She’s too young! Is puberty starting early?

I saw a ten year old girl in fifth grade for a check up this week. Her mom mentioned that she had started to develop breasts about a year ago. When I started talking about the girl’s first period, mom’s jaw dropped open. Mom had been 13 when she started—could her daughter be about to have her first period in elementary school? Why?

Puberty is the process through which boys and girls develop into women and men capable of reproduction. It includes the development of sexual characteristics (pubic hair and breasts), other physical changes (a deeper voice, acne, and body hair) and marked increases in both height and weight (the “pubertal growth spurt”.)


A girl’s puberty starts with breast development, which historically was thought to be normal from age 9 to 14. About 2 years after the beginnings of breast development, a girl can expect her first menstrual period. Two years after that, she’ll have reached her adult height and will stop growing taller. This signals the end of puberty.


Boys begin puberty about a year or two after girls, with a normal range of 10-17 years. Boy puberty begins with an increased testicle size. Boys continue to grow for about 6 years after the beginning of puberty—meaning for two years longer than girls. This accounts for most of the height difference between adult men and women.


There are some very normal minor variations in puberty. During the prepubertal years, many girls will develop a small amount of pubic hair, which does not progress. As long as other findings of puberty don’t occur, the appearance of pubic hair in a young girl is not a cause for alarm. Likewise, many boys going through normal puberty will have a small amount of breast tissue develop. This can occur on one or both sides, and though embarrassing for some boys it does not progress and doesn’t mean anything is going on. I tell the boys not to worry, they are not going to grow breasts. Boy who are self-conscious should choose to play for the shirts, not the skins.


What about early puberty? Many studies have documented that in the developed world, girls are indeed starting earlier. Also, we now appreciate that there are differences in normal puberty among girls from different races. Health authorities now recommend that for Caucasian girls, puberty should be considered early only if it begins before age 8, while African-American girls may begin at age 7. Some authors consider even ages 6 or 7 to be normal. No similar decrease in the age of starting puberty has occurred in boys.


Why has puberty become earlier in girls? The best studies show that the age that puberty begins is most closely correlated with improved nutrition and with body fat. Girls from societies with good nutrition begin puberty earlier. Also, as more girls become overweight, the increased total body fat affects the metabolism of female hormones, leading to a decreased age of puberty. Conversely, girls who are very muscular and lean from sports participation tend to have a delayed puberty.


There are several other environmental exposures that parents sometimes wonder about. A lab-manufactured copy of a normal cow hormone, called BST, is injected into many dairy cows to increase their milk supply. Some people believe that this hormone in milk affects the age of puberty. However, milk produced by BST-treated cows does not contain more BST than milk from untreated cows. Most convincingly, developed countries that have restricted the use of BST (including Canada and countries in the European Union) have seen the same drop in the age of puberty as in the United States, where approximately one third of dairy cows are BST-treated. So whether or not they’re drinking milk from BST-treated cows, girls are starting puberty earlier.

Industrial pollutants including PCBs may act as “endocrine disrupters,” influencing the timing of puberty. Although buying organic produce may decrease your family’s exposures to insecticides, there really isn’t any evidence that it will decrease the exposures to industrial contaminants or allow your daughter’s puberty to begin later.


In 2007, cases were reported of boys developing breast tissue after regular application of skin creams containing lavender oil or tea tree oil. These products contain estrogen-like compounds that are absorbed through the skin. Though no cases of early puberty in girls have been linked to these herbal products, they do have a potent hormonal effect, and girls experiencing early puberty should tell their physicians about all medicines and herbal products that they use. In boys, early puberty has also been caused by inadvertent application of their father’s prescription testosterone creams. Fathers who use this cream need to wash their hands!


Why should we identify children with early puberty? Perhaps the most important consequence of early puberty is decreased adult height. Children who start early will end early, and may have fewer years in which to grow. Since pre-pubertal children grow about two inches a year, a girl who begins puberty four years early may end up eight inches shorter than she would have if she had waited. Also, at least in girls, early puberty can be associated with poor self-image, social isolation, and depression.

Though there is a wide range of normal ages at which puberty occurs, the normal age for girls to begin puberty has decreased. If your child is having physical changes of puberty early, a complete physical examination should be performed by your pediatrician. This should always include careful measurements of height and weight. An isolated finding of early pubic hair itself may not be worrisome, but a six year old girl who has breast development, pubic hair, and a big jump in her height is certainly going through full-fledged puberty early. True early puberty should be referred to a pediatric endocrine specialist for further evaluation.

 

© 2008 Roy Benaroch, MD from http://www.PediatricInsider.com

 

updated for formatting only 11/28/2010

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24 Comments on “She’s too young! Is puberty starting early?”

  1. Deb Neff Says:

    Hi. My daughter is nine years old and she has axillary hair, pubic hair, and breast development. Should I be alarmed? She is somewhat overweight, but not obese. Is this normal? Thanks for your time and information!

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  2. Dr. Roy Says:

    Deb,

    Breast development and hair growth as you described is normal at this age. Unless there are other signs of abnormal growth, there’s nothing to be alarmed about. You should discuss her development with her pediatrician at her next routine health visit.

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  3. Melissa Says:

    Hi,my daughter just turned 8 years old in September and has always been above the 95th percentile in height and about 70th percentile in weight. Long and very lean…very active in sports as well. This past week we went to see her Pediatrician due to a lump in her breast. Found out it was a breast bud growing. She also has alot of auxilary hair and a few long pubic hairs as well. Ok, so my question is, am I looking at the posibility of my child who has been taller than most of kids her age all her life ending up one of the shortest? She is 4 ft 10 in at 8 years old now. Thinking of only 4 years to grow isn’t looking good to me. Is there anything I can do to delay this process?

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  4. Dr. Roy Says:

    Melissa, first it had to be determined whether your daughter is really entering puberty. One small breast bud might stay that size and not grow for even a few more years– that’s not puberty. But if both breasts really develop, then you’re right, she probably only has about 4 years left to grow.

    One test that might be useful is a “bone age”, which will show whether her bones are more mature than expected at her age. If that’s the case, she probably is truly entering puberty. There are also blood tests that can be done.

    If puberty is starting now, that would be considered in the range of “normal”– meaning it’s unlikely that there’s any medical reason for it. However, you could still talk with a pediatric endocrinologist about options for slowing or halting puberty to give her more years to grow. There’s no easy way to do this, and you’ll have to weigh the risks (and discomfort) of monthly hormone injections against the potential height gain. But if you’d like to know more about this, you shouldn’t wait any longer to ask for the referral.

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  5. Melissa Says:

    Well I certainly don’t want to put her through any pain or discomfort. I just feel she will have to grow up way too fast if in fact this is puberty. Emotionally, an 8 year old just isn’t prepared for these body changes. Guess I just hope for slow progression and leave the rest to the big guy upstairs:) Oh, one questions regarding your response…does the endocrinologist do the blood work and bone age test? Her Pediatrician sent her for an ultrasound, because she didn’t feel like the lump was a breast bud in the begining. The radiologist thought it to be the beginning of a bud…though he couldn’t rule out it being something different due to it being solid. I guess my worry is that it could possibly be something else, and I don’t fell 100% secure not looking further into it. She didn’t request any bloodwork and I kind of wish more was done to follow her care. It would put me more at ease. I’m probably being a nervous mom. Thanks for you quick response.

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  6. Dr. Roy Says:

    Your pediatrician or an endocrinologist could order blood tests and the bone age– but I’m not sure that all pediatricians would feel comfortable knowing how to interpret these, frankly. Also, bone age xrays can be tricky to read. They should be reviewed by an experienced pediatric radiologist.

    Radiologists can be very … circumspect about what they say. They’ll never give anyone a 100%, “This is what it is” kind of reading. In the language of a radiology report, you’ll always see words like “likely” or “most consistent with” or “cannot rule out…”, and they often suggest more radiology studies to follow up. A good pediatrician should be able to interpret that and help parents understand if there *really* is anything to worry about. When in doubt, repeat the study later.

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  7. robyn Says:

    I recently noticed a very small patch of pubic hair on the labia of my 5 (almost 6) yr. old daughter. She’s an identical twin, and so far have not found any on her sister. If this were truly precocious puberty, would the hair be the first thing showing up? Or are breasts ALWAYS first? I’m trying to allay my own fears, here…she’s flat as a board. What would I look for, though. Lumps, or what? I think you very much for your consideration…

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  8. Dr. Roy Says:

    Robyn, A little pubic hair appearing on a 5-6 year old girl without any breast development is not a sign of early puberty. True puberty will include breast development and an increase in height velocity (a “growth spurt.”) If you’re worried, I encourage you to bring this up with your pediatrician for a good exam to be sure.

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  9. robyn Says:

    Thanks for your response! One more query: What about underarm sweat? I also noticed a faint bit of “bo” under her sister’s arms recently (the one with NO pubarchy), and yes, we had skipped a bath one day and were physically active, but still, would any activity of those glands possibly signal something?

    I will check with our Dr. if any other concerns arise, but didn’t want to rush her in unnecessarily, as she gets very emotionally traumatized by Drs. visits, and shots. I do work for a Orthodontist, and could take a wrist film for reading of bone age, but so far they have not had any “growth spurts”. Just curious about the sweat…
    Thanks for your time,
    Robyn

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  10. Dr. Roy Says:

    Robyn, some “adult odor” is another sign of normal adrenal functioning (like a little pubic hair), and is probably normal, unless accompanied by breast development or rapid growth.

    Unless you’ve got an experienced pediatric radiologist or endocrinologist to read the film, a bone age is worthless. Even when read by very experienced people, there’s a lot of variation. It’s a tough film to read correctly.

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  11. Melissal Says:

    My Daughter is 6 but has had BO since 4 yrs old. She just started with pubic hair not alot and 2 small acne like bumps on her cheek…she is 95th percentile in height but lean and active and very smart for her age but quite moody these days bursting into tears easily. Her younger sister was born with hamartoma that was benign and removed. Should I be looking at early puberty when she has no bumps in the breast and is flat as a board up top. We are scheduled next month with endocrinologist just reading up on this has gotten me worried. My husband thinks she is just tall due to his height. His mother had thyroid issues and her sisters started early as 9 there menses and my daughter is bi racial. Grandmother with siblings of early menses is African Canadian. Could I just be too alarmed? We had been using lots of lavendar oil and t-tree oil in her hair products. I have stopped that after reading about using such items but we for the most part drink orangic milk but not the cheeses which they love!

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  12. Mrs amir
    my daughter is 11.3 yrs old her menarche started at 10.5yr.she is now 4.10”
    psychologically disturbed. is there any chance to increase her height by diet or stretching exercise or by other means.
    plz help
    i w”ll be great ful to you

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  13. Dr. Roy Says:

    Melissal, “BO” is not a reliable sign of puberty, and neither is moodiness. Being 95%ile in height would only be an indicator of early puberty if her height percentile were increasing faster than expected. Most pre-pubertal kids grow about 2-2 1/2 inches a year– growth faster than that could be a sign of puberty.

    Mrs. Siddiqui, diet changes and stretching exercises will not increase height. Once girls are having regular periods, there is not much growth potential left. A bone age xray could be done to confirm this. If your daughter is “psychologically disturbed” because of her height, I suggest you take her to a psychologist or other counselor.

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  14. eve Says:

    My daughter just turned 7 and the other day she complained that her “breast” were hurting. I checked them and they were hard. Is this a sign of early puberty?

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  15. Dr Roy Says:

    eve, hard lumps can be early breast tissue. Sometimes these develop before puberty, and don’t progress further. But if they’re developing and growing, that’s puberty.

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  16. Kate W. Says:

    Dr. Roy — very thankful to have found this thread. My daughter began showing at 5 with what I thought was just fatty tissue (she had always been wiry, but at about 5 her body began to change, a little tummy, etc. and I thought the breast tissue was a result of that), but our pediatrician informed me at her 6 yr check up that they were indeed breast buds. She is now nearly 8 and has had no other indicators of early puberty other than the breast development, which is significant for her age and makes her feel quite awkward. (She is caucasian.) Her older sister menstruated at 12 1/2, but began breast development at about 9.

    She has had significant weight gain over the last 18 months, despite being active and limited sweets and junk (no soda, very little candy). I think she eats large portions of well balanced meals, she loves vegetables and fruit. We don’t discuss what is being eaten or not eaten, but I do not offer chips and sweets as snacks daily, a treat about 2-3 times a week. Almost no fast food or processed/prepackaged meals.

    We moved from the US to the UK last year and I have taken her to the family GP but he said her weight was in the upper ranges of normal for her height (which it was a year ago) and did not recommend any further medical “interference” (drs words not mine) and I had the distinct feeling he thought I was an overanxious American mom worried about not having a thin daughter. A year has passed and she shows no puberty indicators but the breasts continue to grow and her weight is bothering her (breaks my heart to hear her say she thinks she is fat.)

    Should I push for an pediatric endocrinologist? We have private health insurance, so I can skip the NHS process, but I can’t find one listed in our area (Edinburgh)

    Thank you,

    Kate

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  17. Dr. Roy Says:

    Kate, my understanding of the British health system is that GPs (seeing adults and kids) are the primary care people, and that pediatricians are considered “specialists”. I think seeing a pediatrician would be your next step (and would be your only gateway to a ped endocrinologist if one is needed.)

    If at this point (8 y/o) breast development is the only sign of puberty going on, that would be considered normal. I’d also want to carefully look at her height growth (prepubertal kids should grow 2-2 1/2 inches each year.) A bone age xray can also be a helpful took to get an idea about what to expect from her puberty and growth. Best of luck!

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  18. Mellissa Says:

    Dear Dr.Roy,
    My daughter looks for a career in modeling and I was wondering if she will grow to the height requierments. She is 13 and 5 ft 4.5 inches. Her dad’s family is tall averaging at about 5 ft 9 inches to 6 ft.1 to the men. And 5″6 to 5″9 for the women. Yet I am , well, short at 5″1. My family ranging from 5″2 to 6ft. She got her period for the first time in 6th grade, a year ago. But didn’t get it again until 6 months later. Then stopped for another three months until she got it again. Going on and off. She now gets it every other month regularly. Is she passed her growth spurt or not? P.s she is average weight. 93 pounds.

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  19. Mellissa Says:

    Relating to my last post, I already conntacted her docter and they do not seem to know what is going on with her staage at puberty. They thinkk it is lack of iron. Will that delay puberty?

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  20. Mrs suzen Says:

    Hi my daughter is only 11&1/2 years old and she start her puberty. Her height is 4.7 only. Is it possible to increase more height because both parents are not too tall.

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  21. Dr. Roy Says:

    Mrs. Suzen, since your daughter has already started puberty there really may not be many years of growth left. I recommend you discuss your concerns with her doctor.

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  22. amanda smith Says:

    My daughter just turned 8. She has had axillary hair since 7 and i just noticed she has pubic hair. Should i take her to tbe doctor? Is this ok?

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  23. oyin Says:

    My daughter turned 6 in april, months before i noticed she’s got pubic hair…at first i put dat down to the fact that she’s hairy but now has a lone pimple on her face. should i be worried?

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  24. Dr. Roy Says:

    Sorry people, I can’t keep answering specific questions about all of your kids. These articles give general info. if your question wasn’t answered, go see your kids’ doctor.

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