One of the big milestones in your child’s life would be him or her entering puberty.
For girls, this would include the development of breasts and getting her first period, while boys will see their voices deepening and the development of facial hair.
But more parents in Singapore are now concerned about early puberty, or what is also known as precocious puberty.
This can happen when the body reaches a certain degree of maturity, and the pituitary gland is activated. Hormones will stimulate the sexual organs in girls and boys and lead to a growth spurt.
One of the most well-known cases of early puberty is the case of Lina Medina, a woman born in Peru in 1933, who gave birth to a baby when she was just 5 years old.
Unknown to her parents then, they brought her to the hospital because of her increasing abdominal size, only to learn that she was 7 months pregnant. She later gave birth to a boy by C-section, since her pelvis was too small to deliver the baby naturally. The baby’s father’s identity was is unknown.
As bizarre as it sounds, Medina had fully matured sexual organs because of early puberty, or precocious puberty. A medical report also state that she had her first period at 8 months of age, and prominent breast development by the age of 4.
Early puberty refers to the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys.
Associate Professor Loke Kah Yin, Head & Senior Consultant of the Division of Paediatric Endocrinology at National University Hospital, sheds light on this condition.
Dr Loke, what exactly is early puberty and what causes it?
Puberty refers to the period in which children become sexually mature, and are capable of reproduction. Normal puberty is triggered by the secretion of hormones from the hypothalamus and pituitary in the brain, and is noticed when secondary sexual characteristics appear. These include pubic hair and development of breasts in girls and deepening of the voice with enlargement of the male genitals in boys.
The timing of normal puberty varies from 8 to 13 years in girls and 9 to 14 years in boys. Early puberty refers to the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. This is usually due to a problem with the regulation of these hormones resulting in premature secretion of pubertal hormones from the brain.
How common is this, especially in Singapore?
There are no reports of the incidence of early puberty in Singapore. However, the General Paediatric Endocrinology Clinic at the National University Hospital has seen an increasing number of children whose parents are concerned about early puberty, with an estimated frequency of 50 to 60 new cases per year.
What are the symptoms of early puberty that parents should notice?
The symptoms of early puberty include the development of breast buds in girls, with acne, oily skin, armpit and pubic hair, a growth spurt and menstruation. For boys, the symptoms of early puberty include deepening of the voice, appearance of pubic, armpit and facial hair with acne, oily skin, a growth spurt and frequent erections.
Is early puberty physically harmful to the health of the child?
Early puberty can result in an early growth spurt, so that the child is taller than his peers. However, the bones will fuse earlier if untreated, so that the final adult height may be shorter than his or her genetic potential. Early puberty and maturation will result in bodily changes so that the child will appear different from his peers and may exhibit mood swings and behavioural changes.
How does it affect the child psychologically and emotionally?
The secretion of pubertal hormones can result in mood swings, and the child may become more emotional. For girls, the commencement of menstruation can be frightening to both the child and her parents.
Changes in lifestyle will not prevent the progression of puberty once it has started.
What should parents do if they think their child is going through early puberty?
If you think that your child is going through early puberty, you should bring your child to see a paediatrician or a doctor specialising in paediatric endocrinology to confirm the diagnosis and to determine the cause. In girls, 90 percent of cases are caused by a problem with pubertal regulation and only 10 percent of cases may be due to a secondary cause such as a brain tumour. In boys, 50 percent may be caused by a pathological cause, including a tumour secreting sex hormones.
How will you explain early puberty to the child?
I would explain that the physical changes are a normal phase of transition for every child who will eventually mature to become an adult, like their mother and father. It is just that these changes have occurred earlier than normal, so it needs to be checked and treated if necessary.
What can you do to prevent the onset of early puberty? Can you make changes to lifestyle?
Early puberty can be treated with medications which can block puberty. Changes in lifestyle will not prevent the progression of puberty once it has started.
If the final adult height is likely to be compromised by early puberty and if the bones have not fused yet, then medications to block puberty can be used to optimise the remaining height potential. These medications can also stop the menses and reduce the breast size in girls, and reduce the appearance of acne and the frequency of erections in boys.
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