Early Puberty: When it Happens too Young

6 January 2016, BKK Kids

First, parents need to understand that puberty is about physical development, not intellectual and emotional maturity. In early puberty, a primary concern is physical and hormonal changes, while a secondary concern is final height.

During physical and hormonal changes in early puberty, the parents will have to answer the children’s questions about differences between men and women as well as the physical changes that the children are experiencing at an earlier stage to their peers. This is necessary so that the children will not have any difficulties with their peer group and will be able to cope with teasing from their peers. It is important for the parents to understand their children and know how to talk to them without embarrassing them. It can be a challenging time for both children and parents.

Effect of early puberty on the final “height”

Based on the theory, early puberty causes the skeletons to mature more quickly and bone growth to stop at an earlier age than is the case in children who experience puberty at a later age. The early growth spurt may make children initially tall when compared with their peers, but they may stop growing too soon and end up at a shorter height than they would have otherwise reached. It can eventually result in a short adult stature. Children experiencing early puberty are “initially taller” than their peers because they “start” puberty early, but this means that they also “finish” their growth early.

There is a correlation between early puberty and adult height. In girls, after 2-3 months of their regular periods, they are at 96% of their final height. After that, they will gain the final 4% of their height, or about 5-7 cm. For example, if they are 140 cm tall when they get their first period, they will gain about 6 cm in height and their final height will be 146 cm. In boys, when the voice changes, they are at 94% of their final height and will gain only about another 8-10 cm in height. When puberty begins very early, the children’s height growth stops too soon.

The question is…how to recognize early puberty.

It’s normal for the start of puberty to range from 9-14 years in boys and 8-13 years in girls. Physical changes occur earlier in early puberty, but the signs of puberty in boys are virtually invisible to anyone. Testicular enlargement is the sign of puberty in males. The testicular length increases to over 2.5 cm. In girls, it’s easier to notice physical changes.  Breast development starts with a lump beneath each nipple. After these first physical changes, the boys and girls will grow taller rapidly. Oily faces produce acne and body odor begins. Pubic and underarm hair grows. Emotional changes also occur. In girls, after 3 years of menstruation, their growth stops. At the same time, according to radiographic assessment of bone age, the girls achieve a bone age of 16 years (reaching 99.6% of adult height). In boys, 4 years after the voice changes, their growth almost stops and they achieve a bone age of 18 years or 99.6% adult height.

What to do when early puberty happens?              

Parents should give their sons and daughters separate rooms when they reach puberty.  They will understand that they are growing up and should have their own private spaces. The parents should also give their children advice about reaching adulthood. Height may affect personality and future career, so in order for children to grow properly, please seek medical advice from a pediatric endocrinologist when a daughter and son are 6 and 8 years old, respectively. When the daughter complains of sore nipples or the son is growing tall rapidly, the parents can help children through all of the changes as follows:

Nutrition: Some protein foods will help trigger a release of growth hormone. Eat nutritious foods from 5 groups, as well as vitamins and minerals such as calcium in their proper daily amounts. Avoid non-organic meats as they are loaded with puberty-inducing chemicals. There is also evidence that obesity contributes to earlier puberty in girls.

Deep sleep: According to a study of growth hormones released daily by the anterior pituitary gland in growing children, 50% of growth hormones are released between 22.00-02.00 hours during deep sleep. The children should therefore go to bed at no later than 21.00 hours.

Exercise: Growth hormones are released more after exercise. Children should exercise for 30-60 minutes at least 5 times a week.

In extreme cases, early puberty decreases predicted height to a very low level. Medication can be used to reduce hormones temporarily, delay bone development, and extend the time for height growth. A monthly injection of the medication may increase the final height. However, advice should first be sought from a peadiatric endocrinologist.

By Piyarat Lertbunnaphong, M.D., Paediatric Endocrinologist, Samitivej Children’s Hospital, Sukhumvit Campus.

Editor’s note: This article is sponsored content from Samitivej Children’s Hospital, and it is reprinted here with permission of the hospital.