.

In many cases, there are also family members who are late bloomers.

However, hormone disorders or medical conditions like malnutrition, extreme physical activity and chronic illnesses such as thalassaemia, diabetes, Turner syndrome, Klinefelter syndrome and Kallman syndrome, can sometimes result in the delay.

Delayed puberty can have several effects, which include:

• No pubertal growth spurt, resulting in a short final height.
• Poor bone density, resulting in brittle bones (osteoporosis).
• Poor self-esteem and feeling different from their peers.

Management

When evaluating abnormal puberty, doctors consider the child’s medical history, physical examination, hormone levels and bone maturity.

For early puberty, treatment may involve medication to halt pubertal progression.

Treatment decisions are based on the final height prediction, bone maturation, the child’s ability to cope with changes, and underlying medical conditions, if any.

For delayed puberty, sex hormones (testosterone in boys and oestrogen in girls) to start puberty may be needed.

Any underlying medical condition must also be addressed.

Puberty is a complex process with individual variations in timing and progression.

Parents should play a role in educating their children about puberty to help them understand their body and emotional changes better.

If puberty is early or does not start beyond the typical age range, it is advisable for parents to consult a paediatric endocrinologist for an evaluation and necessary treatment if needed.

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.