A lot has changed in the post COVID world. The children, especially, have had to bear the brunt of being locked inside their homes, without much physical activity, having to spend time sitting in front of their screen for their online classes. This has led to a number of issues, one of them being precocious puberty.
According to a Times of India report, ‘pediatricians are reporting an increase in the number of cases of precocious puberty in the past year or so. This could be an effect of the lockdown which saw kids holed up in their homes for months, lonely, gaining weight and eating unhealthy food. Globally too doctors are reporting this trend’.
What is precocious puberty?
Puberty is when children develop both physically and emotionally into young men and women. Puberty starts on an average in girls between ages 9 and 13 and in boys between 9 and 14. When a child’s physical signs of sexual maturity develop too soon and puberty comes early, it is called precocious puberty. Early puberty is when girls have signs of puberty before 8 years of age and boys show signs of sexual maturity before 9 years of age. This includes breast growth, pubic hair and voice changes. Most children with precocious puberty grow fast at first. But they stop growing before reaching their full genetic height potential.
What causes precocious puberty?
There are two types pf precocious puberty-
Central Precocious Puberty- This gonadotropin- dependent disorder is the most common type of precocious puberty. Most children with precocious puberty have this type. The puberty is started by early secretion of hormones called gonadotropins. These hormones cause the testicles and ovaries to make other hormones- testosterone or estrogen. Gonadotropins include luteinizing hormone (LH) and follicle stimulation hormone (FSH). In girls, early puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. There is usually no underlying medical problem or trigger. This can also be hereditary. Precocious puberty is less common in boys and is more likely to be related to another medical problem. This condition is inherited for about 5% of boys.
In rare cases, central precocious puberty may be caused by:
- A tumor in the brain or the spinal cord
- A birth defect in the brain
- Radiation to the brain or spinal cord
- Injury to the brain or the spinal cord
- McCune Albright syndrome– rare genetic disease that causes hormonal issues
- Congenital adrenal hyperplasia-genetic disorders that cause abnormal hormone production by the adrenal glands.
Peripheral precocious puberty- This is a less common form of the disorder, started by the early secretion of high levels of sex hormones- estrogen and testosterone. There is no involvement of the brain or the pituitary gland but is caused because of problems with the ovaries, testicles, adrenal gland, or a severely underactive thyroid gland.
In girls, peripheral puberty may be associated with ovarian cysts or ovarian tumors.
In boys, it may be caused by a tumor in the cells that make sperms or testosterone or a rare disorder called gonadotropin-independent familial sexual precocity caused due to a genetic defect, resulting in early testosterone production.
What are the symptoms of precocious puberty?
There is no distinguishing factor between puberty and precocious puberty except the timing. Common signs in girls include-
- Breast growth
- Pubic and underarm hair
- Early menstruation
Symptoms in boys are-
- Penis and testicles start growing
- Pubic, underarm hair
- Facial hair
- Deepening of voice
For girls and boys, the symptoms include-
- Rapid height growth
- Adult body odour
How is it diagnosed?
The healthcare provider may ask you to share-
- Health history
- Family history
- He may do a physical exam
- Ask for blood tests to check the hormonal levels such as – Testosterone, luteinizing hormone, follicle stimulation hormone, estradiol and thyroid hormone.
- GnRH test- Gonadotropin-stimulating hormone is made by the hypothalamus in the brain which causes the pituitary glands to release gonadotropins. These then cause sex hormones to be made by the ovaries in girls, or the testes in boys. The GnRH test may show the type of precocious puberty.
- Ask for an X-Ray of the hands and wrists of your child to determine the bone age. This indicates to them if the bones are growing too quickly.
- MRI or CT scan to rule out uncommon cause such as tumor in the brain, ovary or testicle but this is rarely asked.
How is Precocious Puberty Treated?
The goal of treatment for precocious is to stop, and possibly reverse the onset of puberty. Treatment depends on the of precocious puberty and the underlying cause. Sometimes, doctors may suggest watching your child for a few months.
GnRH analogue therapy is suggested if your child has central precocious puberty and no other condition. This is administered to your child once in a month, in a shot. This halts the development while they take it. This is given till your child reaches the normal age for puberty.
If there are other underlying causes for precocious puberty, the doctor will advise treating them which will stop the precocious puberty too.
Sometimes, no treatment is needed.
Complications of precocious puberty
Short height- Precocious puberty ends earlier than normal puberty, hence the children with this disorder stop growing at an earlier age and do not reach their optimum height.
Social and Emotional problems- Early puberty will lead to body and mood changes in your child, much sooner than his/her peers. This may make them self- conscious about the changes and may affect self-esteem and increase the risk of depression.
How can parents help?
While as parents, you may worry if you see early signs of puberty in a child, you can help your children cope with it positively.
Always avoid making comments about your child’s appearance.
Offer praise for achievements, even if little.
Most important, consult a counsellor if you see your child suffer from low self-esteem because of precocious puberty.
If you see signs of early puberty in your child, consult your pediatrician, who may guide you to a pediatric endocrinologist. There is nothing to fear and the doctors will put you on a treatment to take care of precocious puberty.For a quick, hassle-free appointment with the best team of doctors, just click on www.boardofdoctors.com. Our expert Pediatricians include Dr Abraham Cherian, Dr. Akshay Ballal, Dr Chittur Radhakrishnan, Dr Edwin Dias, Dr Jagdish Chinnappa, Dr Naveen Kini, Dr Kavitha Bhat, Dr Priya Biswakumar, Dr Ravi Hiremagalore, Dr Sonal Agrawal, and Dr Suresh Kumar Surapaneni.