Rachel Lamb remembers the day she had a troubling question for her daughter’s pediatrician.
“I told her, ‘She’s starting to develop breast buds. Is this normal?’” the Puyallup mom recalls. Her daughter was 6 and a half years old at the time.
The pediatrician recommended she see a doctor at Seattle Children’s Hospital and Regional Medical Center, one who specialized in precocious puberty. Lamb was stunned.
“I thought, ‘OK, my daughter is physically hitting puberty at 7. This is such a shock,’” Lamb says. “At that time, she was in first grade. I was just not ready for my baby to grow up.”
More and more moms like Lamb are facing the prospect that their daughters are growing up way too early. And while studies show that early puberty is on the rise among girls in this country, there’s no evidence that it’s on the rise among boys.
For nearly 40 years, girls younger than 8 and boys younger than 9 showing signs of puberty were considered to be in precocious, or early, puberty. A 1997 report published in Pediatrics magazine studied 17,000 girls between the ages of 3 and 12 and found that the age of puberty was coming down.
Based on the study, the Lawson Wilkins Pediatric Endocrine Society (LWPES), a nationwide network of physicians headquartered in California, suggested it be considered normal for white girls as young as 7 and black girls as young as 6 to start developing breasts.
“I do believe that there is a trend toward early puberty in general,” says Dr. Angela Badaru, pediatric endocrinologist at Children’s Hospital. “The great news for parents is that the vast majority of girls who go through early puberty do not have worrisome causes. It is simply normal puberty occurring early.”
What to look for
Signs of early puberty in girls can include rapid growth, body odor, pubic or underarm hair, acne, breast growth and, finally, menstruation. “Parents should look for elevation of the breast, nipples getting larger and the raising of the nipple off the chest wall,” says Dr. Anne-Marie Amies Oelschlager at the University of Washington. “If that is occurring, bring it to the attention of your pediatrician.”
Although breast growth and other signs of puberty appear to be happening to girls at a younger age, the average age of the first menstrual period (12) has remained essentially unchanged for both Caucasian and African American girls, experts say.
“When you look at the data, you find that girls are starting puberty earlier, but the age of the onset of menarche [first period] hasn’t changed much,” says Dr. Barbara Marshall of the endocrine clinic at Mary Bridge Children’s Health Center in Tacoma.
That means puberty for girls is being stretched over increasing months and years. “We’re not backing up all events in puberty,” says Sandra Steingraber, biologist and visiting scholar at Ithaca College in New York. “We’re backing up the starting point.” But the result should still be a concern, she says. “Over the course of a few decades, the childhoods of U.S. girls have been significantly shortened.”
Once a child has been referred to a specialist, tests are performed to determine possible causes of the symptoms of early puberty. Hormone levels are determined through blood work, and tests are done to rule out thyroid problems or extremely rare causes such as ovarian cysts or a brain tumor.
Occasionally, the child has accidentally been exposed to hormones. “I remember one kid who came in for early puberty who saw her mother’s birth control pills and thought they were candy,” Marshall recalls.
If abnormalities are ruled out, doctors may suggest treatment to protect the child’s growth potential. “The doctor will always look at the skeletal bone age,” Oelschlager says. “As the estrogen level climbs, the bone is maturing and is sensitive to higher estrogen levels. You can have a huge height gain and then stop growing.”
Oelschlager says hormone injections may be recommended to stop the growth. “This helps them achieve their maximum bone age and prevents them from being short.”
Lamb says this was a consideration for her daughter, who was “growing like crazy” and shooting up way past her friends. The injections would also postpone her daughter’s first period, which was a big concern for Lamb. It was a difficult decision, she said, but “I talked it over with my husband and we just decided not to mess with what was going on with her body.”
So Lamb had a talk with her daughter about menstruation when she was only 8 years old. She wanted to be sure she was prepared. “I’ve heard stories from friends whose mothers never talked to them,” she says. “When their periods started, they thought they were dying.”
Lamb remembers that talk with her young daughter as a very emotional time. “She was crying and saying things like, ‘Why do I have to go through this? Why did this happen to me? Is it going to hurt?’ It was hard.”
What’s causing early puberty?
Causes of the increased rates of early puberty in girls are unclear. Badaru says the number-one cause could be genetic. “If the mom was an early developer, the daughter has a tendency to be an early developer,” she says.
There is some thought that better nutrition in this country has led to a decreasing age of puberty and that increased childhood obesity is also a factor. “There is an assumption that the upward trend in obesity is linked to an upward trend in early puberty,” Badaru says. “In Europe, they’re not seeing a trend in obesity or early puberty.”
Some wonder if increased use of hormones and pesticides in food could be a cause. Steingraber says evidence does not exist that links bovine growth hormone in milk to early puberty. Still, after her daughter’s diagnosis, Lamb changed her family’s diet. “We eat grass-fed meats, organic chicken, hormone-free cheeses and milk,” she says.
Experts say there is no evidence that early puberty or the hormone treatments used to slow its progress have any long-lasting impact on fertility or the age of menopause. Girls who begin menstruating before the age of 8 are at increased risk of developing polycystic ovary syndrome, a treatable condition that causes the ovaries to develop cysts later in life.
The biggest challenge for a girl going through early puberty may be emotional rather than physical, experts say. “When I’m looking at a girl who comes in for early puberty, I’m trying to find out if it’s a problem. The main reason for concern is that it might be too early for them developmentally and emotionally,” says Marshall.
Oelschlager recalls a girl in her elementary school class who got her period before anyone else. “The boys paid more attention to her, and it was very awkward for her because she wasn’t emotionally there yet,” she says.
“The hardest thing is that these children are expected to act like what they look like their age is, not what their age actually is. These girls need to be protected from unwanted attention.”
Lamb says her daughter has not experienced any of that yet, but that could change when she enters fourth grade next year and has recess with fifth- and sixth-graders. Lamb has been grateful that her daughter hasn’t started her period yet, and, at 9, has passed the age threshold for early puberty.
The little girl hasn’t felt too different from her classmates, except for her height. At 5 feet 1 inch, she is a lot taller than everybody else. “Her main problem is her height,” Lamb says. “She just wants to be smaller.”
Elaine Bowers lives in Magnolia with her husband and teenage twin daughters.
Originally published in the September, 2008 print edition of ParentMap.