A Ped’s Perspective: Precocious Puberty
What is precocious puberty?
Precocious puberty or early puberty is defined as signs of puberty starting before the age of 8 in females and age 9 in males. The onset of puberty occurs when the brain signals the pituitary gland to release sex hormones: estrogen in females and testosterone in males. Early puberty most often occurs when the brain prematurely sends signals, and there are no other underlying medical problems or triggers. Less commonly, early puberty occurs due to a medical condition such as a tumor, injury or trauma to the brain or spinal cord, or a genetic condition. Early puberty is more common in females than males.
What is the cause?
Pubertal timing in general has changed drastically with onset of puberty occurring earlier and earlier with each decade that passes. I have been a nurse practitioner for 6 years, and it feels like I have seen more and more kids with precocious puberty in just that short amount of time. There is significant evidence to suggest that obesity with high BMI is a contributing factor in early puberty, and more and more studies are considering the effects of endocrine disrupting chemicals (EDC’s).
A recently published review outlined some of the concerns with EDC’s as they pertain to early pubertal onset. Read the full published article here. Lucaccioni et al. (2020) explained that during a lifespan, there are some critical periods of development that have the potential to be most affected by EDC’s: fetal life, neonatal life, and puberty. These are more critical points because “cells are rapidly proliferating and epigenetic changes are more likely to occur” (Lucaccioni et al. 2020). It makes you consider all of the new personal care products that pre teens are starting to experiment with during this critical time that could be contributing to hormone dysregulation: perfumes, air fresheners and sprays, makeup, scented body washes and lotions, bath bombs, face masks, etc. What is most important to understand as explained by Lucaccioni et al. 2020 is that, endocrine disrupting chemicals can act as both agonists or antagonists of estrogen receptors meaning they may mimic the natural occurrence of hormones and/or they can block normal hormone functions. It is also very interesting that there is evidence to suggest that endocrine disrupting hormones can also be contributing to obesity. According to Biro et al. (2012), certain environmental chemicals, including diethylstilbestrol (DES), bisphenol A (BPA), phthalates, perfluorooctanoic acid (PFOA) can promote change in the basal metabolic rate, shift energy balance in favor of storage of calories, and alter hormonal control of appetite and satiety. This is unfortunately the scary reality that we have to be thinking about; we do not live in a time that you can trust any product that is available to purchase on the store shelves. We, as parents, really need to be advocates for our family to make changes where possible because it can make a big impact in the long term.
Common signs of early puberty:
Breast bud development in girls: firm, sometimes tender, lumps directly under nipples
Enlargement of the penis or testicles in males
Pubic or underarm hair development
Height acceleration
Body odor
What are the health concerns related to precocious puberty?
The long term effects of precocious puberty are still unclear, but studies show a link to cancer (ovarian and breast in females & testicular in males), cardiovascular disease (high blood pressure), obesity, metabolic diseases (insulin resistance, prediabetes, type 2 diabetes), and short stature. Short stature is common because significant development of bones and muscles occurs during puberty, and growth stops when puberty ends. The height acceleration that occurs with early puberty can mean that your child will stop growing too soon.
If you notice any early pubertal changes, I would recommend follow-up with your child’s medical home. The provider will be able to get a thorough history, assessment, and growth history comparison to decide if labs, a bone age, and/or follow-up with an endocrinologist are necessary next steps to determining true precocious puberty. Premature thelarche is another possible diagnosis that results in early breast bud development in girls without other physical signs of puberty. A full work up will help guide diagnosis and treatment.
So what can you do now?
My biggest recommendation is to be mindful of the products that you are using in your home and on your body; you cannot control everything, but it is very easy to make a few simple swaps to reduce toxin exposure in your everyday.
A few areas of focus should be:
Household cleaning products: all purpose cleaners, floor cleaner, soft scrubs
Laundry: detergent, fabric softener, dryer sheets
Personal care products: soaps, body wash, lotions, diaper creams, sun screens, perfumes
Air fresheners: candles, plug ins, room sprays/ deodorizers
We found one company that we trust that has products that touch all of these areas making it so much easier. I will share my top recommendation to start with below; this one purchase will significantly reduce toxin exposure in your home for yourself and your family. I also love that they have a very generous loyalty program so you earn in store credit back on each monthly purchase. It has truly made the process so much less overwhelming.
Focus on what you can control, and otherwise do not worry about what is out of your control.
Kelly, MSN, APRN, PNP-C
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