As parents, we often feel that our children are growing up way too fast in today’s society of continuous digital content, social media and provocative images. When we see our kids showing signs of puberty earlier than we expect, our parental alarm starts sounding.
According to the National Institutes of Health (NIH), puberty begins between ages 8 and 13 for females and ages 9 and 14 for males. That being said, the trend generally seems to be shifting to puberty beginning on the earlier side.
Earlier changes seem to be the new normal for American children, but you should not be concerned. The reasons behind the earlier development of puberty are not completely understood, and are thought by some to be due to a number of reasons — including chemical changes in our diets, higher intake of soy, increased obesity rates and increased stress on our kids. These are simply theories, however, with little scientific evidence behind them.
Studies into early puberty are ongoing. Factors such as race and genetics are known to contribute to when a child will start puberty. For example, African-American boys and girls begin the process of puberty earlier than Hispanic or Caucasian boys or girls. In addition, girls tend to get their first period around the same age as their mothers did.
Is Early Puberty Normal?
The majority of the time, early development of puberty is within the realm of normal. The American Academy of Pediatrics (AAP) even suggests that signs of puberty starting before eight years old for girls or before nine years old for boys — such as pubic hair development or body odor — may occur before a child has started true puberty, and the majority of the time are not a cause of concern. Premature thelarche is when breast tissue develops in young children. This is normal as long as there is no pubic or underarm hair development associated with it.
Even though changes in our children are known to be happening sooner, there are times when you may want to consult your child’s pediatric healthcare provider. Progressive breast development before age eight for girls or penile enlargement before age nine for boys has a small risk of being associated with an endocrine issue, according to the AAP. It may be worrisome if growth plate closure, which occurs normally during puberty, happens earlier than normal. Consult your child’s provider to determine if there may be an underlying biological reason for early puberty if your child is under age eight and showing these signs.
Precocious (early) puberty — sexual development before the age of eight in females or nine in males — may result from premature activation of hormone release due to certain tumors or endocrine disorders. Precocious puberty occurs more frequently in girls, but 80 to 90 percent will simply be the result of normal variation, with no real reason for this being identified.
Males who develop precocious puberty are more likely to have an underlying biological cause identified, but about half of these cases will still not have an identifying reason recognized.
In contrast, if your child is a 13-year-old female or a 14-year-old male and has not shown any physical signs of puberty, the cause may need to be investigated further. Your child’s provider may need to explore anorexia or bulimia, anemia, poor nutrition or other conditions that affect bone age.
Puberty that occurs outside the average time frame is usually a normal finding, and as parents you should recognize that you are not the only ones seeing this happening in your kids. Precocious or delayed puberty, however, may result in rare cases from a genetic or endocrine disorder or a tumor and your child’s provider should investigate. For puberty that does not start within the typical period of time, a work-up may be needed. Labs may need to be drawn and referral to a pediatric endocrine specialist, a nurse practitioner or provider who focuses on child hormones, may be warranted. There are medications available that may aid in delaying puberty or helping puberty to start.
The psychosocial impact that early or late puberty may have on a child should always be considered. Puberty is a stressful and confusing time, and if it’s happening earlier or later than your child’s peer counterparts, may put an even bigger emotional burden on your child. When approaching the time of puberty in general, it is important to talk to your child about changes that will happen. Even if your son or daughter has not started showing signs of puberty, your child’s friends may have, and you should thus alleviate any anxiety and answer questions your child may have. Do not hesitate to ask your child’s provider for recommendations as to how to address the subject. There are also a number of books and online programs that can aid in your child’s education, including. American Girl: The Care and Keeping of You; pbskids.org/itsmylife – It’s My Life; U.S. Department of Health and Human Services, Office on Women’s Health: Body Works Toolkit; CDC’s Positive Parenting Tips.
Sarah Gosian, RN, CCRN, is an RN with five years of experience in pediatric critical care. She is nearing the end of her studies and will soon be a pediatric primary care/acute care NP.