Early Puberty in Children

1. When is it early puberty in children ?
Early puberty or Precocious puberty is when children start developing secondary sexual characters which mark the onset of Puberty. This is considered early if it happens before 8 yrs of age in girls and less than 9 yrs in boys.

2. What are the first signs of puberty ?
The first sign of puberty in girls is the start of breast development, it is manifested initially as increase in size of the breast which is usually painfulto touch. This may happen on one side at a time or can be bilateral.
In boys the first sign is the increase in the size of the testis.

There are certain features which are seen commonly in both:

  • Change in behaviour – become more argumentative, angry or irritable
  • Appearance of hair in the axilla and the pubic region
  • Sudden spurt in height
  • Change in voice in boys
  • Acne

3. What are the reasons for early puberty ?
There can be multiple reasons for early onset of puberty the commonest being Familial, where either one of the parents may have had early puberty as well or may be sporadic (with no suggestive cause or family history). But other than these also there some conditions which can lead to early puberty :

  • CNS conditions – tumors, hypothalamic hamartomas, cysts, radiation, injury to the brain
  • Genetic mutations can also lead to early puberty
  • Infections – meningitis, encephalitis, brain abscess
  • Some associated syndromes- Pallister- Hall, Russel- Silver, Neurofibromatosis
  • Tumors – of the ovary, testis, HCG secreting tumors
  • Adrenal disorders

4. What are the problems associated with early puberty ?
Onset of puberty is associated with both physical and emotional changes.
Of prominence of the physical changes is the advancement of bone age, an increase in bone age leads to early fusion of bones which in turn leads to compromised adult height. So to put it simply, the child may appear talk in comparison to peers at the onset of these pubertal changes but may lose out on years of growth due to the bones fusing early and may end up being short eventually.
Another important aspect especially in girls is the mental immaturity and stress associated with the onset of periods (menarche) in these young girls. This may be a cause of concern both for the child and parents and needs to be addressed as well.

5. Can this be treated ?
The first step is make a diagnosis for early puberty and look for any underlying cause for it.
The treatment involves pausing or stopping these pubertal changes. This is done by GnRH analogues – namely two Leuprolide or Triptorelin, which are given as injections. These are continued for the duration till you intent to postpone puberty.
Puberty resumes once these injections are stopped.