Puberty is a complicated process both physically and psychologically. We are familiar with the symptoms: breast buds, first menstrual cycle, facial and pubic hair, deeper voice, and body odor. If any of this occurs in a girl before the age of eight, and in a boy before the age of nine, it is known as central precocious puberty (CPP.)
Identifying a child in precocious puberty often starts with a startled mother calling her pediatrician to explain that her four- or six-year-old daughter appears to be developing breasts. The primary pediatrician will refer the young patient to a pediatric endocrinologist and call for a bone age X-ray. An X-ray of the left hand and wrist can determine age. In a CPP child, a six-year-old may have the bone age of a nine-year-old. Although the cause of early puberty is often unknown, the endocrinologist can treat it with medications that will halt puberty and slow the growth of bones to the normal two inches or so a year. If not treated, the growth spurt of these children may peak too early. As a result, they may not even reach five feet in height.
A child with precocious puberty is typically treated with histrelin, which blocks the release of sex hormones that are causing the early onset of puberty. The treatment is usually a monthly or weekly injection, but can also be administered as an under-the-skin implant, or nose spray. Once the child reaches the appropriate age for puberty, the treatments are ended and puberty begins as it should.
Coping with puberty when it happens in the typical fashion is difficult enough. The emotional and psychological impact on a child with CPP is even more stressful. Children with CPP may find that family members, friends and adults treat them differently. Teachers and caregivers may expect them to act in a certain way because they look older. Children want to look the same as their peers and may be embarrassed by the physical differences. Indeed, a child’s self-esteem must be carefully monitored if he or she is experiencing early puberty.