Early puberty

Why your daughter could start puberty in grade two — and how to help her deal with it

Marcia Kaye 0

When Lizzie Papadakis* started growing dark hair on her legs at age six, her mom, Anne, wasn’t too concerned. She put it down to her husband’s Mediterranean heritage. But when Lizzie developed underarm hair at age seven, body odour at eight and pubic hair at nine, Anne started worrying. “I thought, what’s going on?” says the Newmarket, Ont., mother, who herself had been a late bloomer. “Is it from hormones in the meat, or what?”

She’s not alone in her worries. While boys are largely “safe” from this growing phenomenon, girls today are developing signs of puberty at seemingly much earlier ages than a generation or two ago. Parents are left wondering what’s happening, what’s normal and how best to deal with little girls who seem to be turning too quickly into women.

Fuelling the fear is a widely publicized study from the Cincinnati Children’s Hospital Medical Center, which reported last August that breast development in seven- and eight-year-old girls is twice as common today as it was in 1997. In fact, the study found that breast development begins at age seven in 10 percent of white girls, 23 percent of black girls and 15 percent of Hispanic girls.

Puberty in grade two! Should we be freaking out?

For the most part, no, says Jean-Pierre Chanoine, head of the endocrine and diabetes unit at BC Children’s Hospital in Vancouver. Very early puberty — or precocious puberty, as doctors call it — should be checked out by your GP or paediatrician to rule out any underlying problems. However, what some parents deem “early” is increasingly categorized as “normal.” A generation ago, doctors considered eight to be the minimum age for normal breast development in girls.

Today, it’s seven. “We don’t call it precocious puberty unless breast development starts before age seven,” says Chanoine. In girls, the usual order of things is breast development, pubic hair, underarm hair, first period; in boys, larger genitals, pubic hair, facial hair, deeper voice. But the order can change, and growth spurts can happen anytime throughout the process. When it comes to precocious puberty, in girls it’s the breast development that counts, and in boys enlarged genitals; doctors don’t worry much about other signs such as BO or even pubic hair. A 2008 University of Calgary study found that in the majority of girls who grow pubic hair before age eight (and boys before age nine), the other markers of puberty will arrive at the normal times.

What’s considered normal today? On average, girls in several parts of the world are growing breasts much earlier than they used to. Research from Denmark’s Rigshospitalet in Copenhagen found that the average age for breast development in girls was 9.86 years in 2006, down from 10.88 in 1991. That’s a full year sooner.

But, interestingly, during that same 15-year time frame, the age of the first period changed by only a few months, dropping from 13.42 to 13.13. So why the disconnect between the big change in age of breast development and the tiny change in age of first menses? “Nobody has a good answer for that,” Chanoine says, “but it does support the theory of environmental causes.” He explains that if humans were evolving toward earlier puberty in general, all children would reach all the stages of puberty earlier, and that’s not happening; as well, precocious puberty remains a rare occurrence in boys.

Chanoine also says that girls from developing countries who are adopted by families in developed countries show earlier breast development than their counterparts in their home countries. That could suggest that the causes are better nutrition, higher body fat levels and a high-protein, high-fat diet, among other theories.

But it’s definitely not hormones in the chicken we feed our kids. Hormones and steroids have been banned in chicken sold in Canada for more than 30 years. Growth hormones are legal in cattle, but there’s 1,000 times more estrogen in four ounces of cabbage than in a six-ounce serving of beef from treated animals. A recent Danish study found that in 2006, girls aged eight to 10 actually had lower levels of sex hormones than girls in 1991.

So what is the cause? Well, we’re better nourished, we eat more protein, and we’re fatter than ever before. A German study from the Fulda University of Applied Sciences suggested a higher intake of animal protein and total protein was associated with earlier puberty. Other possible factors include obese mothers, overweight girls and inactivity, which can cause obesity.

There are also reports of possible links to chemicals such as phthalates, used in packaging, toys and plastics, and to reduced exposure to natural sunlight. A 2010 study from the University of California at Berkeley found a link between early puberty in girls and the absence of biological fathers in the home, but only for higher-income families. No one knows why, but evolutionary biologists have suggested everything from greater exposure to pheromones from unrelated males, more exposure to artificial light from computer screens, and even weaker bonding with busy working mothers. There’s another theory that today’s “early” puberty isn’t early at all, but has returned to what healthy neolithic girls experienced (around 10,000 years BCE); in countries and eras where food is scarce, puberty is delayed, the theory goes.

In a very small number of girls, the cause of precocious puberty is a cyst or other growth on the ovaries or brain, which can affect the secretion of sex hormones. But Chanoine says there’s usually no reason to worry: “In the vast majority of girls with precocious puberty, we don’t find any cause. It just happens spontaneously.”

Helping kids cope

Once parents have confirmed there’s nothing medically wrong, they need to pass that reassurance on to their daughters. “Things will become a drama if you make them a drama, so don’t turn it into a big deal,” says Line Tremblay, a clinical psychologist and associate professor at Laurentian University in Sudbury, Ont., who has led studies on how girls’ physical development affects them psychologically.

Signs of puberty cause some girls to feel pride, others embarrassment, and still others anxiety. It’s important to recognize that an early-maturing girl will likely feel a little self-conscious, at least initially. “It’s not being early or late that may cause awkwardness — it’s being different,” says Vancouver sexual health educator Saleema Noon. The girl who’s the first in her class to have breasts needs to know that with every passing month, the gap will narrow until all the other girls have caught up (see “Easing into the Changes”).

Early puberty doesn’t always bring a corresponding increase in sexual feelings. “If puberty is progressing gradually, there may be low amounts of hormones circulating, with no changes in sexual feelings, or mood swings,” Chanoine says. Still, it’s important to prepare girls for what’s to come. Noon recommends telling them that sexual feelings are normal and healthy, and that it’s OK to explore your own body in private.

There may be extra attention from older boys, which many early-maturing girls don’t welcome; some girls may feel as though peers are rejecting them because they’ve started to look different. In any case, Tremblay recommends that parents encourage age-appropriate activities and friendships. For early-maturing girls who also show early interest in boys, parents need to have early and frequent discussions of sexual health and sexual risks.

In most cases, though, an early-maturing daughter will still, at heart, be your little girl. “Her body may look older, but in her head she’s still only nine or 10,” notes Tremblay. “Often parents and teachers don’t realize that they’re expecting more mature behaviour from the girl, but she can’t do it.” Even though Kira Kanusky* got her first period in grade four, the Richmond Hill, Ont., girl remained a typical 10-year-old in every other way. And that’s how the family continued to treat her. Her mom, Donna, recalls, “She still played with Barbies!”

What are the risks?

• Precocious puberty can come with a higher risk of breast cancer and other reproductive cancers later in life, probably because of the longer exposure to hormones, such as estrogen. It’s also been linked to higher rates of asthma, adult obesity and type 2 diabetes, and higher levels of triglycerides and bad LDL (low-density lipoprotein) cholesterol. That’s because children who enter puberty early are more likely to also be overweight.

• Boys can experience early puberty, but it’s much rarer than in girls and much more likely to signify an underlying problem, such as a tumour. So if your son notices an increase in the size of his testicles (generally the first sign that puberty has begun) before age nine, a medical checkup is essential.

• Early puberty in girls carries a greater risk of anxiety, aggression and early sexual involvement, but psychologist and researcher Line Tremblay of Laurentian University in Sudbury, Ont., stresses that it’s only a risk, not a predictor, and that age of puberty is only one of many factors. “Our research shows that most girls with early puberty don’t experience any negative outcome. They adjust well.”

• Since the onset of menses promotes bones to stop growing, extremely early puberty may prevent a girl from reaching her full adult height. A hand X-ray can show if a girl’s bones are growing normally.

• If early puberty is deemed dangerous to a child’s health, doctors can stop it with monthly injections of Gonadotrophin-releasing hormone, or GnRH. When the injections stop, development will continue, although Vancouver paediatric endocronologist Jean-Pierre Chanoine says that it won’t necessarily enable girls to reach their full adult height. A 2010 study from the University of Barcelona in Spain reported that early-maturing girls who received metformin, a medication for diabetes, started their periods later, were taller and much leaner, and had healthier blood profiles than early-maturing girls who didn’t get the drug, but more research is needed.

Easing into the changes

The tunic of Ivy Weldon’s* school uniform concealed the changing contours of her chest, but her gym outfit couldn’t. “At first I just thought she was getting jiggly because she’s on the chunky side,” says her mother, Leah, of Aurora, Ont. “But by nine, it was obvious she was developing little boobies.” Leah decided that her daughter needed some type of bra for coverage and comfort.

For early-developing girls like Ivy, being different can be tough. But a little parental guidance and understanding can smooth the way. That’s why, instead of introducing her daughter to a women’s lingerie store, Leah chose a department store that was familiar to Ivy. The girl tried on a couple of what her mom calls “little bra-let things, more like a shaped undershirt,” and chose one that she comfortably wore for the next several months. Now 10, she’s graduated to a bra with small cups. “In the beginning, it bugged her that her strap might be showing,” Leah says. “Now she’s more, like, who cares?”

Kira Kanusky* was just 10 when she got her first period — but she didn’t panic. She’d been armed with information from both her mom and school, and took it in her stride. “She just came to me and said, ‘I think I need a pad,’” recalls her mom, Donna.

Young girls can easily handle a slim pad with adhesive strips or wings, tucked discreetly into backpacks for at-school changes. The younger the girl, the more reminders she might need to change the
pads regularly.

*Names changed by request.

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