Puberty is an unsettling stage in anyone’s life, but if it appears at the age when a child is still playing with her dolls, it can be very worrying indeed.
Puberty involves huge physical, emotional and hormonal changes as the body prepares for reproduction. There is also rapid growth and weight gain and the appearance of body hair and for many, an unwelcome crop of acne.
Girls develop breasts and begin to have menstrual periods, while boys begin to produce sperms and their voice becomes lower pitched.
So far, there is no real agreement among doctors about whether we are just seeing a continuation of this decline in the average age at which puberty occurs, or whether it is a part of a more worrying environmental trend towards children growing up too quickly.
However, most agree that if breasts and pubic hair development happen before the age of eight or nine in the case of girls, or signs of puberty manifest themselves in boys under ten, it is “abnormal”. However, the onset of signs of puberty before age seven or eight in girls and age nine in boys can be physically and emotionally difficult for children, and can sometimes be the sign of an underlying health problem.
There is also evidence that children with early sexual development become sexually active earlier. There are also thoughts whether early childhood could have a knock-on effect, which makes them susceptible to adult health problems, such as cancer and heart diseases.
In Britain and in some other European countries, it is now more or less established that up to at least one in six children is affected. Indeed, there are some recent studies that show that school girls as young as six are already entering puberty. There are also a few studies from some African and Asian countries reporting similar early childhood development in puberty and early sexual maturity too.
Whatever the cause, a growing number of children are being deprived of childhood and are turning physically into mini-adults at an increasingly young age. But without the emotional maturity to deal with these changes, they are vulnerable to exploitation.
Signs of early puberty
In girls, the common signs include any of the following before the ages of seven or eight: breast development, pubic or underarm hair development, rapid height growth or spurt, onset of menstruations (periods).
In boys these include: acne, enlargement of testicles or penis, pubic, underarm or facial hair development, rapid height growth, voice deepening, acne, “mature” body odour.
Similarly, some girls and boys may experience early growth of pubic and underarm hair that isn’t associated with early puberty and may require evaluation to rule out “true” early puberty or other health problems.
Going through puberty early can also be difficult for a child emotionally and socially. For example, girls with early puberty may be confused or embarrassed about physical changes, such as getting their periods or having enlarged breasts well before any of their friends. But the hardest part may be teasing that children with the condition, especially girls.
Even emotions and behaviour may change in children with early puberty; girls can become moody and irritable. Boys can become more aggressive and also develop a sex drive inappropriately for their age.
Causes of early puberty
The onset of puberty is normally by the hypothalamus (the area of the brain that helps control the function of some glands), in particularthe pituitary gland which releases hormones that stimulate the ovaries in girls or testicles in boys to make sex hormones.
Sometimes, the early puberty stems from a structural problem in the brain (brain injury due to head trauma), an infection such as meningitis, or a problem in the girl’s ovaries or thyroid gland that triggers the onset of puberty ahead of schedule, but this is usually isn’t always the case.
In about 5% of boys, early puberty is inherited.
Starting puberty early can be passed on from the father to the son. But less than 1% of girls affected by early puberty have inherited the condition.
More girls experience early puberty which is very much linked with their lifestyle, diet and in particular in girls who are overweight in their very young age, especially in 6 to 9 year olds.
Others attribute largely to nutritious improvement, food containing more vitamins, minerals, proteins, fat and other ingredients. But the most harmful are foods containing hormones, such as in chicken, meats and even in some fruits and vegetables growing in some industrial countries.
A study confirmed that the stress of family breakdown alters the balance of growth hormones and other chemicals in the body, speeding up a child’s physical development. This includes the absence of biological fathers which may be one of the common causes as girls whose fathers had left home started their periods earlier, due to the psychological trauma they undergo.
Early puberty has also been linked to watching too much TV, movies and playing TV games at a very young age. There are evidence that children who watch three hours TV in a day produce less of the sleep hormone and the sleepless condition create physical and mental stress, and as a result child develop a misbalance in their sexual hormones.
Diagnosing puberty
I strongly recommend every parent who observes any signs of early puberty or any sexual maturity in their children before the age of 7to 8 to seek advice from a medical professional. The signs include, in girls early breast development, rapid height growth, menstruation (periods), excessive developing acne, in boy’s enlargement testicles or penis, changing voice or pubic or underarm hair.
The physical changes boys and girls go through during puberty are usually evidence to a doctor during an examination. To confirm a diagnosis of early puberty of your child a doctor may order blood and urine tests to detect elevated sex hormones or possible x-ray of your child’s bones.
Further testing may also be necessary. Scanning can help to roll out specific causes of early puberty, such as a growth in the girl’s ovaries, or boy’s testicles. Fortunately, all of the above mentioned diagnostic facilities are now available including magnetic resonance imaging (MRI) scan for affected children to be appropriately diagnosed by specialists.
Is there any preventative medicine to prevent the development of early puberty or treat affected children?
Not surprising, the drug industry has developed quite a few drugs for prevention and also for possible treatment of premature puberty. The mean effects of these drugs are to block the early production of growth hormones, but the medical professionals are not happy to routinely prescribe powerful drugs, normally used to treat cancer, for young children.
Worrying developments
As a medical professional, and a gynaecologist for over 32 years, I am very familiar with the facts on early puberty and early maturity in young children.
I have met quite a number of children in The Gambia, in particular girls, with similar conditions who were brought to me by their parents.
As I strongly recommend, one should seek medical advice by medical professionals for performing an appropriate diagnosis for underlying health problems and for possible treatments.
We are extremely lucky to live in an environment without toxic and harmful industrial chemicals which are the commonest causes for hormonal changes in very young children. But this does not mean that we should also ignore other causes, such as obesity and the possibility of early pregnancy.
Recent studies in the UK indicate that 148 girls, aged 13 or younger out of who became pregnant, 62 per cent were diagnosed as having early sexual maturity. We are also facing high rates of teenage pregnancy in The Gambia through unwanted pregnancy or early, underage marriage.
(To be continued next Thursday)
For further information, email [email protected], or send text messages only to Dr Azadeh’s WhatsApp on (00220) 7774469 from 3 to 6 pm
The author Dr Hassan Azadeh, MD, is a senior lecturer at the University of The Gambia, and clinical director at the Medicare Health Services.
