Introduction:

Puberty marks the end of childhood and is the stepping-stone into adulthood. During this period number of changes in children's bodies as they develop into young men and women

Normal puberty

The age of onset of puberty varies widely. In girls, the breast bud is usually the first sign, and is seen on average at 10-11 years. Pubic hair usually begins to appear 6-12 months later. Along with these physical changes comes the pubertal growth spurt. Menstruation begins, on average, 2 to 2.5 years after the onset of puberty. The mean age for a girl's first period is about 12-13 years. Wide variations are seen in the sequence and timing of these events, but the peak growth spurt always precedes the first period.
In boys enlargement of the testes is usually the first sign followed by appearance of pubic hair. The growth spurt in boys comes a little later than in girls

Precocious (early) puberty

Precocious puberty is often defined as the onset of true puberty before 8 years of age in girls or 9 years of age in boys. (Isolated breast development that doesn’t progress to the rest of puberty is called premature thelarche, and is a different, benign condition).

Who gets it?

Precocious puberty is 10 times more common in girls than in boys.

Causes of precocious puberty

In most cases of precocious puberty, the cause is unknown. In some instances, the pituitary signals the ovaries and testicles to make female and male hormones at an earlier than usual time. In other cases, signs of puberty occur prematurely because of abnormalities in the ovaries, testicles or adrenal glands. Exposure to sex hormones in the environment (found in some hair and skin care products, meat from sex-hormone fed animals and hormonal pills) can also cause early sexual development. Tests are usually necessary to determine the cause of precocious puberty.

What are the symptoms?

In girls, the signs to watch for are the development of the breasts, the growth of pubic hair or underarm hair, a change in the appearance of the external genitals, and the beginning of menstrual periods.

In boys, watch for enlargement of the testicles or penis, the appearance of pubic hair or underarm hair, acne, and the deepening of the voice.

Increased height and weight may be seen in boys or girls.

Effects of precocious puberty

Most children who begin puberty early are tall compared to other children of their age, but stop growing earlier too, resulting in a short final height. This occurs because their bone age (skeletal maturation) is advanced and their bones fuse early. It also results in early reproductive capacity.

Social concerns

Due to early puberty these children may be taller and look older than their peers. They tend to be treated by others according to their appearance, rather than their actual age. Children develop their self-esteem and behave according to how they are treated, hence their parents, teachers, relatives etc. should be reminded that they should treat them like other children of their age.

The child may feel embarrassed by the physical effects of puberty. The child should be told that all children experience puberty, but in his/her case it has occurred sooner than usual. He/she should know that these changes in their body are normal and the children should be allowed to participate in their normal activities.

Children who look older than their age are at an increased risk of sexual abuse, hence appropriate precautions should be taken. Encourage your child to discuss with you any worries or concerns that he/she may be having.

How early can it occur?

Sexual development may begin at any age. Pregnancy has been reported as early as 5 1/2 years old.

How is it diagnosed?

Early puberty is suspected on the basis of the physical examination. Laboratory tests are important to determine which puberty hormones are present, and where they are coming from. These may include X-Ray of the wrist and hand for bone age (skeletal maturation), hormonal tests of the blood involving multiple samples, ultrasonography of the uterus and ovaries and Magnetic resonance imaging.

How is it treated?

Medicines are available to slow or stop early puberty. This also improves the growth outcome. Sometimes surgery is needed to remove ovarian cysts, or other ongoing sources of puberty hormones.

How can it be prevented?

Often early puberty cannot be prevented. We do know that exposure to puberty hormones such as estrogen can trigger some types of early puberty. Reducing children’s exposure to estrogen or other sex hormones is wise.