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When Puberty Starts Early
by Wenda Reed

Jaden’s breasts began budding last year. This year they are growing, and the Redmond girl has a little downy, fair hair in her underarm and pubic areas. Her mother, Sarah, won’t let her go to school without an undershirt on, and buys her T-shirts a little larger than normal. This summer, she is making her daughter’s tank tops and looking for swimsuits that don’t emphasize her bustline.

Jaden is 6.

Although she is ahead of the curve — and is being tested for a relatively uncommon condition known as central precocious puberty — Jaden is not unusual in showing breast development earlier than expected.

Is puberty starting earlier?

Yes and no. Girls are developing breasts at an earlier age, but there is no evidence that they are beginning their periods any sooner. Puberty follows a predictable timeline, after hormones released from the brain signal the ovaries to produce estrogen. The process begins with breast budding (a gland just below the nipple starts to get bigger) and progresses through growth of pubic, underarm and leg hair, a significant growth spurt, widening of the hips and redistribution of body fat, enlargement of the vagina and a little white discharge, and the beginning of menstruation. Breasts continue to grow throughout this two- to five-year process. Acne and a “mature” body odor usually occur after menstruation begins.

From the 1970s until 1997, the normal age for the onset of puberty was considered to be 8 to 13 years, with the mean age of breast development at 11.2 years, according to Dr. Gad Kletter, a pediatric endocrinologist at Swedish Medical Center in Seattle. “It was considered abnormal if a girl began to mature prior to 8 years of age,” he summarizes.

In 1997, University of North Carolina professor Dr. Marcia Herman-Giddens and her colleagues shook up the medical community by releasing a longitudinal study of more than 17,000 girls aged 3 to 12. They found that it was normal for white girls as young as 7 and black girls as young as 6 to start developing breasts (with the mean age of 9.96 years for white girls and 8.87 years for African American girls). The growth of pubic hair was also occurring at a younger age.

“Girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms,” Herman-Giddens concluded. However, the study showed the average age for beginning menses was 12.16 years for African American girls and 12.88 years for white girls, which follows the averages of the past 30 years.

Kletter points out that the researchers did not collect hormonal data. “It may be that some girls were obese, and fatty tissue may have been considered to be true glandular breast tissue. Also, the age of menarche was the same as for prior reports, inferring that these girls took longer to complete puberty.”

Dr. Leslie Walker, chief of adolescent medicine at Children’s Hospital and Regional Medical Center in Seattle, agrees. “Girls are somewhat earlier in beginning to have breast development, and there is more of a time span between breast budding and beginning menses.”

Why are younger girls developing breasts?

The dramatic increase in obesity levels in the past 30 years is cited as the most common cause for the earlier onset of puberty. Dr. Joyce Lee, a pediatric endocrinologist at the University of Michigan Health System, released a study of 354 girls in the March 2007 issue of Pediatrics. She and her fellow researchers found that girls who were overweight (had a higher than average BMI or body mass index) at age 3 and had large increases in body fat between age 3 and starting first grade began puberty earlier.

Leptin, a hormone secreted from fat cells, is required to initiate puberty, Kletter explains. “It’s a signal that tells the brain the body is large enough and there is enough food so it’s time to reproduce.”

Other theories abound, but none have panned out based on solid research. One of the most popular is that hormones in our milk and meat may be triggering earlier estrogen production in girls. This theory, which Kletter calls “bogus,” was initially based on a study of chickens fed growth hormones in Puerto Rico. He states that there is no data to support the claim. “There is no proof of hormones causing earlier puberty,” Walker agrees. “It is difficult to tell if kids are getting bigger, which drives the hormone production, or if it’s the other way around” (more hormones making children bigger). Which is the cause and which is the effect?”

Some scientists theorize that insecticides in common use may degrade into compounds that have an estrogenic effect in young girls, but this has not been proven. Others believe that chemicals know as “phthalate esters,” found in toys, vinyl flooring, detergents, cosmetics and lotions may be “endocrine disrupters” that interfere with hormonal functions. Experts agree on the need for research into these possible causes.

Does your daughter need to see a doctor?

Early breast development does not, in itself, mean that there’s a medical or hormonal problem. Some girls may show early breast development that later disappears or is not accompanied by other early signs of puberty. However, the National Institutes of Health and children’s hospitals around the country recommend you talk to your child’s health care provider if your daughter shows development of breasts, pubic and underarm hair and increased growth rate (taller than classmates) before age 7 or 8. “If you have a younger girl with breast budding and pubic hair, or if it seems like she’s developing earlier than other kids in the family, it’s good to check it out,” Walker summarizes.

Your daughter may be referred to a pediatric endocrinologist, who will evaluate her for “precocious puberty” (also called “central precocious puberty”). The doctor will order blood or urine tests to detect higher than normal levels of sex hormones, as well as X-rays of her wrist and hand to show whether bones are maturing too quickly. In rare cases, precocious puberty results from a brain tumor or other structural problem in the brain, or disorders of the adrenal glands, ovaries or hypothalamus. These circumstances will be ruled out with MRIs, CT scans and/or ultrasounds.

Most girls with early signs of puberty have no serious underlying disorders or identifiable reasons for the condition. This is true of Jaden, whose breast development, pubic hair and height — coupled with tests that showed the 6-year-old’s bone age at 8.5 years — led her doctor to diagnose precocious puberty. However, her slightly elevated hormone levels have stopped rising, though her breasts are still growing. The doctors have adopted a “wait and see” approach.

After careful evaluation, girls diagnosed with precocious puberty may be treated with synthetic hormones to stop the process. “If a girl is maturing rapidly, she will have less time to grow before she is done, and will therefore end up short,” Kletter explains. “The early development will also create psychosocial stresses, as this young lady will be different from her peers. Also, handling menstruation at the age of 7 or 8 is a burden the girl may not be ready to cope with.”

How do you talk to your daughter?

Whether your daughter is diagnosed with precocious puberty or is simply developing early, she is likely to have more problems with self-esteem than her peers, according to Walker, who cites a litany of studies. “Kids tease them and treat them as though they have sexual feelings early,” she says. “People react to what they see, not the girl’s real age. Older boys make passes at them.”

Keeping her little girl a “normal happy kindergartner” has been the top priority for Jaden’s mother, Sarah. “I tell her she doesn’t have to be ashamed or embarrassed. Eventually, everyone else will catch up with her and everything will be fine,” she says.

Sarah let Jaden’s teacher know what is going on and is in close contact with the school nurse. She’s been careful to tell Jaden what she needs to know about maturing early, without going into topics like boys, sex and acne. She also used Terry’s Story, a gently humorous story/coloring book for ages 5 to 8 put out by TAP Pharmaceuticals. It presents a child who is always “too soon” for everything, including bodily changes (www.TooSoon.com).

“She loved it; she read it right away and colored it, and six to eight months later, she re-read it,” Sarah says. “I had to tell her that she doesn’t need to tell everyone she has the ‘Too Soons.’”

Her advice to other parents of children who develop early is to “treat them as normally as possible, schedule appointments around their activities, minimize impacts in their daily lives and treat them like their age level.”

Walker says Sarah’s approach is exactly right, and offers the following suggestions:

• Give information appropriate for your daughter’s age level, so that it’s not scary to her. Emphasize that the changes are a natural, good thing. Give concrete, honest answers to questions.

• Start early and keep up a constant dialogue with your daughter about her body changes, rather than having one big “sex talk.” She will be listening, even if it looks as though she isn’t.

• Talk about your values with regard to modesty, sexuality and other issues, and give your daughter guidelines as you talk about puberty. Studies show that the most powerful influence on children is their parents.

• Make teachers and school officials aware that your daughter is developing early. The school nurse may be able to talk to elementary school classes.

• Help your daughter find the right clothes, including the comfort and support of a sports bra, if necessary. Try not to dress her older than her age.

Sara Rigel, supervisor of community health programs at Swedish Medical Center, does not recommend taking 7-year-olds to the hospital’s “Growing up Female” classes, geared to 9- to 12-year-olds. “Even if the physical changes are happening early, the other topical content (including boys and sex) isn’t right for them,” she says. “They zone out if the information is given too early.”

Sometimes 8-year-olds may benefit from the class or similar classes offered at Children’s, Overlake and other local hospitals, Rigel says. “If I get an inquiry, I ask ‘Has she begun to physically develop? Is she asking questions? Does she see siblings and friends developing?’”

“It’s great to bring siblings or friends together, or a mother and aunt or other family members for a total support system,” Rigel adds. Classes like “Growing Up Female” answer all questions in a frank, concrete way so that girls can know what to expect and will have less fear about it.

“Our class is a starter for continued conversation,” she adds. “Parents of early developing girls should let them know that it’s safe to ask anything in their families.”

Wenda Reed is a Bothell freelance writer and regular contributor to Seattle Woman.

©2007 Caliope Publishing Company