Jennifer Benton’s daughter was five years old when her kindergarten teacher pointed out something unusual: the little girl was developing breasts.
“It was really concerning,” said Benton, 39. “She might have been a tall little girl, but she was still a little girl.”
It was 2019, and the little girl loved playing with dolls, going out for ice cream, and watching her favorite show on Nick Jr. “Bubble Guppies.”
“How could her body be bigger than her actual age?” Benton remembers asking. Following the teacher’s suggestion, Benton took her daughter to see their local doctor in Ashtabula, Ohio.
At that time, Benton had never heard of precocious puberty. Having grown up in the Black community, where rates of early puberty are among the highest in the U.S., Benton knew of girls as young as 7 and 8 who had started their menstrual periods or needed bras. But no one in Benton’s family realized that there was an actual medical diagnosis, or that the prescribed hormonal treatments called puberty blockers could help slow physical changes if necessary.
Benton said, “Girls were labeled as being ‘fast’ or ‘too mature for their age.’ Now I understand that they were suffering from precocious puberty.”
How early is too early for puberty?
Research indicates that the average age of onset of puberty—ranging from 8 to 13 years for girls in the U.S.—has declined by about three months every decade over the past 40 years, according to a 2020 global data analysis.
More concerning is that an increasing number of children are showing signs of puberty—breast development, acne, pubic hair, or voice changes—even at an age younger than average. Starting puberty significantly earlier than age 8 for girls or age 9 for boys— a condition known as precocious puberty—can have lasting effects on the child’s mental and physical development.
Precocious puberty remains rare, affecting less than 1% of the population in the U.S., according to the National Institutes of Health. It is not clear why it is occurring more often, although potential causes include diet, obesity, genetics, socioeconomic status, and possible exposure to certain chemicals.
Children who enter puberty earlier than average can be treated as older and may experience inappropriate sexualization by society. Research suggests that precocious puberty may be linked to depression and anxiety. It may also increase the likelihood of developing eating disorders. Surprisingly, it can also prevent children from growing to their full height since growth plates typically close toward the end of puberty.
Dr. Aviva Sopher, an assistant professor of pediatrics at Columbia University Medical Center, said, “Sometimes when children go through puberty early, their bones age much faster.”
Precocious puberty, race, and ethnicity
Evidence indicates that race and ethnicity have clear associations with precocious puberty. A comprehensive study published in 1997 in the journal Pediatrics found that 14.3% of Black girls began developing breasts or pubic hair at age 6, compared to just 3.7% of white girls the same age. Earlier this year, a study published in the Journal of Adolescent Health found that Black girls were more than twice as likely as white girls to start puberty early. Hispanic girls were 1.16 times more likely to show signs of precocious puberty compared to white girls.
From
It’s difficult to know how many young Black and Hispanic children go through early puberty without medical guidance or treatment compared to white children. However, Dr. Karen Klein, an endocrinologist at Rady Children’s Hospital in San Diego, said that medical care for early puberty remains unequal.
She said, “There are definitely issues with access to care.”
Early puberty is on the rise
In the mid-19th century, girls typically started their periods – which usually comes about two years after breast or pubic hair development – at an average age of 16.5.
Today, puberty begins between ages 8 and 13, on average, with girls typically getting their periods at age 12.4.
A recent study conducted by Italian researchers reported a sharp increase in rates of rapid early puberty in girls during pandemic lockdowns. Similar trends have been observed in Korea, Turkey, and parts of China. A smaller study published in the Journal of Endocrinology and Metabolism in New York indicated that stress related to COVID and limited physical activities and weight gain could contribute to these sharp increases.
For boys, who start puberty between ages 9 and 14, they too are beginning puberty earlier than in the past, but early puberty is very rare for young boys compared to girls. When a boy begins puberty very early outside the normal range, it is often due to a serious cause such as a tumor on the brain affecting the gland that produces hormones.
For girls, early puberty often lacks a clear cause, according to Dr. Sovar, a pediatrician at Columbia University.
Doctors stress that not all children need medical help, although they and their parents can benefit from awareness and guidance about what is happening in their bodies. The best treatment approach for an individual child may depend on seriously taking physical changes into account, as well as gaining access to specialists and potentially complex and costly tests.
Ignoring signs as “childhood fat”
When Benton took her 5-year-old daughter to the pediatrician for the first time, the doctor dismissed the changes in her body as “childhood fat.”
Even when Benton mentioned that her daughter was crying much more than usual, the doctor insisted that she didn’t need to worry.
Later, after a specialist diagnosed the child with early puberty, Benton said she wrote to the medical board in Ohio to complain about the missed diagnosis. She then discovered that there was no mention of “early puberty” in her daughter’s medical records or visit notes at all, even after Benton had asked about it several times.
Some doctors had previously suggested that the age of diagnosis for early puberty should be closer for Black girls than for white girls. Shankar responded to this by saying that the diagnosis of early puberty and treatment decisions should not be based solely on race or even age but should be based on thorough hormonal, physical, and psychological assessments.
Shankar said, “Just because they belong to a certain race and ethnic origin does not mean they do not deserve a comprehensive, individualized evaluation to see if they would benefit from treatment.”
However, doctors must be cautious not to “over-medicate,” according to Shankar. In addition to physical tests and examinations, pediatricians should take the time to understand each child’s personality and circumstances to assess who would benefit more from reassurance regarding the changes in their bodies rather than prescribing puberty blockers, which reduce the production of sex hormones in the brain.
On
Although injected medications have proven to be safe for children experiencing early puberty, they can cause rare side effects such as injection site reactions or weakened bones if given to children who do not really need them.
Shankar said, “We need to walk a fine line.”
When do puberty blockers need to be used?
Deciding whether children under 8 years old who show symptoms might benefit from hormone treatments requires careful consideration, according to child experts.
For example, if a young girl begins developing breasts at age 5 or 6, but this growth slows down, she may not start seeing other puberty-related changes until she approaches the typical age range of 8 to 12 and gets her first “normal” period.
For these girls, early puberty may be less concerning and puberty blockers may not be necessary.
Soofer said, “It depends on the age, how advanced it is, how height is affected, the child’s maturity, and how the family feels about it.”
A study published in the Journal of Pediatrics and Adolescent Medicine in 2021 estimated that 44% of girls who began developing breasts between ages 7 and 8 experienced rapid early puberty; about 15% of them needed treatment.
Shankar said, “Those under 7 years old are more likely to need treatment in the majority of cases.”
Olivia underwent X-rays to determine if her bones were growing faster than usual, and she also had an ultrasound to evaluate her ovaries and a series of blood tests to assess hormone levels. All results were above the normal range for her age.
She underwent a four-hour test where blood was drawn from her, received a hormonal injection to stimulate her pituitary gland, and then had additional blood draws to measure how her hormone levels reacted.
At this point, in 2020, her endocrinologist stated that the girl, who was then six years old, was on track to get her period by age 7, given the rapid progression of her puberty.
Benton chose to start her on a puberty blocker called Lupron (leuprolide). Initially, the girl received the injection once a month, then every three months for three years until she was 9.
Long waits and high costs for care
The significant hurdle for some families is the very few endocrinologists who diagnose and treat early puberty. Many children and their families face long waits for appointments and must travel long distances.
Shankar said, “In many cases, accessing care for early puberty faces the same issues we see in accessing healthcare in general. Many of these children may not receive timely care.”
In Benton’s case, she had to drive an hour to the testing location in Cleveland, and after waiting three months for an appointment, each visit with the endocrinologist took 45 minutes.
Experts say insurance companies typically cover the cost of medications when there is a clear diagnosis. Without insurance, prescribed hormones—GnRH inhibitors that interrupt the production of sex hormones in the pituitary gland—can cost thousands of dollars per month.
According to the latest U.S. Census data, the uninsured rate for children was twice as high among Black and Hispanic populations compared to non-Hispanic white children.
Shankar said, “For some families, price can be a major issue, especially when the percentage of cost-sharing is high.”
Most
The companies that sell puberty blockers offer payment assistance programs to help families afford medications, but applying for these programs can be a complicated process.
Benton said that insurance covered her daughter’s Lupron injections after she completed the required tests.
Power of Diagnosis
Patra Rhodes-Wilson’s daughter also began developing breast tissue at age 5. Like Benton, Rhodes-Wilson, who is Black, said she had never heard of early puberty.
Sydney was diagnosed at age 7, but her hormone levels stabilized normally when she was closer to age 9.
Rhodes-Wilson, who lives in Champaign, Illinois, said her daughter benefited greatly from the early puberty diagnosis.
Rhodes-Wilson, 38, said, “There’s a sense of relief that this thing has a real name to it. ‘I’m not crazy’.”
With guidance from Sydney’s doctor, Rhodes-Wilson began paying more attention to the types of foods she kept at home and helped the girl stay active. Rhodes-Wilson believes that lifestyle changes helped prevent Sydney’s hormone levels from rising.
As for her daughter, Benton believes that puberty blockers have returned the girl’s childhood.
Benton said, “She’s a smart girl, but she’s still learning and growing. “I didn’t want anyone to think she had to be wiser than she is.”
Many doctors share concerns that very young girls may be treated as older because of physical changes.
Rhodes-Wilson said, “I’m more protective of her now.”
After their daughters’ experiences, both Benton and Rhodes-Wilson say they have heard from friends, family, and strangers on social media – mostly from Black and Hispanic people – who believe they have also gone through early puberty or have children in the midst of it. Many had never heard of the condition or treatment options.
Rhodes-Wilson said, “African Americans don’t feel we have any other resources, so we just bear it ourselves.” “I tell people now: if something is wrong with your child and your doctors aren’t taking it seriously, seek a new doctor. Try to get the help you need.”
Image: A girl looks through a file with drawings. (Caroline Goutman for NBC News)
Source: https://www.aol.com/puberty-starting-earlier-ever-doctors-200803300.html
Leave a Reply