Precocious puberty is when a child's body begins changing into that of an adult (puberty) too soon. When puberty begins before age 8 in girls and before age 9 in boys, it is considered precocious puberty.
Puberty includes rapid growth of bones and muscles, changes in body shape and size, and development of the body's ability to reproduce.
The cause of precocious puberty often can't be found. Rarely, certain conditions, such as infections, hormone disorders, tumors, brain abnormalities or injuries, may cause precocious puberty. Treatment for precocious puberty typically includes medication to delay further development.
Precocious puberty signs and symptoms include development of the following before age 8 in girls and before age 9 in boys.
Make an appointment with your child's doctor for an evaluation if your child has any of the signs or symptoms of precocious puberty.
To understand what causes precocious puberty in some children, it's helpful to know what causes puberty to begin. The brain starts the process with the production of a hormone called gonadotropin-releasing hormone (GnRH).
When this hormone reaches the pituitary gland — a small bean-shaped gland at the base of your brain — it leads to the production of more hormones in the ovaries for females (estrogen) and the testicles for males (testosterone).
Estrogen is involved in the growth and development of female sexual characteristics. Testosterone is responsible for the growth and development of male sexual characteristics.
Why this process begins early in some children depends on whether they have central precocious puberty or peripheral precocious puberty.
The cause for this type of precocious puberty often can't be identified.
In central precocious puberty, the puberty process starts too soon. The pattern and timing of the steps in the process are otherwise normal. For the majority of children with this condition, there's no underlying medical problem and no identifiable reason for the early puberty.
In rare cases, central precocious puberty may be caused by:
Estrogen or testosterone in your child's body causes this type of precocious puberty.
The less common peripheral precocious puberty occurs without the involvement of the hormone in your brain (GnRH) that normally triggers the start of puberty. Instead, the cause is release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland.
In both girls and boys, the following may lead to peripheral precocious puberty:
In girls, peripheral precocious puberty may also be associated with:
In boys, peripheral precocious puberty may also be caused by:
Factors that increase a child's risk of precocious puberty include:
Possible complications of precocious puberty include:
Some of the risk factors for precocious puberty, such as sex and race, can't be avoided. But, there are things you can do to reduce your child's chances of developing precocious puberty, including:
To diagnose precocious puberty, the doctor will:
X-rays of your child's hand and wrist also are important for diagnosing precocious puberty. These X-rays can help the doctor determine your child's bone age, which shows if the bones are growing too quickly.
Your child's doctor will also need to find out which type of precocious puberty your child has. To do so, he or she will perform a test called a gonadotropin-releasing hormone (GnRH) stimulation test.
In this test, the doctor will take a blood sample, and then give your child a shot containing the GnRH hormone. More blood samples are then taken over a certain period of time to check how hormones in your child's body react. In children with central precocious puberty, the GnRH hormone will cause other hormone levels to rise. In children with peripheral precocious puberty, other hormone levels stay the same.
Other tests also are necessary for children with peripheral precocious puberty to find the cause of their condition. For example, the doctor may run additional blood tests to check other hormone levels or, in girls, he or she may do an ultrasound to check for an ovarian cyst or tumor.
The primary goal of treatment is to enable your child to grow to a normal adult height.
Treatment for precocious puberty depends on the cause. However, in some cases, there is no identifiable cause for precocious puberty. In this instance, your child may not need treatment depending on his or her age and how rapidly puberty is progressing. Your child's doctor may want to monitor your child for several months to see how he or she is developing.
Most children with central precocious puberty, in which there's no underlying medical condition, can be effectively treated with medication. This treatment, called GnRH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide acetate (Lupron Depot), or triptorelin (Trelstar, Triptodur Kit), which delays further development. Some newer formulations can be given at longer intervals.
The child continues to receive this medication until he or she reaches the normal age of puberty. On average, 16 months after he or she stops receiving the medication, the process of puberty begins again.
Another treatment option for central precocious puberty is a histrelin implant (Supprelin LA), which lasts for up to a year. This treatment is effective for central precocious puberty without the pain and inconvenience of regular injections, but it does require a minor surgical procedure. The implant is placed under your child's skin through an incision in the inner area of the upper arm. After a year, the implant is removed and, if necessary, replaced with a new implant.
If another medical condition is causing your child's precocious puberty, treatment of that condition is necessary to stop the progress of puberty. For example, if a child has a tumor that's producing hormones and causing precocious puberty, puberty usually will stop when the tumor is surgically removed.
Children who begin puberty early may feel different from their peers. Although there are few studies on the emotional effects of precocious puberty, it's possible that feeling different can cause social and emotional problems, including early sexual experimenting. As a parent, you also may have trouble dealing with your child's early development.
If you, your child or other members of your family are having difficulty coping, seek counseling. Psychological counseling can help your family better understand and handle the emotions, issues and challenges that accompany precocious puberty. If you have questions or would like guidance on how to find a qualified counselor, talk with a member of your health care team.
You're likely to start by seeing your child's pediatrician or a family doctor. Or you may be referred immediately to a doctor who specializes in the treatment of hormone-related conditions in children (pediatric endocrinologist).
Here's some information to help you get ready for your appointment and know what to expect from your child's doctor.
List questions for your child's doctor to help make the most of your time together. For precocious puberty, some basic questions to ask your doctor include:
Don't hesitate to ask any other questions you have.
Your doctor is likely to ask you a number of questions about:
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