11:29am Saturday 04 April 2020

When is early puberty too early? When does delayed puberty need to be hurried up?

“Both boys and girls can be affected by precocious puberty or delayed puberty,” says Dr. Preetha Krishnamoorthy of The Montreal Children’s Hospital, MUHC. “Usually there is no need to worry because some children are early bloomers and some are late bloomers. But parents should still raise their concerns with their child’s doctor so any potential abnormal underlying cause can be ruled out.” (Dr. Krishnamoorthy will be giving a lecture on precocious and delayed puberty during this fall’s Mini-Med at The Children’s lecture series. For more information see below).

Precocious puberty and girls

Puberty for girls starts with breast buds. Later changes include the growth of pubic hair, underarm hair and sometimes acne. During puberty girls have a growth spurt gaining an average of 8 cm each year. On average menstruation occurs around age 12½ years old. Dr. Krishnamoorthy says compared to a generation ago, girls are starting their periods slightly earlier but she says the difference is not significant.

“If a girl shows signs of starting puberty earlier than age seven or eight, she may have precocious puberty,” says Dr. Kristhnamoorthy but she hastens to add that in most instances the child is simply an early bloomer, or in medical parlance, the child may be a variant of normal. In other words, there is no known cause for the early onset of puberty. In very rare cases, says Dr. Krishnamoorthy, a tumour on the pituitary or ovaries might set off the early puberty.

However, Dr. Krishnamoorthy notes that starting puberty early can be difficult for some girls because they simply aren’t psychologically mature. “It can be difficult when a girl age six or seven starts puberty. Developmentally, they are way ahead of their friends and school mates and might think ‘What is wrong with me?’ They also might be teased and/or bullied by their peers,” says Dr. Krishnamoorthy.

According to Dr. Krishnamoorthy, children who start puberty early are at risk of being shorter than average because their growth period is shortened and their bones mature more quickly.

“If parents choose, with the advice of a pediatric endocrinologist, they can put their child on a treatment that lowers the level of sex hormones and slows puberty. This can give the child’s bones a chance to grow longer and give the child a chance to mature psychologically,” says Dr. Krishnamoorthy. “However, in most cases we generally don’t want to interfere with Mother Nature.”

In cases of delayed puberty in girls, medical attention should be sought if there are no signs of the onset of puberty by age 13. Again, Dr. Krishnamoorthy says the likely cause is the child is simply a late bloomer, but an underlying medical condition such as a tumour should be ruled out.

Puberty and Boys

The signs of puberty in boys are the enlargement of the testicles and scrotum. This is accompanied by pubic hair, penis growth, underarm hair and voice change. The typical growth spurt for boys occurs later – usually closer to age 13. “Boys who show signs of puberty younger than age nine or boys who do not show signs of puberty by age 14 should be seen by a doctor,” says Dr. Krishnamoorthy.

Again she is quick to point out that in most cases there will be no medical reason for the early or late start. “More often than not it is simply a case of genetics, such as dad hit puberty later and so will his child” she says. “Very infrequently, a tumour on the pituitary or testicles might be responsible for turning puberty on early or delaying its onset.”

“Ironically, in boys, parents tend to worry more about delayed puberty rather than the early onset of puberty,” says Dr. Krishnamoorthy. “They worry because their son hasn’t had a growth spurt and his friends are towering above him.”

Dr. Krishnamoorthy says for boys, being a late bloomer can be psychologically bothersome because they might be picked on or bullied for being short, while everyone around them has had a growth spurt already.

“It is possible to speed up puberty in boys by giving them a low dose of testosterone to kick-start the process but before we do this, we need to make sure there is no underlying cause for the delay. In most cases, we like to take a “wait and see” attitude, because more often than not within a year or so, a young man will hit puberty and will catch up in height and size with their peers.”

Dr. Krishnamoorthy concludes by saying in most cases for both girls and boys, precocious or delayed puberty has no underlying cause. But she advises parents to talk with their family doctor or paediatrician to simply make sure.

Dr. Krishnamoorthy will be giving a talk on precocious and delayed puberty during the 2012 edition of Mini-Med at the MCH. Registration has begun and seating is limited. Mini-Med is offered in English starting October 4 and in French starting October 5. The cost is $65.00 for adults and $45.00 for seniors and students. Students can register on line at www.thechildren.com or can obtain more information by calling 514-412-4307.


To interview Dr. Krishnamoorthy please call:

Lisa Dutton, Manager
Public Relations and Communications
The Montreal Children’s Hospital,MUHC

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