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The Precocious Puberty Phenomenon

Kim Kuhn, Amanda Bardwell

Alicia Martin, a mom of three in New York City, will never forget that day in Central Park. “My daughter, who had just turned five, asked me to pick her up and put her on one of the rocks,” she recalls. “When I did, I smelled a terrible odor, and I couldn't figure out where it was coming from. Then I realized the stench was my daughter's body odor! Later that evening, I noticed she had started growing underarm hair. I was terrified, and my mind was racing. ‘She's going to be wearing a bra and getting her period by the time she's in kindergarten! She'll be robbed of her childhood. How is she going to deal with this? How will I?’”

Earlier puberty—the transition period that ends with sexual maturation and the ability to reproduce—is a real phenomenon. According to the National Institutes of Health, puberty usually begins between ages 8 and 13 in girls and lasts about two to five years. Breast development is typically the first noticeable sign, as well as armpit and pubic hair, acne, a growth spurt, and, last, menstruation. Now, an increasing number of girls are starting puberty earlier than age 8.

What's Normal, Anyway?

When Jennifer Fisher's daughter, Kylie, was 6, she walked up to her mom after using the bathroom and said, “Mommy, I have hair down there.” Fisher dismissed her: “Oh, no…you don't.” But then Kylie showed her. “I was in shock,” says Fisher. “I still carried Kylie around sometimes. She needed help getting dressed! All I could think was, ‘This can't be right! This is what happens to twelve-year-olds, not first-graders.’”

Actually, that's no longer the case. Until the late 1990s, experts went by the results of a 1960s study that settled on a typical age of 11 for the start of puberty. Marcia Herman-Giddens, an adjunct professor of maternal and child health at the University of North Carolina, did, too—until she noticed all the girls with breast development or pubic hair by age 7 in her clinic. She published a game-changing study in Pediatrics in 1997 that found Caucasian girls were developing breasts at age 9; African-American girls at age 8. Today some little girls are starting even younger than that, a condition known as precocious puberty. In fact, one recent study in Pediatrics found that by age 7, more than 10 percent of Caucasian girls had started growing breasts (double the percentage from a decade earlier), along with almost 25 percent of African-American girls and 15 percent of Hispanic girls. And by age 8, those percentages spiked to 18, 43, and 31, respectively.

Figuring out whether your daughter really is starting puberty, though, is a little tricky. Pubic hair must be a surefire sign, right? Not unless it's accompanied by breast development or a growth spurt, explains Paul Kaplowitz, M.D., author of Early Puberty in Girls and division chief of endocrinology and diabetes at Children's National Medical Center, in Washington, DC. “Pubic and/or underarm hair and body odor alone is usually simply an early maturation of the adrenal glands that rarely requires treatment.” Also, he adds, in overweight girls it's difficult to distinguish breast development from fat tissue—something an expert can determine.

But whether your third-grader is going through precocious puberty or is “just” on the earliest dawn of normal, odds are neither of you is happy about it. Throughout her childhood in Lewisville, TX, Madeline Staddon was like other girls her age: She had a giant dollhouse and a basket of Barbies that she loved to dress up with her friends. But at age 7, Staddon started developing breasts, which she thought were “something weird on her chest.” Around the same time, she grew pubic and underarm hair. And then, at age 9, just as she was settling into fourth grade, she got her period. “I was freaked out, especially since I was the only girl this was happening to,” says Staddon. “The doctors told me I was going through puberty, but I didn't understand why all of these grown-up things were happening to me when I was just a kid.”

What's Going On?

Experts can't agree on a definitive cause behind most cases of early puberty, but they've noted some possible contributing factors. For instance, several studies have shown that girls who weigh more tend to have an earlier onset of puberty. “Probably the biggest factor driving puberty earlier is that girls today have higher body mass indexes than their mothers' generation did,” says Frank Biro, M.D., director of adolescent medicine at Cincinnati Children's Hospital and coauthor of studies on early puberty. “The body knows how much energy is stored in fat tissue, by way of a hormone, leptin. When leptin levels are high enough, the brain gets the message that it's OK to start puberty. Heavier girls, with more fat tissue, have more leptin.”

One theory, reported in the journal Child Development, is tied to evolution. Some studies have shown that kids raised in stressful homes go into puberty earlier. In tough times, a species' survival is best served if its offspring mature (and hence reproduce) as soon as possible. That seems plausible—families are under more pressure than ever—but it's very hard to prove, and, thus, controversial.

Other research seems to suggest that chemicals might be a culprit. For instance, a few small studies, such as one done in Puerto Rico and reported in the journal Environmental Health Perspectives, have shown an association between premature breast development and high exposure to phthalates, chemicals found in many common household products. Others implicate the hormones in chicken and milk.

However, “there is no clear evidence so far that specific environmental chemicals are a big factor in early puberty,” explains Dr. Kaplowitz. This may be because the exposure to those chemicals came years before, he notes. Anecdotally, making changes might work—one mom says removing dairy, sugar, and white flour from her daughter's diet seemed to slow down her development. However, plenty of other parents would disagree. Fisher says, “I was careful about what Kylie ate, I made sure she exercised, I paid more for organic milk, and I even tried herbs that supposedly help eliminate estrogen. Nothing made a difference.”

The Emotional Side of Early

It's clear girls are showing sexual characteristics such as pubic hair and breast development at much earlier ages than girls did 30 to 40 years ago. And that's not easy. Staddon felt isolated because none of her friends could relate. “I was really embarrassed and self-conscious,” she notes. “Mom said, ‘Everyone goes through it,’ but I cried, ‘None of my friends are.’”

Along with a disconnect from peers, another major issue affecting a girl going through early puberty is that she'll look older than she really is. The reason—precocious puberty or being on the so-called early side of normal—hardly matters. “Whenever there's a mismatch between how a child appears and her age, that's a cause for concern,” says Jane Mendle, Ph.D., assistant professor in the department of human development at Cornell University College of Human Ecology and author of multiple studies on the psychological outcomes associated with early puberty. “An early-maturing girl might be placed in a situation that is difficult to handle, such as being asked out by older boys, offered alcohol, or given more responsibility by her parents. But it's all an illusion—just because a child looks more mature compared with the other kids doesn't mean she is.” Possibly because of this age/looks discrepancy, early puberty is linked to an increased likelihood of depression, eating disorders, and substance-abuse problems. However, as Mendle is quick to point out, these are not absolutes. “Early puberty is a risk factor, but plenty of girls are resilient and navigate it just fine,” she says.

Girls Who "Look Older" Can Be Put In Situations They're Not Ready to Handle 

Along with the psychological effects, a primary reason an endocrinologist might recommend treatment is the effect on adult height. Though many children who enter puberty at 7 or 8 might start off taller than their peers, they actually can wind up shorter because they stop growing earlier. “In order for bones to grow to their genetically determined length, you need a certain amount of time,” explains Luigi Garibaldi, M.D., clinical director of pediatric endocrinology at Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center. “If puberty starts too soon, the window of growth is smaller, so they stop growing earlier.”

Can It Be Stopped?

In many cases, experts don't recommend medical intervention to halt puberty. “It's girls who are maturing so fast that they're at risk of growth or psychological problems that we treat,” says Dr. Garibaldi.

The psychological aspect is somewhat subjective, and thus something you'll want to discuss with your pediatrician. The growth issue is more clear-cut. An endocrinologist can help you determine whether or not your child needs treatment based on blood tests, an X-ray of the hand to determine bone age and growth potential, and sometimes an MRI of the brain or pituitary gland and/or an ultrasound of the uterus and ovaries to rule out underlying conditions (in rare cases, precocious puberty can be the symptom of a more severe disorder). Then, if you and your doctor determine it's best to stop puberty, the options are to treat the underlying medical condition directly, if it's known, or to use medication—such as an injection (Lupron Depot) or an implant (Supprelin)—that stops the pituitary gland from producing the hormones that trigger puberty. Such treatment can slow down or even reverse the signs of puberty—and once the child stops the medication, she will immediately resume puberty.

Treatment Can Slow Down or Even Reverse the Signs of Puberty — But It's Not Always Recommended 

If you hear your child doesn't need treatment, though, that may not make you feel much better. You want to do something to help your daughter. And you can. “A good parent-child relationship, with a lot of warmth, little criticism, and an open dialogue, can be one of the best buffers against the negative psychological effects of early puberty,” says Mendle.

Jennifer Fisher agrees. By age 7, Kylie was the tallest girl in her class. By 9, she had pimples, started to grow breasts, and seemed to have mood swings. Doctors never recommended treatment, and after spending months trying to find an answer, Fisher decided to channel all of her energy toward helping her daughter cope with her changing body. “For a long time, I focused on fixing what I perceived to be a problem. But I realized that I couldn't control Kylie's body, but I could control my attitude toward it,” she says. “I can create a positive environment by being open with her and make this passage—whether buying a bra, shaving, or getting her period—special. I tell her, ‘This is exciting. It's nothing to worry about.’”

Education is key. Talk to your doctor or turn to reputable sources such as healthy children.org to find out what's normal. Some girls want to talk about it; others don't. Take cues from your child, suggests Mendle. You can also give her resources that will teach her what to expect, such as The Care & Keeping of You: The Body Book for Girls, an American Girl book. Staddon's mom gave her the classic Are You There God? It's Me, Margaret. She related to the character—a girl confused by puberty.

Bottom line: Having a child go through early puberty is frightening, but try to keep it in perspective. As Alicia Martin says, “The fear was absolutely overwhelming, but in retrospect it was a blip in her childhood. She's now a happy, healthy thirteen-year-old. I just want other moms to know that they will get through this.”

And so will your girl. “By the time they were thirteen, my friends had all caught up,” says Staddon. “Actually, it was pretty cool because, since I was ‘in the lead,’ I could support them. I'd say, ‘I've been down this road before. I can help you.’”

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