Puberty is when a child’s body begins changing into that of an adult. It is called precocious (early) puberty when it starts before 8 years in girls and before 9 years in boys. On the other hand, if it does not occur by 13 years in girls and by 14 years in boys, it is considered delayed puberty.
Signs of puberty include breast growth, pubic hair, onset of menstruation, rapid increase in height or shoe size, changes in body shape and development of the body’s ability to reproduce.
When should you contact your health care provider?
When your child has any of the following:
- Precocious or delayed puberty.
- Contra-sexual pubertal development: when there is development of male characteristics in females or vice versa.
- Onset of menstrual periods without any other signs of puberty.
- More than 5 years between breast development and first menstrual period.
What are the causes of early or delayed puberty?
Precocious puberty may be caused by genetic disorders, exposure to estrogen or testosterone containing medications, tumors, brain abnormalities or injuries and radiation treatment for tumors. Children who are obese have a higher risk of developing precocious puberty. Sometimes the cause of precocious puberty cannot be found.
Causes of delayed puberty include genetic disorders, hormonal disorders, eating disorders, excessive exercise, infections, tumors, brain abnormalities or injuries, chemotherapy and radiotherapy for tumors.
What diagnostic procedures should I expect for my child?
Your paediatric endocrinologist will take a detailed medical history and conduct a physical examination including breast and pubic/pelvic examination. He or she may then request for some diagnostic tests including blood tests to assess for hormone levels and chromosomal abnormalities, and radiologic tests to assess your child’s bone age, brain or pituitary gland, thyroid gland, ovaries and adrenal gland. The specific tests will depend on your child’s history and examination findings.
What are the complications of precocious or delayed puberty?
Children with precocious puberty may be tall initially compared to their peers, but without treatment, they will eventually end up short because their bones mature quickly and they stop growing earlier.
Children who develop puberty early or have delayed puberty may have low self-esteem and are at higher risk of depression or substance abuse.
Can puberty disorders be treated?
Yes, treatment depends on the symptoms and the cause of the puberty disorder. This may include:
- Observation and regular follow up in situations where the disorder is likely to resolve on its own.
- Hormone therapy for precocious puberty to delay further progression and for delayed puberty to trigger the onset of puberty.
- Surgery for disorders that require structural correction.
- Counseling/ Psychotherapy is vital to help children and their families deal with the emotional and social impact of pubertal disorders.
