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Preparing Your Child for Puberty
by Dr. Michael Faust (Top - R) and Dr. Ben Kleifgen (Top - L)

Puberty can be a weird time. Transforming from a "kid body" to an "adult body” involves physical and emotional changes that can make a kid feel out of control. These changes happen at different speeds in different people. Even within an individual child, different body parts may grow unevenly. For example, a girl's left and right breasts may grow at different rates at first. Some kids gain weight right before their growth spurt, which can affect self-image (but remember that no one should "go on a diet" during this time, as they need the extra nutrition).

The first sign of puberty in girls is typically the development of breast buds around age 10 to 11, although it can be as early as 8. Breast development can be accompanied by some soreness. Pubic hair develops within the following year. A girl's first menstrual period usually happens 2-2.5 years after her breasts start to develop. The average age of the first period is about 12.5 years of age, but varies widely. Boys usually start with enlarging testicles, followed by penis growth, increased muscle mass, pubic and underarm hair, and a deepening voice. Both boys and girls experience a dramatic growth spurt during this time--up to 4 inches in a year. Sometimes a boy develops enlarged breast tissue, call gynecomastia. While this may be alarming, it is normal and will go away by the end of puberty. Acne, body odor, moodiness, and new interest in sexuality are other changes.

Normal puberty begins between ages 8 and 12 years in girls and between 9 and 14 years in boys. Anything earlier is considered early or precocious puberty. If a girl does not show any signs of puberty by 14 years, or if she has not had her first period more than 5 years after breast development, she is considered to have delayed puberty. For boys, no testicular enlargement by age 14 would be considered delayed. Keep in mind, though, that these are large windows of time, especially if you are watching all your friends start to develop when you have not. Kids go through puberty at very different times and at different rates, and just about everyone comes out the other end perfectly normal.

Children are going through puberty earlier, although it is important to note when "these days" are compared to "those days". Certainly, teenagers in earlier centuries tended to go through puberty much later than teenagers today, probably due to modern improvements in overall health and nutrition. Studies from the 1940's - 1980's show that, on average, girls showed the first signs of puberty (breast buds) around 10.5 - 11 years old. In the last 20 years, the age appears to have dropped to closer to 9 years in African-American girls and 10 years in white girls. The latest research seems to show that the average age of puberty has stopped going down.

We’re not entirely sure why children are entering puberty earlier. People in industrialized countries are healthier on average than their counterparts from earlier generations. However, that does not entirely explain the drop in puberty in the last few decades. Obesity causes hormonal changes that lead to early puberty, and the rate of childhood obesity has skyrocketed. In addition, some research has suggested that environmental toxins such as pesticides, plastics, industrial compounds, and hormone supplements given to cows that end up in beef may play a role, but the jury is still out.

The factors listed above affect the average age of puberty for large groups of people. Your individual son or daughter will go through puberty at his or her own pace. Most of the time, when a kid starts puberty early, her hormonal clock is simply set a little earlier than her peers.

When it comes to early (but still normal) puberty, genetic and metabolic factors play a role. If your mother had her first period early, you are likely to do that same. Being obese or having been born with a low birth weight can also contribute to early puberty. Racial and ethnic background also has an effect, with African-American girls starting development slightly earlier than white girls.

Before talking about treatment, it's important to point out the difference between precocious puberty (remember, before 8 in girls and 9 in boys) and simply earlier-than-average puberty. In the US, about 1 in 5000 to 1 in 10,000 girls experience precocious puberty. It is about 10 times less common in boys. Puberty can be triggered by an abnormality in the hormone-regulating glands in the brain (the hypothalamus and pituitary), or because the testicles or ovaries start making their own hormones without waiting for cues from the brain. These situations can lead to abnormally early puberty or "out-of-order" puberty; for example, developing body hair or muscle mass before genital enlargement. In these cases, it is important to speak to your pediatrician or family doctor, who may refer you to a specialist who deals with hormone abnormalities (an endocrinologist).

Early puberty almost never requires treatment. However, true precocious puberty may be caused by hormone abnormalities or other serious disease, so it should be investigated. Sometimes, and endocrinologist can give hormones that delay puberty until an appropriate time, but this treatment is usually reserved for extreme cases.

There are several concerns with starting puberty early.  From a psychological standpoint, no one wants to be seen as different – at least not in an area that is beyond their control. From a physical standpoint, early puberty can significantly affect their final adult height.  From about one year-of-age until starting puberty, children grow about 2-2 ½ inches per year.  This is followed by a growth spurt, then eventual cessation of growth.  A child who hits their growth spurt a couple years early can be noticeably taller than their peers for a while.  But missing out on a couple years of that slow pre-pubertal growth ultimately leaves them shorter as an adult. 

Children rarely want to be seen as different from their peers. We all know that other children can be cruel.  If a precocious child has breast development, or acne, or has gotten quite tall, they can be a target for teasing and bullying.  Anything that makes a child feel unaccepted by their peer group can be very difficult for them.  It can affect them in many ways. They may withdraw, or they exhibit bullying behaviors. They may become depressed, or anxious, or oppositional. Their school performance may even falter. If a parent sees evidence of behaviors like this, they should speak with their child’s doctor to discuss whether seeing a therapist would beneficial.

You can start the conversation about puberty around 4th grade.  Of course, if your child is showing signs earlier than that, then you need to start at that point. 

Keep the discussion pretty matter-of-fact. Early puberty can cause anxiety in the child and the parent alike.  In most cases, there isn’t much to be done but watch and wait, so try to keep your own worry and anxiety from affecting the child.  Gentle reassurance is the best approach. You must, however, discuss some aspects of puberty sooner than you otherwise would like. Do not over-burden your child with everything you know about human sexuality in one conversation.  Share some information with them and then give them some time to process it. Spread the initial conversation out over a few days. Your goal is to give them the information you think is necessary, and let them know that it is safe to talk to you about these issues.  You ultimately want this to be an ongoing conversation throughout their adolescence. 

Whether or not your child has started puberty, by 4th grade children have probably heard more that you might think, so it is important to weigh in on these issues.  You know what is best for your child and it is important to instill your values starting at an early age.  Giving your child additional resources is wise.  A good book on puberty can be a helpful way for a child to learn.  By reading with you child, you can use the book as a starting point for healthy conversations about growth and development.  Older children, of course will not want to take that approach, but you should be willing to discuss the topics they bring forward.

Do you need pediatrician?

Call WHS Washington Pediatrics at (724) 250-6001. Accepting new patients in Washington and Cecil locations.

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