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Should I be concerned my daughter started puberty before age 10?
Typically, puberty for girls - the transition into sexual and reproductive maturity - begins around the age of 10 or 11. However, some children experience physical and emotional changes associated with puberty earlier than that. When puberty begins in girls before the age of 7 or 8 years old, they are in precocious (or early) puberty. Parents should be reassured that in most cases, early development is not due to medical problems, and it is generally slow to progress. However, while precocious puberty is increasingly common, there can be physical and psychological consequences of starting to develop too early. There are different reasons a girl may start to develop early, and whether or not a parent needs to seek treatment can depend on why it is happening.
What is precocious puberty?
True precocious puberty in girls includes the development of breast buds, growth of pubic or underarm hair, a significant growth spurt, body odor, possible acne, and the onset of menstrual periods before the age of 7 or 8 years old. Many children may show only some signs of early puberty, for instance the growth of pubic or armpit hair without any other sexual development. This may actually be "partial" precocious puberty and is generally not a sign of any underlying conditions. Partial precocious puberty without the onset of a period is due to adrenal gland androgen production, which is not directly related to ovarian activation (https://www.karger.com/article/pdf/3363250). These children will usually show other expected signs of puberty later on at the usual age.
Puberty is starting earlier and lasting longer. Girls today are beginning the first clinical signs of puberty - the development of breast tissue - almost a year earlier than their counterparts 40 years ago (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550972/). However, while historical data from Europe shows that the age of average age at which girls start their periods (the last clinical sign of puberty for girls) dropped dramatically from about 17 in the early 19th century to 13 in the mid 20th century, this trend has slowed: more recently, the average age of first menstruation dropped by only 2.5 to 4 months over 25 years (https://www.karger.com/article/pdf/3363250). In addition, there is a persistent racial gap: about 10% of white girls and 15% of black girls get their first period before age 11 (https://pubmed.ncbi.nlm.nih.gov/12359816/). Early menarche has been linked to some risk of health conditions later in life, such as breast cancer.
What you can do if your daughter is showing signs of early puberty
Make sure your daughter knows what is happening to her body and why. This can be hard because even if she looks grown up on the outside, she is still a child in her head! You can start with some age-appropriate books about puberty, such as The Care & Keeping of YOU: The Body Book for Younger Girls followed later (in Stage 2 or 3) by The Care & Keeping of YOU 2: The Body Book for Older Girls, which are terrific resources she can read alone or with you. You may want to explain that the types of changes she is experiencing normally happen when girls are a little older, and prepare her for what she can expect. If you want a refresher for yourself, be sure to check out The Body Agency’s Puberty Guide.
The most important thing you can do is make sure she sees you or some other trusted adult as someone she can talk to on an ongoing basis about what’s happening. That way, you can help her navigate all the stages of puberty (it can last up to five years!) and be alert for any signs of potential problems.
You should also speak to her pediatrician to see if you can identify a reason your daughter is developing early, or a therapist if she could use some guidance adapting to the changes underway.
What should my daughter’s pediatrician do?
Puberty is a natural process, and medical intervention is not usually necessary, but treatment may be suitable for some girls who get their first period before age 8 (https://medlineplus.gov/genetics/condition/central-precocious-puberty/). Your daughter’s pediatrician should do a physical exam, may run some tests to see what type of precocious puberty your child has and what may be causing it, and possibly refer her to a pediatric endocrinologist further evaluation and treatment if appropriate.
When treatment for precocious puberty is recommended, it typically includes medication to delay further development.
Does my daughter need treatment for precocious puberty?
In many cases no. However, there can be physical, emotional or social consequences for girls who reach puberty too early in life. It can be difficult to navigate the logistics of period management and being treated differently by peers that can occur when they are obviously more developed than older peers. Children stop growing when puberty ends, so precocious puberty can result in a girl not reaching her full height. Girls who experience puberty early are more likely to experience low depression and anxiety than their later-maturing peers, and also poorer self-esteem and body image. They may also at be greater risk of substance abuse, poorer academic outcomes, and earlier sexual activity (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958977/).
Why do girls start puberty early?
The earlier onset of puberty in girls more generally has been widely attributed to higher rates of obesity (because fat cells make estrogen), socioeconomic factors like fetal nutrition and child dietary habits, and environmental factors including exposure to endocrine disrupting chemicals or external sources of estrogen or testosterone such as creams (https://www.karger.com/article/pdf/3363250). Rarely, structural problems like a genetic anomaly, tumor or central nervous system injury can result in early puberty, but that is far less common. In many cases, there is no known reason and no medical problem causing precocious puberty. Early onset of periods in particular are often hereditary (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958977/).
Can I prevent my daughter from experiencing early puberty?
In most cases, no, because many contributing factors (like heredity and ethnicity) are not changeable. You can, however, limit her exposure to reproductive hormones and help her consume a good diet so she can maintain a healthy weight. You can also minimize household stress and create a supportive environment for her to grow and develop at her own pace.
