Precocious Puberty and Its Physical and Psychological Effects

Published on: December 11, 2016

What is precocious puberty, and what can parents do to help their children through it? By Piyarat Lertbunnaphong, M.D.   Menstruation in young girls is not a dangerous issue or ordinarily be cause for alarm. However, if the first menstrual cycle (menarche) occurs too early, it can be a symptom of precocious puberty. Early menarche as a symptom on its own is not a clear indication of precocious puberty; the best course of action is to visit a pediatric endocrinologist who can perform an examination and provide a diagnosis.

Normal puberty

Normal puberty for young girls usually starts at around nine to ten years of age, and for young boys at about 11 to 12 years of age. In normal puberty, hormones from an area of the brain called the hypothalamus signals the pituitary gland to produce hormones known as gonadotropins (luteinizing hormone [LH] and follicle stimulating hormone [FSH]). These gonadotropins in turn stimulate the sex glands to produce sex hormones.
Unusual development at an earlier age than is considered normal can have significant psychological consequences
In girls, it is the ovaries that produce the main female sex hormones that stimulate breast development, rapid growth, and menstruation. In boys, it is the testes that produce the male hormones, causing the formation of muscles in the body, pubic and underarm hair, and spontaneous ejaculations. The female sex hormone (estrogen) generates increased bone growth velocity and closure of the epiphyseal growth plate (epiphyseal fusion), which causes both girls and boys to stop growing. The estrogen hormone is produced by the ovaries and also by fat cells. In the case of boys, if the male hormone (testosterone) is being produced in excess by the testes, this can stimulate the conversion of testosterone to estrogen, causing breast swelling or enlargement and, finally, causing the child to stop growing taller.  

Precocious puberty

Signs and symptoms

Precocious puberty is found in both males and females. In a girl, the first visible evidence will often be a breast bud, which is a small lump found under one or both nipples, usually before the age of eight. The child will grow unusually fast, and can begin menstruating before the age of nine. For boys, the symptoms usually include testicular enlargement of more than 2.5 cm in length, rapid height growth, acne, and growth of pubic, underarm, facial hair, etc. Precocious puberty is about eight to twenty times more commonly found in girls than in boys.[1]
Early menarche as a symptom on its own is not a clear indication of precocious puberty
Special attention should be given to girls with precocious puberty before age six and boys with precocious puberty before age nine. Often the symptoms are latent or hidden, at least initially, and prompt attention and examination by a pediatric endocrinologist is of great importance. For example, in a family where the parents are somewhat on the shorter side, if your daughter of seven to eight years old is rather plump or overweight and appears to be growing taller more rapidly than usual, you may wish to take steps to make an appointment with a doctor in order to correctly diagnose the cause. If a child is going through precocious puberty, then not only will they grow faster than usual; they will also stop growing faster than usual.   

Psychological effects

Unusual development at an earlier age than is considered normal can have significant psychological consequences. For instance, boys may have a lot of body hair or body odor, causing them to feel unwelcome by friends and uncomfortable in general society, engendering feelings of shyness, fear or lack of assertiveness and personality issues. 
Special attention should be given to girls with precocious puberty before age six and boys with precocious puberty before age nine.
Of particular concern is precocious puberty in girls, as it can have very negative or damaging psychological effects from criticism in public or in social groups. Very pronounced and obvious symptoms can sometimes lead to young girls feeling unable to handle or accept the disparagement or negative social consequences or opinions of boys and others, and can, in extreme cases, cause issues of sexual harassment or abuse.  

Causes and factors

There are a variety of causes and factors contributing to the onset of precocious puberty. One possibility is heredity—perhaps the father experienced early puberty or the mother began menstruating before the age of 9. There may be unusually accelerated functioning of the reproductive hormones, for unknown reasons or perhaps due to tumors or growths. Another possible factor could be nutrition or dietary deficiencies, such as eating foods contaminated with synthetic estrogens and/or active substances like estrogen, crispy or crunchy snacks, fried foods, greasy foods, and fast foods. Another important contributing factor is overeating, causing childhood obesity, especially in girls who are overweight or obese as they have a tendency towards premature puberty and early onset of the menstrual cycle.  

What to do when early puberty happens

Parents should give their sons and daughters separate rooms when they reach puberty. They will understand that they are growing up and should have their own rooms. Parents should also give their children advice about reaching adulthood.  Height may affect personality and future opportunities, so in order for children to grow properly, please seek medical advice from a pediatric endocrinologist when a daughter and son are six and eight years old, respectively, if they may be showing signs of early puberty.  When the daughter complains of sore nipples or the son is growing tall rapidly, parents can help their children through all of the changes by following these tips: ▶ Nutrition Some protein-rich foods will help trigger a release of growth hormones. Eat nutritious foods from the five groups, as well as vitamins and minerals such as calcium in their proper daily amounts. Avoid non-organic meats as they are loaded with puberty-inducing chemicals. There is evidence that obesity also contributes to earlier puberty in girls.[2] ▶ Deep sleep According to a recent study of growth hormones released daily by the anterior pituitary gland, in growing children, 50% of these hormones are released between 10pm and 2am during hours of deep sleep.[3] It is, therefore, recommended that children go to bed no later than 9pm. ▶ Exercise Growth hormones are released more after exercise. Children should exercise for 30 to 60 minutes at least five times a week.   In extreme cases, early puberty decreases predicted height drastically. Medication can be given to temporarily reduce hormones, delay bone development, and extend the time for height growth. A monthly injection of the medication may increase the final height. However, advice should be sought from a pediatric endocrinologist to determine the best course of action.   References
  1. G Teilmann et al. (‎2005). Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics, 116:1323-8
  2. JM Lee et al. (‎2007). Weight status in young girl and the onset of puberty. Pediatrics, 119:e624-30; and KK Ong et al. (2009). Infancy weight gain predicts childhood body fat and age at menarche in girls. J Clin Endocrinol Metab, 94:1527-32
  3. Huseman et al. (‎1986). Endogenous dopaminergic dysfunction: a novel form of human GH deficiency and short stature. J Clin Endocrinol Metab, 62:484-490
Photo by Caleb Woods.  

About the Author

Dr. Piyarat is a Pediatric-Endocrinologist. She graduated from the Faculty of Medicine Siriraj Hospital with a Medical Degree, and also is certified by the Thai Board of Pediatrics and Thai Sub-Board of Pediatric-Endocrinology and Metabolism. She currently works at Samitivej Children’s Hospital (Sukhumvit Campus).
The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects. BAMBI News welcomes volunteer contributors to our magazine. Please contact