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Puberty: How Early is Too Early?

Hillary Lockemer MD Childrens/Family, Pediatric Endocrinology

Parents often feel unprepared for their children to go through the normal stage of life called puberty, no matter at what age this occurs. Many are concerned that children are starting puberty at younger ages now than in the past.

How do you know if your child is going through puberty TOO early?

Normal Puberty vs. Early Puberty

Normal Puberty

GIRLS:

True puberty in girls starts with breast buds. For most girls, this change begins around 9 years old. It takes 2-3 years from the start of breast development to the first menstrual cycle.

BOYS:

Puberty in boys is defined by an increase in testes and penis size. For many boys this starts around 10-11 years old; however there is a lot more variation compared to girls (just look at any middle school!). Puberty in boys can begin anywhere from 10-16 years old.

Early (Precocious) Puberty

GIRLS:

Breast development before 8 years old is considered early; however, this seems to be changing.

Additionally, African-American and Hispanic girls tend to start puberty earlier than Caucasian girls.

Many doctors therefore use breast development before 7 years old in caucasian girls and breast development before 6 years old in African-American and Hispanic girls as the cutoff for true precocious puberty. Having cycles before age 9 is also considered too early.

BOYS:

Penis and testes growth that occurs before 9 years old is considered precocious puberty.

Normal Variants

Premature Adrenarche:

  • Defined as the development of pubic hair, underarm hair, body odor, and/or acne
  • Can occur without true signs of puberty
  • This typically occurs around 4-6 years of age.

Premature Thelarche:

  • Defined as breast development that occurs before 8 years of age, but without other signs of puberty.
  • Most common in babies and toddlers because of exposure to mom’s hormones during pregnancy or breast feeding.
  • Can also occur with exposure to oral and topical estrogens, or plant estrogens such as tea tree oil, lavender oil, and soy.

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Frequently Asked Questions About Puberty

Why are kids starting puberty earlier than in the past?

Girls do seem to be starting breast development at younger ages than in the past.

Interestingly, the age of first menstrual cycle has not changed in over 70 years (average 11.5-12 years old).

While many are concerned about exposure to growth hormones or estrogen in foods, these hormone levels are usually either not detected or found in such small amounts that they are not likely to affect puberty timing. The more likely cause is higher rates of children who are overweight or obese; these children tend to experience premature adrenarche and precocious puberty more often than children of normal weight.

What can happen if my child goes through puberty too early?

GIRLS:

For most girls, there is no clear reason why they started puberty too soon. The biggest concern is that once the body makes estrogen, the growth plates close and may result in short stature. Depending on a child’s maturity level, having menstrual cycles at a young age could also be distressful.

BOYS:

Precocious puberty (puberty that occurs too soon) in boys is more concerning. Often there is an underlying medical reason that causes boys to have precocious puberty. It is very important to make sure any boy who has increasing penis and testes size before 9 years old be evaluated by a specialist.

What should I do if I think my child is going through puberty too early?

Talk to your child’s pediatrician about your concerns. Many times they can just follow your child’s growth and exam. Sometimes an x-ray of the left hand, blood work, or referral to a specialist, like a pediatric endocrinologist, is needed for further testing or treatment.

About Hillary Lockemer, MD

Dr. Hillary Lockemer is a pediatric endocrinologist with WakeMed Physician Practices – Pediatric Endocrinology. She is board certified in pediatrics and pediatric endocrinology and has been involved in numerous research studies related to pediatric endocrinology. Schedule an appointment with Dr. Lockemer today. You can also follow Dr. Lockemer on her Facebook page.

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