Puberty, grow ahead of time
The onset of puberty does not usually occur until the 8-9 years, however, some children develop early physical and sexual characteristics. You know the complications associated with this phenomenon.
Although there is some variability between the age of onset of puberty in different racial groups, typically is in girls occur between 8 and 13 years, and somewhat later, between 9 and 14 years old children, and currently considered precocious puberty to which began before age 8 in girls and 9 years in children.
You have to differentiate between two situations:
· Advanced precocious puberty: consider early puberty when it starts between 8 and 9 years in girls, and between nine and 10 years in children. In reality, it would be the end of normal puberty, and therefore not considered pathological.
· True precocious puberty: is one that starts before age eight in girls and nine children.
· Girls: breast augmentation (also known as Thelarche), emergence of armpit and pubic hair (pubarche), and onset of menstruation (menarche).
· In children: changes in the voice, which are more severe, appearance of genital, body and facial hair (usually in the upper lip), and increasing the size of the sexual organs.
Common children will be the acceleration of growth, so during this time are the highest in its class. However, this is a mirage, since hormonal changes also make that part of the bone where these grow (epiphysis) also closed ahead of time. For this reason, if not start treatment, precocious puberty has resulted in a much lower than average adult size. Initially it seems that they will be very high but that then they are short people because their growth stops also prematurely are children.
On the other hand, children feel psychologically affected to be so different from his other classmates, which undermines their self-esteem and make them show themselves sad and ashamed.
Parents should be alert to the emergence of lugs before time, which may be the first manifestation of precocious puberty. In girls, the changes are more obvious and easy to detect, but not so in the case of children. For this reason, it is very important to not miss the routine controls of health of the pediatrician, who will evaluate all the symptoms that make up the precocious puberty. For example, the size of breasts, testicles, and degree of body hair, is encoded on a scale that measured the pediatrician to check if it is or not normal for their age.
· Hormones of the hypothalamus/pituitary gland (Central hormones): produced in an area of the brain from which are secreted into the blood, medium through which to reach the different sexual organs, stimulating them so that they also start their hormone production.
· Hormones from the gonads or sexual (peripheral hormones): they are hormones produced by the sex organs (testis, ovary) and which give rise to the appearance of secondary sex characteristics: growth of hair, breast, changes in voice enhancing, start of menstruation in girls...
First activate the hormones Central (the hypothalamus and the pituitary gland), which in turn activate peripheral hormones, which are responsible for late changes affecting the body. Therefore, changes that alter this balance in either of the two levels may be the cause of an onset of puberty too soon, and because of this there are two types of precocious puberty:
· Central precocious puberty (PPC): for reasons that alter the hormones of the hypothalamic-pituitary doing to be activated early: brain injury, trauma, infections of the central nervous system, tumours, malformations... Sometimes the exact cause is not known, and is then referred to as idiopathic central precocious puberty. The CFP represents 90% of the cases.
· Peripheral precocious puberty (PPP): produced by an excess of peripheral hormones, due to various causes, such as tumors of the sexual organs, cysts...
In both types of precocious puberty signs and symptoms are similar, although treatment varies depending on what is the cause. In girls is more common idiopathic central precocious puberty, while children in more than 40% of the cases it is secondary to any recognizable disease.
But there are a number of complementary tests that your pediatrician may request to confirm the diagnosis of precocious puberty. The pediatrician on the lower header, can ask some of them and in other cases will be referred to specialist in Pediatric Endocrinology, and they are:
- Study of bone age: since hormonal changes also accelerate the change of the bone, one of the ways to see if chronological age corresponds with the hormonal age is to assess bone age. This is checked with an x-ray of left mano-muneca. If there are home pubertal bone age will be accelerated, showing changes that are 2-3 years higher than chronological age.
- Hormonal study: since the final cause of the onset of puberty is the activation of any hormone that should be still asleep, can be measured in blood these hormones to see if they are abnormally high. You can also make a hormone test that consists in the administration of a (gonadotropin) hormone to see if it turns the shaft hypothalamus-pituitary, measuring levels of hormones in blood.
- Pelvic ultrasound: girls can be measured so the size of the ovaries and uterus to see if they show signs of maturation.
It is necessary to continue treatment until it is considered that the skeletal age, chronological age, psychological maturity and the prognosis of final size are appropriate to reinstate the age of puberty.
With regard to the treatment of precocious puberty, it is not always necessary, but you have to evaluate each case in particular. If you observe changes in the behavior of the child and poor school performance, it would be appropriate to establish at least one visit by a psychologist who would determine if you need to associate or not psychological treatment.
Likewise, children who suffer from this problem are often embarrassed by the physical differences or even voice about his classmates, therefore if you see that your self esteem has fallen, we recommend to take a look at our article on techniques to improve child self-esteem.
Precocious puberty
Puberty is one of the most important in the life of any individual periods, since it marks the transition between childhood and adulthood, and is characterized by different maturation, both sexual and psychic, changes that lead finally to a being adult with capacity to reproduce. It involves a series of hormonal changes that give rise to secondary sex characteristics, and to an increase in the rate of growth up to final size and reproductive maturity. In practice, it begins when they begin to notice physical changes in which until then was only a child: Bud of armpit and pubic hair, the breast augmentation, voice changes, rapid growth...Although there is some variability between the age of onset of puberty in different racial groups, typically is in girls occur between 8 and 13 years, and somewhat later, between 9 and 14 years old children, and currently considered precocious puberty to which began before age 8 in girls and 9 years in children.
You have to differentiate between two situations:
· Advanced precocious puberty: consider early puberty when it starts between 8 and 9 years in girls, and between nine and 10 years in children. In reality, it would be the end of normal puberty, and therefore not considered pathological.
· True precocious puberty: is one that starts before age eight in girls and nine children.
Signs and symptoms of precocious puberty
Physical signs that we will see in children with precocious puberty are the own of the onset of puberty, but with the difference that occur before time:· Girls: breast augmentation (also known as Thelarche), emergence of armpit and pubic hair (pubarche), and onset of menstruation (menarche).
· In children: changes in the voice, which are more severe, appearance of genital, body and facial hair (usually in the upper lip), and increasing the size of the sexual organs.
Common children will be the acceleration of growth, so during this time are the highest in its class. However, this is a mirage, since hormonal changes also make that part of the bone where these grow (epiphysis) also closed ahead of time. For this reason, if not start treatment, precocious puberty has resulted in a much lower than average adult size. Initially it seems that they will be very high but that then they are short people because their growth stops also prematurely are children.
On the other hand, children feel psychologically affected to be so different from his other classmates, which undermines their self-esteem and make them show themselves sad and ashamed.
Parents should be alert to the emergence of lugs before time, which may be the first manifestation of precocious puberty. In girls, the changes are more obvious and easy to detect, but not so in the case of children. For this reason, it is very important to not miss the routine controls of health of the pediatrician, who will evaluate all the symptoms that make up the precocious puberty. For example, the size of breasts, testicles, and degree of body hair, is encoded on a scale that measured the pediatrician to check if it is or not normal for their age.
Causes of precocious puberty
The onset of puberty depends on a complex balance between different hormones in the endocrine system of the body. In general, there are two groups of hormones:· Hormones of the hypothalamus/pituitary gland (Central hormones): produced in an area of the brain from which are secreted into the blood, medium through which to reach the different sexual organs, stimulating them so that they also start their hormone production.
· Hormones from the gonads or sexual (peripheral hormones): they are hormones produced by the sex organs (testis, ovary) and which give rise to the appearance of secondary sex characteristics: growth of hair, breast, changes in voice enhancing, start of menstruation in girls...
First activate the hormones Central (the hypothalamus and the pituitary gland), which in turn activate peripheral hormones, which are responsible for late changes affecting the body. Therefore, changes that alter this balance in either of the two levels may be the cause of an onset of puberty too soon, and because of this there are two types of precocious puberty:
· Central precocious puberty (PPC): for reasons that alter the hormones of the hypothalamic-pituitary doing to be activated early: brain injury, trauma, infections of the central nervous system, tumours, malformations... Sometimes the exact cause is not known, and is then referred to as idiopathic central precocious puberty. The CFP represents 90% of the cases.
· Peripheral precocious puberty (PPP): produced by an excess of peripheral hormones, due to various causes, such as tumors of the sexual organs, cysts...
In both types of precocious puberty signs and symptoms are similar, although treatment varies depending on what is the cause. In girls is more common idiopathic central precocious puberty, while children in more than 40% of the cases it is secondary to any recognizable disease.
Diagnosis of precocious puberty
The suspected diagnosis of precocious puberty shall be given primarily by physical examination of the child and the appearance of secondary sex characteristics mentioned in the first paragraph, as body hair, breast development and sexual organs, an acceleration of growth, or the presence of acne...But there are a number of complementary tests that your pediatrician may request to confirm the diagnosis of precocious puberty. The pediatrician on the lower header, can ask some of them and in other cases will be referred to specialist in Pediatric Endocrinology, and they are:
- Study of bone age: since hormonal changes also accelerate the change of the bone, one of the ways to see if chronological age corresponds with the hormonal age is to assess bone age. This is checked with an x-ray of left mano-muneca. If there are home pubertal bone age will be accelerated, showing changes that are 2-3 years higher than chronological age.
- Hormonal study: since the final cause of the onset of puberty is the activation of any hormone that should be still asleep, can be measured in blood these hormones to see if they are abnormally high. You can also make a hormone test that consists in the administration of a (gonadotropin) hormone to see if it turns the shaft hypothalamus-pituitary, measuring levels of hormones in blood.
- Pelvic ultrasound: girls can be measured so the size of the ovaries and uterus to see if they show signs of maturation.
Treatment of precocious puberty
The treatment of precocious puberty will depend on the cause that has caused it, and may be medical or surgical (in the case of cysts or tumors). In 90% of cases, being of central origin, is intended to suppress the abnormal activation of hormone axis hipofisis-hipotalamo - gonads, to stop the secretion of sex hormones, and slow down the development of secondary sex characteristics and stop bone maturation ahead, thus avoiding the spurt of growth and preserving the potential adult size. To do so is given hormone treatment (gonadotrophin analogues) in the form of intramuscular injections every 25-28 days.It is necessary to continue treatment until it is considered that the skeletal age, chronological age, psychological maturity and the prognosis of final size are appropriate to reinstate the age of puberty.
With regard to the treatment of precocious puberty, it is not always necessary, but you have to evaluate each case in particular. If you observe changes in the behavior of the child and poor school performance, it would be appropriate to establish at least one visit by a psychologist who would determine if you need to associate or not psychological treatment.
Likewise, children who suffer from this problem are often embarrassed by the physical differences or even voice about his classmates, therefore if you see that your self esteem has fallen, we recommend to take a look at our article on techniques to improve child self-esteem.
Article contributed for educational purposes