Early Puberty: How Young Is Too Young?

Children start puberty at different ages based on many factors, including activity level, race, and
genes. Precocious puberty can be a sign of a medical condition that calls for a doctor’s attention.
Other times, precocious puberty has no apparent reason but can be slowed down with treatment.

When a child has precocious puberty, she or he starts developing sexual characteristics early, before
ages 7 or 8 for girls and age 9 for boys.

The exact age is a matter of debate. Some doctors have suggested lowering the official age of
precocious puberty. Others say that doing so will lead to not identifying children who would benefit
from treatment.

Further complicating matters are racial differences in how soon puberty starts. By age 8, 38% of
African-American boys and 48% of African-American girls show some signs of puberty. By comparison,
28% of white boys and 14% of white girls have begun to develop by the same age. So far, it’s unclear
what portion of this age difference is due to race.

Parents concerned about their children’s development can compare their child’s age to how old they
were when they started puberty.

In the end, parents and pediatricians need to look at the child’s development and the many factors
surrounding it to determine what defines too early.

Intervene Early or Wait and See?

Parents who think their child has precocious puberty should see their pediatrician. Rarely, early
puberty is the first sign of a serious medical condition like a tumor or neurological disorder. Treating
the condition can put puberty on hold until the appropriate age. Often puberty simply starts early for
no apparent medical reason.

While it may be a relief to know precocious puberty is not usually a sign of a more serious medical
condition, kids with precocious puberty may stop growing before they reach their full adult height.
They also face possible teasing by other kids.

Bones matures during puberty, and when puberty starts early, the growth spurt begins and ends
sooner than normal. At first, children with precocious puberty tower over their friends who haven’t
started to grow. But within a few years, they may stand among the shortest in their class. Diagnosing
the condition early can help the child’s growth return to the appropriate pre-precocious rate.
What Precocious Puberty Looks Like

Early puberty looks like “normal” puberty, except it starts at a younger age. The signs include breast
development, penis and/or testicle growth, rapid jumps in height, pubic or underarm hair, and acne.
Suddenly a teenager’s body odor may fill the air. All familiar signs, except for the timing.

Early Puberty In Girls

Puberty starts for girls with the development of breast buds. Later changes include the development
of pubic hair, underarm hair, and acne. During puberty, girls typically grow 2 to 3 inches each year,
but have their largest growth spurt on average around age 12 1/2. Puberty ends for girls when
menstruation starts. If a girl shows any sign of beginning puberty -- the onset of breasts -- before
turning age 7, she may have precocious puberty.

Early Puberty in Boys

The first sign of puberty in boys is the enlargement of the testicles and scrotum. That is followed by
pubic hair, penis growth, underarm hair, and voice change. The typical growth spurt for boys occurs
later -- usually closer to age 14. Boys younger than age 9 who show signs of puberty should be seen
by a doctor.

How Doctors Diagnose Early Puberty

Your pediatrician will probably start out asking a lot of questions about the child’s development and
both parents’ medical history. A physical exam allows the doctor to compare the child’s development
to his or her actual age.

Blood and urine tests help detect abnormal hormone levels. Doctors sometimes use imaging and
scanning tests (CT scans, MRIs, and ultrasound) to look for tumors that could have set off early
puberty. In most cases, however, there is no apparent anatomical cause.

An X-ray of the child's wrist can help determine how quickly the bones are maturing. If the bone age is
far ahead of the child’s actual age -- for instance, if a child of age 6 has a bone age of 11 -- the child is
in danger of not growing to his or her full height.

Your pediatrician may refer you to a pediatric endocrinologist for evaluation and treatment.

Treating Precocious Puberty

Many parents of children with precocious puberty choose to put their child on a treatment that
lowers the level of sex hormones and slows puberty to a crawl.
Delaying puberty can give the child’s bones a chance to grow at their own pace for a longer period of
time. It also gives the child’s mind, emotions, and social skills a chance to come up to speed. Puberty
can then happen later, when all systems are ready to take it on together.

Questions for the Doctor

When children have precocious puberty, parents and doctors need to work together to determine the
best course of action. The following questions can help parents get the conversation started.

What tests are you going to use to determine if my child has precocious puberty?

Do you see any signs to suggest this is caused by a tumor or some other medical condition?

What options are available to treat this condition?

What are the side effects?

How long do you recommend my child stay on this treatment?

How will I know if the treatment is working or not working?

What local services are available to help me support my child’s emotional well-being?

By working closely with medical professionals who understand precocious puberty, parents can make
sure their children have the best possible childhood.