Early Puberty in Girls
An interview with Suruchi Bhatia, M.D, director of pediatric endocrinology and diabetes, Sutter Pacific Medical Foundation
Most parents expect their girls to start puberty around the age of 12, but research has shown that an increasing number of children are showing early signs of puberty as early as age 5.
How Young Is Too Young?
An August 2010 study in Pediatrics found that by age 7, 10 percent of Caucasian girls, 23 percent of African American girls, 15 percent of Latino girls, and 2 percent of Asian girls had started developing breasts. "Every week, we see about 10 children with early puberty from all over the Bay Area," confirms Suruchi Bhatia, M.D.
The trend has alarmed both parents and doctors alike, who are now conducting research to determine why it’s occurring and what can be done about it. Although they don’t have all the answers, they do have some good news for parents whose children might be experiencing early puberty.
It’s All About the Bones
Girls primarily experience three phases of puberty: breast development, the growth of pubic hair, and then the first period. Of those three stages, the most concerning is early onset of menstruation. That’s because most girls stop growing at the end of puberty. If they get their periods early, they could also stop growing early, making them shorter than expected.
Fortunately, early signs of puberty, like breast development, do not necessarily lead to early menstrual onset. Doctors use blood tests and bone-age X-rays to test girls for what’s called advanced bone age, and in fact, most girls who have early pubertal signs have regular bone growth and experience their first period at a normal time—on average age 12 or 13.
Who Needs Treatment?
"While in the past, any child who started pubertal signs before 8 used to be considered an early maturer, most kids we see with early puberty don’t have pathology," says Bhatia. "For those girls meandering slowly through puberty, I’d prefer them to proceed naturally. Only a very small subset needs treatment."
Generally, treatment is a gonadotropin-releasing hormone analogue. The medication blocks hormones from the pituitary gland, which delays menstrual onset.
For children who are showing early signs of puberty but don’t need medication, monitoring is important. "If I see a 7-year-old with breast buds, and six months later she looks the same, I’m much more reassured than if I see she’s headed towards menstruation," explains Bhatia.
So far, no one knows for certain what causes early puberty.
One issue could be America’s skyrocketing obesity rate, as overweight children often experience puberty early. "But I see plenty of thin kids with early puberty so it’s not the whole story," muses Bhatia.
"The speculation in the last few decades is that chemicals and xeno-estrogens in plastics and soy products cause early puberty. There are some big studies currently being done, so we hope to have some answers in the next decade."
Preventing Early Puberty
Until then, it’s hard to suggest prevention methods. Yet Bhatia does have a few tips for general healthy living:
- See your pediatrician regularly and follow your child’s growth curve and body mass index.
- Make sure your kids are on a healthy diet of natural, unprocessed food and getting plenty of exercise. Eat soy products in moderation.
- Try to avoid sources of xeno-hormones. Buy organic milk and meat, if possible. After that, buy organic fruits and vegetables that aren’t peelable or washable.
- Use plastics that are BPA-free and phthalate-free. Don’t microwave food in plastic containers.
- If you or a family member uses topical hormones, keep them away from your children. For instance, if Grandma has an estrogen patch, make sure your girls don’t touch it when they play on her arm.
Sometimes the Best Treatment Is Talk
If your girl is an early bloomer, she may have challenges feeling different from her peers. You can help her by talking to her, normalizing her experience, and explaining that everyone will go through puberty eventually. Bhatia often recommends American Girl Library’s The Care & Keeping of You for her patients and their parents.
She also advises parents to talk to their children’s teachers. "You could ask them to be more sensitive about bathroom breaks and keep an eye out for bullying. If you can help your child come to a place of acceptance and understand what’s happening to their body, treatment often isn’t necessary," assures Bhatia.
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