According to a recent study by the American Academy of Pediatrics, the average age of puberty in girls may be declining. Diane Stafford, MD, assistant clinical director of the Division
of Endocrinology at Children's Hospital Boston, comments on the trend.
For girls, the hallmark of puberty is breast development. Early growth of public and axillary hair may be cause for concern, but it's not a true indicator of puberty. A girl age 8 or younger that begins developing breast tissue could be considered precocious and may warrant further evaluation. While breast development between 7 and 8 years may be normal, rapid progession or development significantly earlier than normal for the family history may be problematic.
Even when the data is adjusted to account for an average increase in body mass, the numbers still indicate that girls are hitting puberty slightly earlier. It's important to remember that with overweight girls, visual observation of breast development may not be enough. Palpation to differentiate fatty tissue from breast tissue is a better way to determine if puberty has started.
One of the most significant medical ramifications of precocious puberty is that the patient is likely to grow up to be far shorter than her peers.
Many children have difficulty handling the emotional and physical changes of early puberty. The most common concerns for these kids are that they are more likely to feel different from their peers, more likely to be a target for bullies and more likely to have sexual contact before they are cognitively ready.
The decision to halt puberty with treatment is more subjective than most things we do in medicine. We approach it on a case-to-case basis to ensure that it's the right course of action for the patient. A girl with breast development prior to age 6 should certainly be referred for evaluation. Girls with breast development between 7 and 8 with no family history of early puberty or with short stature may also warrant evaluation. In any case where the pediatrician, parent or child is concerned about early puberty, a referral to an endocrinologist to discuss treatment can be a good idea.
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