I recently saw a 7-year-old patient with a little breast budding — which is usually the earliest sign of puberty. Her parents came in very worried. They wanted to know what’s causing their daughter to start to develop breasts while she’s still playing with dolls. Are the hormones in milk and meat to blame? Is it the pretty plastic water bottle she loves? Is it antibiotics in the food chain? Would she get her period at age 8?
When I told her parents that about 15 percent of girls her age have breast development, their jaws almost hit the floor. They wanted to know how that could be possible, and if they should be worried.
I tried to reassure them, but I understood their concerns. As a pediatric endocrinologist, I often see patients like the little girl who began puberty at such a young age. We know that girls who go through puberty early are more likely to experience various medical and psychological problems, such as depression, obesity, eating disorders and even cancer when they’re older.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
While most people think menstruation is the start of puberty, actually breast development or pubic hair are the first signs. Armpit odor and armpit hair, acne and even moodiness are not medical hallmarks of puberty, but they are all associated with it.
In the past, having signs of puberty before age 8 was considered abnormal, but now we know that as many as 15 percent of all girls have breast development when they are 7, and 10 percent have pubic hair by then. By age 8, more than 25 percent are developing breasts, and almost 20 percent have pubic hair. These rates are higher for girls of African-American and Hispanic descent when compared to Asian and Caucasian girls. And it turns out that periods probably are not starting earlier; rather puberty may be taking a longer time.
I reassured my patient’s parents that their daughter was not that early compared to her peers. But they still wanted to know why it was happening. We can’t offer definitive answers as to why girls are entering puberty earlier, but we do have some ideas.
Research I helped conduct with colleagues at the University of Cincinnati Medical Center and Mount Sinai Hospital in New York City found that the largest risk factor for early puberty may be obesity. Fat is a very active hormonal gland, and fat cells convert other hormones into estrogen. The more fat tissue a girl has, the higher her chance of starting puberty earlier. What we don’t know is whether obesity is the actual cause, or if there is some other common cause that triggers obesity and puberty in the first place (which obesity then makes worse).
But this particular girl was not overweight, and her parents wanted to know what other risks their daughter might have had that could have led her to start puberty earlier. This is where the explanations surprise most people.
There is a large body of research that shows a link between toxic stress and the earlier onset of puberty. For example, girls who grow up with domestic violence or without a biological father in the house are more likely to get their periods earlier than other girls. The theory is that the brain perceives this chronic stress as a low-grade threat, triggering the brain to start reproduction as soon as possible.
[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]
My patient’s parents said these stresses are not present in their home, and that left us with our last category: environmental triggers.
Here, the data is less clear. While we suspect that many chemicals may be involved, we can’t draw a direct link between specific substances and early puberty. Part of the problem is that we are all exposed to a large variety of chemicals, and they all work together, so isolating one in particular is impossible.
There are other factors that researchers are exploring. One is the effect of specific dietary patterns, even in normal-weight girls. For example, a diet with lots of healthy fiber seems to be protective. Scientists are also looking at whether exposure to excessive screen time or lack of sleep plays a role.
In the end, we didn’t pin down any particular trigger that would explain why my 7-year-old patient had breast budding, which is often the case. The good news is she didn’t have anything wrong with her. Once her parents understood this and that the rest of her friends would be closely following her in terms of development, they felt reassured.
We instead focused on how they as parents can support their daughter. There are many things you can do, but here are my top tips:
Be honest and open. Explain to your child in age-appropriate and understandable language what is happening to her body. Reinforce the fact that all children go through these changes and that they are normal for her. Kids are used to their bodies changing — they grow and lose teeth — and you can put these new body changes in the same context.
Treat her in a way that’s age-appropriate. And make sure everyone else treats her in an age-appropriate way as well. An 8-year old who looks older than her years is still an 8-year-old. It’s important for everyone in the child’s life to consider the child’s chronological age when interacting with her. That also means she wears clothes for her age, not her size (sometimes a challenge to find but not impossible) and watches media that is age-appropriate.
[See: 9 Sports Injuries That Sideline Kids.]
Focus on emotional and physical health. As your child matures, find activities that you both enjoy doing so you can continue to spend time together. It’s amazing how much kids start to talk when you’re in the car, on a walk or doing an activity side by side, and this gives your child an opportunity to open up with you about what’s going on in her life.
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Why Are Girls Starting Puberty Earlier? originally appeared on usnews.com
