When puberty occurs too young

But it’s important to realise that puberty is primarily about physical development and not just children outgrowing their clothes and the rules made by their mums and dads.

Puberty ranges from 9-14 years in boys and 8-13 years in girls. When it occurs at the younger ages in the spectrum, 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. 

Early puberty causes the skeleton 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 shorter than they would have otherwise reached. It can eventually result in a short adult stature.

There is a correlation between early puberty and adult height. In girls, after 2-3 months of their regular periods, they are at 96 per cent of their final height. After that, they will gain the final 4 per cent of their height, or about 5-7 cm. In boys, when the voice changes, they are at 94 per cent of their final height and will gain only about another 8-10 cm in height.

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 odour 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 (99.6 per cent 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 per cent adult height.

Height may affect personality and even future career options, so in order to ensure that children grow properly, it is advisable to seek medical advice from a paediatric endocrinologist as early as age six 6 for a girl and 8 for a boy. Parents can also help children in the following ways:

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 evidence that obesity also contributes to earlier puberty in girls.

Deep sleep: According to a study on growth hormones released daily by the anterior pituitary gland in growing children, 50 per cent of growth hormones are released between 10pm and 2am during deep sleep. The children should therefore go to bed no later than 9pm.

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.

 

 

Dr Piyarat Lertbunnaphong is a paediatric endocrinologist at Samitivej International Children’s Hospital, Sukhumvit Campus. Call (02) 711 8236-7.