Precocious puberty

For most parents, few developmental milestones are more dreaded than their daughters starting puberty. The idea of their sweet, innocent little girl turning into a moody, hormonal young woman is enough to keep most moms and dads up at night. The only saving grace for some of these parents is the belief that puberty is still years away.

But what if, even with a daughter still in kindergarten, the physical and emotional rollercoaster ride of puberty is lurking just around the corner? According to a recent study by the American Academy of Pediatrics, this is reality for more and more American families. The study followed girls of various ethnicities, locations and backgrounds, and found that by 7 years old, more than 10 percent of Caucasian girls and 23 percent of African-American girls showed signs of breast development, indicating that puberty has begun.

“Plenty of children are not psychosocially capable of handling the emotional and physical changes of an early puberty.” -Diane Stafford,MD

There are plenty of theories about what’s causing the shift, but most lack scientific backing. Environmental factors like an increase in the amount of hormones found in food or continued exposure to household toxins like bisphenol A (BPA) are often blamed, but based on current data, many in the medical community feel their role in earlier-occurring puberty is overstated.

“There are studies suggesting that BPA and other endocrine disruptors can cause changes in pubertal development in animals, but data on how this relates to humans is limited,” says Diane Stafford, MD, assistant clinical director of the Division of Endocrinology at Children’s Hospital Boston. “Given the complexity of pubertal timing, and the number of things we still don’t know about it, it’s difficult to make a clear cause and effect association between any particular environmental exposure and changes in the timing of puberty.”

An increase in the average weight of American children is also believed to be a factor. Girls who are overweight may grow faster and go through puberty earlier, and being overweight makes it more difficult to distinguish between fatty breast tissue and true breast development. However, when data from older studies of the timing of puberty are adjusted to account for an average increase in body mass, the numbers still indicate that girls are hitting puberty slightly earlier, regardless of weight.

One of the biggest concerns with precocious puberty is the effect it will have on the child’s adult height, since most of a person’s adult height is achieved during pubescent growth spurts. But children who enter puberty at a young age often finish growing early as well. By the time they reach adulthood they are often much smaller than their peers who grew steadily until their early teens.

Emotionally, early puberty can lead to a number of difficulties, from self-esteem issues to an increased likelihood of taking unnecessary risks. How a young girl reacts to the changes in her body—and how others react to her as a result—can make the preteen years very difficult for girls who start developing before they’re mentally prepared.

“There are plenty of children who are not psychosocially capable of handling the emotional and physical changes of an early puberty,” says Stafford. “The most common concerns for these kids are that they’re more likely to feel different than their peers and become an easier target for bullies. There is also concern that they’re more likely to have sexual contact before they’re cognitively ready.”

In cases where an early puberty may pose serious physical or emotional problems, there are medical treatments that can delay the process until the child is old enough to handle the change. In addition to counseling, a drug is introduced into the patient’s system that quiets signals from the brain to the ovaries, reducing the rate of estrogen production and slowing the body’s transition to adulthood. Then, when enough time has passed and the patient is ready, treatment is stopped and the body naturally picks up where it left off. The procedure is proven to be safe, but as Stafford points out, the decision to use drug therapy for conditions that don’t directly threaten a patient’s health can’t be made lightly.

Girls who entry puberty early run the risk of being much shorter by the time they reach adulthood

“The decision to halt puberty with treatment is more subjective than most things we do in medicine,” she says. “So everything you do must be looked at on a case-to-case basis to ensure it’s the right course of action for the patient.”

Not surprisingly, most parents who opt to have their child undergo puberty-suppressing therapy have a harder time ending treatment than they do signing up for it, especially the fathers.

“Picking a time to end therapy can be particularly tough for dads, who have a hard time letting go of their ‘little girl,'” she says. “But no matter how hard the decision, I always remind them that puberty isn’t a disease, it just feels that way sometimes.”