JOIN USPrema (name changed) took her six-and-a-half year-old daughter Rishika for a consultation with a doctor when Rishika was teased by her classmates about her body, although her daughter was reluctant to narrate the exact story.
On examination, Rishika was found to be obese and had just begun breast development. This meant that she had hit puberty earlier than most of her classmates. In Rishika’s case, obesity had triggered the early onset of puberty. Early puberty in girls is one of the most common hormonal changes that affect many young girls today, both emotionally and physically. Among the many reasons for onset of early puberty may be faulty eating habits and lack of physical activity among children.
Neeti (name changed) attained menarche at the age of five, and her parents had failed to recognise the signs of early puberty (breast development). Her parents had never heard of something like this before — a five-year-old girl attaining menarche.
Her parents then sought medical help and upon examination, it was found that a problem with Neeti’s brain had triggered the onset of early puberty. Neeti then was put on medication in the form of hormonal injections to stop the early development. If not for the medication, Neeti would have stopped growing and her height would have been not more than four feet.
Rishika and Neeti represent thousands of girls in our society who are early bloomers. This phenomenon is ten times more common in girls than in boys.
Symptoms
The first signs of puberty in girls is the onset of breast development. Typically, this happens between the age of 8 and 13 years. Menstruation occurs 2 to 2.5 years after the onset of breast development. Girls experience a growth spurt (grow taller) after the onset of breast development.
Growth slows down after menstruation and girls stop growing about two years after menarche. Other pubertal changes in girls include appearance of pubic and axillary (underarm) hair, genital development and the onset of menstruation (periods). They may also have a strong body odour, experience mood changes and acne (pimples) during puberty.
Beginning of puberty before the age of eight years in girls is known as early or precocious puberty. There have been reports indicating an increased frequency of early puberty in girls for over two decades. This may be due to an improvement in the nutritional status over the past few years, especially in developing countries.
The majority of girls (95 per cent) who start puberty early will show signs of it between the ages of six and eight, and these girls go through a normal pubertal process. However, in cases like that of Neeti’s, early development can be triggered before the age of six due to a tumour or infection in the brain, thyroid problems and other hormonal inaccuracies. Girls who are obese or overweight (as is the case with Rishika) may also go through puberty at an early age. Exposure to cosmetics, medicine or food containing certain preservatives can also act as catalysts.
If it occurs early, puberty can induce early bone maturation and eventual short stature. Hormonal changes can induce psychological and emotional disturbances too.
A seven-year-old girl with a physical maturity of a 12-year-old may not show a corresponding mental maturity.
She may not know how to respond to bullying or sexual remarks by people around her. Studies shows that early puberty in girls may increase the risk of sexual abuse, bullying and sexual activity. Moreover, a girl studying in Class I, II or lower primary may not be prepared to manage her monthly period.
Advice for parents
*Education about normal pubertal process can help parents cope with early puberty and its effects.
*Parents should seek medical opinion early on if they notice signs of breast development, pubic hair or menstruation at any age before eight.
*Depending on the age of the child, parents should explain to the child that these changes are normal.
*Educate the child about self care, personal hygiene and sex.
*Parents should also make sure that the siblings and friends refrain from bullying the child and measures should be taken to educate them too
*Watch out for change in behaviour such as signs of depression, dieting, etc and seek professional help if necessary
*Treatment is available to delay puberty, to boost growth and prevent emotional trauma
(The contributor is a paediatric endocrinologist at Apollo Hospital, Bangalore.)