Precocious and Early Onset Puberty

Precocious and early puberty can have consequences that range from physical to emotional. According to the Mayo Clinic, girls with precocious puberty tend to grow quickly at first and are often tall compared to other girls their age, but they are often shorter as adults because their bones mature faster than normal and stop growing earlier. In another interview with Dr. James-Todd about early onset puberty, she said that for each year earlier a girl starts puberty, there is about a 20% increased risk of certain diseases associated with an earlier pubertal onset. These diseases include, but are not limited to, breast and ovarian cancers, diabetes, and heart disease. 

A 2007 study led by Jane Mendel, Ph.D., et al. found that girls who experience puberty earlier can also suffer from psychological issues. The study found that they may feel anxious, self-conscious, and a sense of emotional distance from other girls their age. Girls with precocious puberty can often look three or four years older than their actual age in height and physical development, and this can create social difficulties as well because they may be seen and treated differently. Moreover, a different study by Dr. Mendel et al. in 2010 explains that because emotional maturity can happen at a different time as physical maturity, an early onset of puberty can lead to dealing with changes in relationships with adults and peers, as well as new feelings of sexual attraction and emotional changes dictated by hormones at an age when children are not ready for these challenges. These physical and psychosocial struggles can lead to depression, poor self-esteem, and even suicide attempts.

According to pediatric endocrinologist Erica Eugster, M.D., treatment may be needed to help a child reach their full height potential and to avoid negative psychosocial effects. Deciding whether or not to treat a child depends on their age and the progression of puberty. Accepted medical treatments include GnRH antagonists that suppress hormones to halt further puberty development. These can be delivered in a few ways:

• Intranasal - a nasal spray
• Subcutaneous - a small implant under the skin
• Intramuscular - an injection administered monthly, every three months, or every six months

According to the Mayo Clinic, these medications are given until a girl reaches a typical puberty age. Puberty then resumes as normal around 16 months after stopping treatment. Unfortunately, these medications can be expensive and insurance does not always cover them. For specific medical advice, reach out to your child’s pediatrician.

Precocious or early onset puberty can present daunting challenges and create a lot of stress for both girls and their families. These complex health conditions are neither the fault of the girls or their families. Even so, addressing and managing these multifaceted problems become the responsibility of the parents and caregivers who may already have to contend with a multitude of daily life stressors and limited access to basic resources. Below are some things that can be done to try to navigate these complex issues.

• Be an advocate. Find a pediatrician with whom you can work in a partnership to address questions or concerns that you may have regarding any early signs of your child’s development. Some pediatricians may not commonly treat patients with early puberty or may not know the options for treatment. There are doctors known as pediatric endocrinologists who specialize in treating disorders connected to the endocrine system and hormones, including early puberty. Your child’s pediatrician may be able to refer you to a pediatric endocrinologist. For those in Boston, Massachusetts, Boston Medical Center has a Section of Pediatric Diabetes and Endocrinology; Boston Children’s Hospital and Tufts Medical Center also have Endocrinology Divisions, all of which provide care to children with a range of endocrine-related disorders, including early puberty. You may be interested in asking these following questions:

• • Do you need to run tests to diagnose early puberty? What are these tests?
  • Are there any options to treat early puberty? What are the side effects of these treatments?
  • Are there any resources to help me support my child’s emotional health?
  • What would happen if we do not start a treatment?

 If your child is old enough, make sure to engage them in the conversation and ask how they are feeling or if they have any questions. You may also want to suggest that they write down a few questions before their appointment–it could be about how they are feeling, any physical changes that are occurring, or anything else they would like to discuss with their doctor. In addition, consider finding a therapist for family support and to help with any emotional and psychological concerns.

• Eat healthy foods and promote healthy exercise. While accessing and affording healthy, organic foods can be difficult, eating as healthy as possible has many benefits for the body besides reducing the chances of an earlier onset of puberty. Although farmer’s markets can be expensive, there are local farms, even in urban areas, where affordable options are available. See the resources below for more information about Boston-based food initiatives. Although making sure a child gets enough exercise can also be a challenge, physical activity can help balance puberty-related hormones. Speak with your pediatrician for guidance about the different types and levels of exercise that are suitable for your child.
  
• Minimize toxic chemical exposure. It is very difficult to avoid exposure to toxic chemicals given that they are common in the many products people use. Try to minimize your child’s exposure to the sources of harmful chemicals as much as possible. People can limit the amount of dust in their homes by using a HEPA filter vacuum and damp cloths for dusting. Some plastic products can be replaced by more natural choices like reusable glass bottles or food storage containers. There are alternative skin and hair care products made without harmful chemicals available in many different places. Think of your purchasing power and vote with your wallet by choosing safer products. The more people demand safer, cleaner products, the more companies will respond.