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Ahead of Schedule: What Parents Need to Know About Precocious Puberty

Worried your daughter is developing too soon? Here's what experts say to look out for.

Precocious Puberty

Finding a lump in your little girl’s breast is enough to frighten any mother. Panic led one such Wilmington, Delaware, mother to seek a doctor’s diagnosis. Luck was on their side: No cancer or disease for the 7-year-old, but she was heading into puberty early.


Researchers can’t agree on the origins of precocious puberty or whether it’s on the rise, but they do know it’s cause for concern. While doctors search for answers, it’s important for parents to know the signs and what to do if they suspect early puberty.


Puberty Defined

In girls, normal puberty is defined by breast bud development and the appearance of pubic hair. “Precocious puberty, or early-onset puberty, is defined as any breast development prior to age 8, in a girl, or any testicular or penile enlargement prior to age 9, in a boy,” said Dr. Evan G. Graber, a pediatric endocrinologist at Nemours/Alfred I. DuPont Hospital for Children in Wilmington. “The changes are due to increased levels of estrogen and testosterone.”


It’s more common — and less likely to be connected to a deeper medical condition — in girls, said Julie Cristol, CNM, MSN, clinical director at Lifecycle WomanCare in Bryn Mawr.


But parents shouldn’t shrug off signs of early or precocious puberty. Dr. Beth I. Schwartz, MD, a pediatric and adolescent gynecologist at the Sidney Kimmel Medical College of Thomas Jefferson University, suggests parents who notice any hormonal changes early “alert someone. That way someone will have some time to intervene.” It’s important to quickly rule out serious conditions like brain or ovarian tumors and thyroid problems — and decide whether to medically postpone puberty.


The mother of the 7-year-old took that advice seriously when she felt the lump in her daughter.


“I was wondering what it was, and hoping it wasn’t something else,” she said. After seeing an expert and ruling out a more serious condition, she explained to her daughter what was happening and that everything would be all right.


“She just wonders why she’s changing,” said the mom, who asked not to be identified to protect her daughter’s privacy. “It doesn’t seem to bother her as much.”


Soon, her daughter will begin therapy to postpone puberty.


Unproven Theories Abound

“It’s not known why the signal that normally suppresses puberty in a child all of a sudden gets switched off and the child has puberty early,” Graber said.


Some of the theories center on elevated body mass index (BMI), increased exposure to levels of endocrine-disrupting chemicals, and high levels of stress. But for now, that’s largely speculation.


Be on the Lookout

Symptoms of precocious puberty can be obvious or subtle, but most pediatricians can pick up on them and refer you to a specialist. Parents shouldn’t be afraid to reach out to their pediatrician or a specialist if they are concerned or witness these symptoms in kids under 8 or 9:


• Breast development
• Testicular enlargement
• Visual changes
• Balance problems
• Frequent urination
• Birthmarks
• Freckles in the underarms


Even though you’re a savvy parent when it comes to health, there’s lots about early-onset puberty you can’t Google. Early puberty is associated with polycystic ovary syndrome and a risk factor for breast cancer development, according to Cristol. Therefore, “older teens should be aware and encouraged to avoid other risks such as excessive alcohol use and smoking,” she said.


Body Image

“There is some evidence going through early puberty causes negative consequences on body image and increases risky behavior,” Schwartz said. “Most of the time, doctors don’t know why precocious puberty happens, but in around 10 percent of girls, there is an underlying cause that needs to be figured out. It could be anything from a significant thyroid problem, to rarely, a brain or ovarian tumor.”


Accelerated bone growth is another negative side effect of early-onset puberty. Elevated levels of hormones increase the speed of bone growth, so kids experience a growth spurt earlier than their peers followed. That’s followed by another change in hormone distribution, which causes bones to stop lengthening, and instead get stronger. Children who start puberty very early can end up being shorter than classmates, Graber said.


Adult Doctor Visit

No matter when puberty happens, the American College of Obstetrics and Gynecology (ACOG) recommends that girls have their first gynecologist visit between the ages of 13 to 15. Schwartz strongly advises girls to visit with an OB-GYN before they go to college in order to avoid scrambling for a gynecological appointment in an emergency.

The first visit is meant to be a discussion. Rarely does it involve an internal or pelvic exam. “There’s nothing that’s going to feel weird or scary,” Schwartz said.


And puberty can be jarring for all kids. Help your adolescent deal with these changes by:


•Building confidence and self-esteem.
•Asking them about their experiences with peers.
•Enlisting help from teachers, coaches, and other care providers.
•Talking about puberty and let your child know it’s something everyone goes through.
• Maintaining open communications, even when it’s uncomfortable.


“If parents aren’t embarrassed to talk about these kinds of things, then their kids won’t be,” Schwartz said.



Photograph via iStock.