Should precocious puberty be a matter of concern?

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Can't associate puberty with a five-year-old? Well, then you haven't heard of precocious puberty. Here we have the mighty P word uncloaked for you. Read on

precocious puberty

Precocious puberty shouldn’t be viewed as a fearful medical diagnosis

It wasn’t a good day for five-year-old Aaria Nath. She’d been feeling squeamish all through, was restless in the class and by the time she got home, her stomach was hurting. She went to the washroom to freshen up and came out howling. “She came running and sobbing. ‘Mumma, I got hurt… there’s blood all over my bloomers’ she said. I was shocked,” recollects her mum, Ananya Nath. It was a case of precocious puberty or early puberty.

Puberty, in itself, is a crazy time. And when it happens to a really young child, the craziness is manifold. To begin with, how do you explain the insane changes happening to a usually gregarious 5 to 6-year-old? Then there is the physical discomfort to be dealt with. The body has matured, but has the mind? The layers to this issue are many and need to be dealt with extreme sensitivity and caution.

“Puberty is a phase in life during which a sexually immature child develops into a potentially fertile adolescent and thereafter, an adult. The pubertal process is brought about by the awakening of a mechanism involving the nerves and hormones,” explains Dr Sanjivni Khanna, director and head of department, obstetrics and gynaecology, Fortis Hospital, Delhi.

Kamna Chhiber, head, mental health and behavioural sciences, FMRI, Delhi, feels that the key lies in being transparent with the child. “When talking to your child about puberty and the changes that accompany it, what is important is to not avoid the questions that your child is raising. One should look at things factually and try to explain them in a way that he or she can grasp it.”

What is precocious puberty?

The age at which puberty ensues is quite variable and is usually between 8 to 13 years in girls and 9 to 14 years in boys. Puberty is only considered early if its onset occurs before the age of 8 years in girls and 9 years in boys. In such a situation, parents should consult a doctor to find out if there is any underlying health problem.

Signs of early puberty

During puberty the reproductive organs of the child become functional. According to Dr Aarti Sahni, gynaecologist, SCI International Hospital, Delhi, following are the signs of precocious puberty that parents must look for in their children:

The signs in girls are:

  • Breast development
  • Development of pubic and under arm hair
  • A growth spurt when the child gains height of 7-8 cm on an average in a year
  • Acne on face and back

In boys, the signs are:

  • Penis, testicles and scrotum grow in size
  • There is a deepening of voice
  • Growth of muscles
  • Appearance of facial hair
  • Rapid growth spurt

Then there are the emotional and behavioural changes as the child matures. It is very essential to counsel the child at this stage and give him or her emotional support. Parents should reassure their children that this is a normal phenomenon in their lives and it just happened a bit early in their case.

Causes of precocious puberty

To understand the causes of precocious puberty, we need to know the normal changes that happen in the body which lead to puberty.

  • The brain starts the process by making a hormone called gonadotropin-releasing hormone (Gn-RH).
  • The pituitary gland releases more hormones. Gn-RH causes the pituitary gland to release two more hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
  • Sex hormones are produced. LH and FSH cause the ovaries to produce hormones involved in the growth and development of female sexual characteristics (estrogen) and the testicles to produce hormones responsible for the growth and development of male sexual characteristics (testosterone).
  • Physical changes occur The production of estrogen and testosterone causes the physical changes of puberty.

This process begins early in some children, depending on whether they have central precocious puberty (CPB) or peripheral precocious puberty (PPB).

For the majority of children with CPB, there’s no underlying medical problem and no identifiable reason. In rare cases, the following may cause central precocious puberty:

  • A tumor in the brain or spinal cord
  • A defect in the brain present at birth, such as excess fluid buildup (hydrocephalus) or a noncancerous tumor (hamartoma)
  • Radiation to the brain or spinal cord
  • Injury to the brain or spinal cord
  • Hypothyroidism

As for PPB, estrogen or testosterone in your child’s body causes this type of precocious puberty. In both girls and boys, some of the reasons that may lead to PPB are:

  • A tumor in the adrenal glands or in the pituitary gland that secretes estrogen or testosterone
  • Exposure to external sources of estrogen or testosterone, such as creams or ointments

It should be noted that at times, there maybe isolated development of breasts, or of axillary and pubic hair. These situations may be incomplete forms of sexual precocity and the child may continue to have a normal growth rate. Observation and investigations may be warranted. The isolated early onset of menses is worrisome and always needs assessment.

At times, the reason for precocious puberty cannot be ascertained. And occurs through a long process, beginning with a surge in hormone production, which in turn causes a number of physical changes. Every person’s individual timetable for puberty is different.

Continue reading to know about the possible complications of precocious puberty

precocious puberty

In case of precocious puberty, parents should not make it look like a big deal

Possible complications arising of precocious puberty

Early puberty in children can pose some physical as well as emotional complications. Dr Prakash Vemgal, head of department, neonatology and paediatrics, Fortis Hospitals, Bangalore, states some of them:

Slow growth. Children with precocious puberty may grow fast at first and be tall, compared with their peers. But because their bones mature more quickly than normal, they often stop growing earlier than usual. This can cause them to be shorter than average as adults.

Social and emotional problems. Girls and boys who begin puberty long before their peers may be extremely self-conscious about the changes occurring in their bodies. This may affect self-esteem and increase the risk of depression or substance abuse. Early treatment of precocious puberty, especially when it occurs in very young children, can help them grow taller than they would without treatment.

Stress. Even when it happens to an average 12-year-old, puberty can be a confusing time. It can be all the more stressful for younger kids with early puberty. They might feel awkward about looking different from their peers.

Explaining precocious puberty to children

Explaining these hardened medical jargons to a 5-year-old is not only onerous, but also futile. But can we afford not to talk about it at all? “Children and their parents should not view precocious puberty as a fearful medical diagnosis. Reassurance holds the key,” says Dr Pankaj Aneja, senior consultant physician and endocrinologist, Fortis Hospital, Delhi. According to him, what’s really crucial and comforting to remember is that most children with signs of early puberty do fine, medically, psychologically, and socially.

Thirty-year-old media professional, Naina Rawat (name changed) recalls getting her ‘periods’ when she was in Class III. “It happened in class and being a sporty child, I assumed I had hurt myself. I was scared witless to even telling my mum about it. Finally, when I mustered enough courage to say that ‘I was bloody down there’, my mum flipped. The last thing on her mind was that perhaps I had attained puberty,” says Rawat.

A visit to the doctor confirmed that hers was a case of precocious puberty and there was nothing to worry about. However, Rawat can’t seem to forget the grim atmosphere at home that day. “It was like I had some disease which had my parents in knots,” she sighs. Today, she laughs it off and feels if ever it happens to her child, she will first ensure that the little one is relaxed and comfortable.

“Make sure the child understands that everyone will go through the same changes but can happen earlier in some kids and later in others. Encourage him or her to take part in regular physical and social activities,” says Dr Vemgal.

As parents, we need to be sensitive towards our children’s emotional needs and physical changes during puberty in general. So it goes unsaid that a child who’s dealing with precocious puberty needs to be handled with much more sensitivity, love and care.

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Written by

Divya Nair