Precocious Puberty

When children’s bodies begin developing into adult bodies much earlier than expected, it can raise concerns and questions for families. Understanding what is happening and why can help parents support their child through this challenging time.

Table of contents

• What is precocious puberty?
• Signs and symptoms
• Types of precocious puberty
• Causes
• How precocious puberty affects children
• Diagnosis
• Treatment
• Supporting your child

What is precocious puberty?

Precocious puberty is when children’s bodies begin changing into adult bodies too soon^[1]. Puberty is the natural process during which children develop the physical and sexual features of adults. In their brain, an area called the hypothalamus releases chemicals that cause another gland, the pituitary gland, to release hormones. These hormones stimulate the sex glands to produce more hormones—estrogen in girls and testosterone in boys—which cause the body to mature^[1].

Most of the time, puberty occurs after age 8 in girls and after age 9 in boys^[1]. Precocious puberty is when these changes begin before age 8 in girls or before age 9 in boys^[4]. However, Black, Hispanic, and Native American children might naturally reach puberty earlier than these ages^[1].

The condition is more common in girls than in boys. About 20 out of every 10,000 female children are affected by early puberty, while fewer than 5 in every 10,000 male children experience it^[5].

Signs and symptoms

Children with precocious puberty develop the same physical changes that occur during normal puberty, but at a much younger age^[1].

In girls, signs of precocious puberty include breast growth before age 7 or 8, the start of menstruation (periods) before age 10, and rapid height growth before age 7 or 8^[4]. In boys, the signs include enlargement of the testicles or penis and rapid height growth before age 9^[4].

Both girls and boys may develop pubic or underarm hair, voice deepening, acne, and mature body odor^[4]. Children with precocious puberty also experience rapid growth spurts^[1].

Types of precocious puberty

There are two main types of precocious puberty based on what causes the early development^[2].

Central precocious puberty, also called gonadotropin-dependent precocious puberty, is the most common type^[3]. This occurs when the brain releases hormones too early, which causes the ovaries or testicles to produce sex hormones too soon. With this type, puberty starts too early but develops in the normal sequence^[1].

Peripheral precocious puberty, also called gonadotropin-independent precocious puberty, is not triggered by the early release of hormones from the brain^[3]. Instead, it is caused by problems with the reproductive organs (ovaries or testicles) or adrenal glands, or by exposure to sex hormones from outside the body^[5].

Causes

The cause of precocious puberty often cannot be found, especially in girls^[1]. In 90 to 95 percent of girls with central precocious puberty, the cause is idiopathic, meaning doctors don’t know for certain why it happens^[3]. In boys, however, there is more likely to be an underlying medical reason^[4].

When a cause for central precocious puberty can be identified, it may include brain tumors, brain trauma, brain infections, brain abnormalities, or radiation treatment^[5].

Peripheral precocious puberty may be caused by tumors or growths on the ovaries, adrenal glands, testicles, pituitary gland, or brain^[7]. Other causes include genetic conditions such as McCune-Albright syndrome, severe hypothyroidism (when the thyroid gland doesn’t make enough thyroid hormone), and adrenal gland disorders^[5]. Sometimes, exposure to creams, medications, or supplements containing estrogen, testosterone, or other sex hormones can trigger peripheral precocious puberty^[5].

In many cases, precocious puberty can run in families^[4].

How precocious puberty affects children

When puberty ends, growth in height stops. Because children with precocious puberty start growing early, their skeletons mature and bone growth stops at an earlier age than normal^[4]. Most children with the disorder grow faster than their peers at first, but they also stop growing before reaching their full genetic height potential^[7]. Their early growth spurt may make them initially tall when compared with their peers, but they may stop growing too soon and end up at a shorter height than they would have otherwise^[4].

Going through puberty early can also be hard for children emotionally and socially^[4]. Children may not be emotionally prepared for the physical changes of puberty and may feel self-conscious about these changes^[3]. Girls with precocious puberty may be confused or embarrassed about getting their periods or having enlarged breasts well before any of their peers. They may be treated differently because they look older^[4].

Even emotions and behavior may change in children with precocious puberty. Girls can become moody and irritable. Boys can become more aggressive and may develop a sex drive inappropriate for their age^[4].

Diagnosis

Diagnosing precocious puberty involves reviewing the child’s and the family’s medical histories, doing a physical exam, and running blood tests to measure hormone levels^[9]. X-rays of children’s hands and wrists are also helpful because they can show if the bones are growing too quickly^[9].

A test called a gonadotropin-releasing hormone stimulation test helps identify which type of precocious puberty a child has^[9]. The test involves taking a blood sample, then giving the child a shot containing the hormone. More blood samples taken over a period of time show how hormones in the child’s body react. In children with central precocious puberty, the hormone causes other hormone levels to rise. In children with peripheral precocious puberty, other hormone levels stay the same^[9].

Children with central precocious puberty may need an MRI of the brain to check for brain issues that might be causing the early start of puberty^[9]. Children with peripheral precocious puberty need additional testing to find the cause of their condition, which might include more blood tests to check hormone levels or, in girls, an ultrasound to check for an ovarian cyst or tumor^[9].

Treatment

The primary goal of treatment is to help children grow to a normal adult height^[9]. Treatment also helps address the emotional and social challenges that come with early puberty.

Long-acting analogs of GnRH (gonadotropin-releasing hormone), also called GnRH agonists or puberty blockers, have been the gold-standard treatment of central precocious puberty worldwide for many years^[11]. These medications work by stopping the production of sex hormones, which delays puberty^[3]. Treatment usually includes medicines given as monthly injections, though newer formulations that last three months or six months, and even a yearly implant, are now available^[11].

With proper treatment and care, most children with precocious puberty will ultimately experience a normal and happy adolescence^[3]. Treatment, especially when given early, helps children reach a normal adult height^[7].

Not all children with central precocious puberty require treatment^[14]. In some cases, especially if the child is close to the borderline age (7 to 8 years) and the progression of puberty is not rapid, the doctor may recommend careful observation instead of medication.

For peripheral precocious puberty, treatment focuses on addressing the underlying cause, such as removing a tumor or treating a hormonal disorder^[5].

Supporting your child

Parents and caregivers play a crucial role in helping their child through this challenging time. Talk to your child honestly about what is happening. He or she may be confused or embarrassed about being different from other children^[18]. Explain that his or her body has started developing early but is growing normally^[18].

Help your child build healthy self-esteem. Encourage your child to talk about concerns and problems making friends. Although your child may look older, remember to treat your child according to his or her age^[18]. Be positive, as children usually value an adult’s interest and praise^[18].

Make an appointment with your child’s healthcare professional if your child has symptoms of precocious puberty^[1]. Follow-up care is a key part of your child’s treatment and safety^[18].