While puberty can be confusing for anybody, it can even be difficult for some. As one adjusts to the changes in one’s body, the emotional changes do not make the task any easier. It is about hormones, after all. In girls, puberty generally starts between the ages of eight and 13 years, and in boys, between nine and 14.
However, according to a recent study, children in India are now attaining puberty at a much earlier age than usual. In fact, as per the Indian Council of Medical Research (ICMR) statistics, at least 13 million children in India are experiencing early puberty. While the phase itself can be tough to adjust to, early or precocious puberty can have another detrimental impact, such as shorter final adult height, premature bone maturation, and even self-consciousness, low self-esteem and anxiety among kids.
“Research has shown a 15-fold increase in early puberty over the past 20 years,” says Dr Vimal Dassi, director, urology, robotic surgery and kidney transplant, Max Super Speciality Hospital, Vaishali, Ghaziabad.
While multiple reasons can lead to it, the rise in early puberty these days is due to hormonal disturbances in children most commonly due to obesity, lack of physical activity and eating calorie-rich food. “Many children are obese these days due to a lack of physical activity and an increase in screen time. This has caused early pubertal changes in many children,” explains Dr Ritu Sethi, associate director, gynaecology, Max Hospital, Gurugram, and founder of Aura Speciality Clinic, Gurugram.
While lifestyle is a big determiner of one’s health, there can be other, concerning causes behind it, such as tumours in the adrenal gland, testes, or ovaries, genetics, and exposure to certain products that contain estrogen or testosterone. According to Dr Dassi, while the causes among girls are usually idiopathic, for which no reason can be identified; in boys, it is usually due to an underlying pathological condition. Certain studies have also found a link between diabetes and the early onset of puberty in both boys and girls.
Watch out for signs
The signs of early puberty are the same as puberty, only the timing is different. According to experts, the signs in girls are development of breasts, beginning of menstruation, and growth of pubic and underarm hair. Similarly, the signs seen in boys are deepening of voice, growth of facial, pubic and underarm hair, enlargement of the penis and testicles, and development of muscles.
Some signs that are common in boys and girls include acne, body odour and a growth spurt. Hence, parents must watch out for these signs, says Dr Sethi.
At times, precocious puberty can be a hint of something serious. “It can be one of the signs of underlying serious disease like a brain or other tumours, Gonadal, etc. Once a child is diagnosed with precocious puberty, he will require detailed family history, examination, and evaluation to look for the cause,” explains Dr Dassi.
While these can be concerning, there can be other physical and emotional impacts. “Early puberty may cause a growth spurt in a child, but when puberty ends, the child stops growing. Therefore, they may be shorter than other children of the same age,” says Dr Aruna Kalra, gynaecologist, CK Birla Hospital, Gurugram. “It can also be embarrassing for children, who are developing quicker than their peers. These issues can lead to emotional, behavioural, and social issues, and the child may even have trouble with anxiety and depression. Also, such children may be at a higher risk of developing substance use disorders and engaging in high-risk behaviours,” she adds.
It can also make the child more prone to stress, eating disorders and disruptive behaviour disorders, and can make her avoid social situations and lose interest in things that she usually enjoys, the expert says.
In the long run, it can also impact their reproductive health, as it raises the “risk of development of reproductive tract cancer with testicular cancer in males and breast cancer in females,” says Dr Dassi. Also, “boys with early puberty have potential for sexual abuse,” he adds. Also, some studies suggest that precocious puberty in girls can slightly increase their risk of developing breast cancer later in life, however, more research is required into it.
Is there a treatment?
Before delving into the treatment, it is important to understand the physiology behind it. Precocious puberty is chiefly of two types:
Central precocious puberty: A more common type, central precocious puberty is just like normal puberty that happens earlier than normal age. In this, the pituitary glands start making hormones that make ovaries to make estrogen and testicles to make testosterone. These are the sex hormones, which cause changes during puberty.
Peripheral precocious puberty: Then there is peripheral precocious puberty, which is triggered by the hormones testosterone and estrogen, and the pituitary gland and the brain aren’t involved. Generally, it is an issue with the testicles, ovaries, or adrenal glands.
In the case of central precocious puberty, “turning off the pituitary gland’s production of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) is the main goal,” explains Dr Kalra. Both LH and FSH act upon the processes in the reproductive system. “Treatment includes a Gonadotropin-releasing hormone (GnRH) agonist, or puberty blocker, which is a synthetic hormone that works by stopping the production of reproductive or growth hormones,” the expert adds.
While it’s impossible to prevent precocious puberty in most cases, “limiting the child’s exposure to reproductive hormones from outside sources may prevent it. Such sources may include estrogen or testosterone creams, lotions or other medications,” says Dr Kalra. Also, maintaining a healthy lifestyle is the key here. “It is preventable in some cases if one maintains a healthy diet, exercise and the body mass index of the child is in the normal range,” says Dr Sethi.
Parents’ role
It can be perplexing for the kid, and hence, parents need to step up. “Give your child a simple, truthful explanation about what is happening. Explain to her that the changes are normal and happen to everyone. It is only that her body started developing a little too early. Also crucial is to watch out for any signs of teasing or other issues that may be affecting your child emotionally. And avoid making comments about your child’s appearance,” recommends Dr Dassi.
Also, just listen non-judgementally, and show them that you understand. “Your child will also compare her body to her peers’ and may feel worried about her development, body shape and size. Hence, listen to her concerns,” explains Dr Kalra. Also, “be accepting of your child’s need for privacy, and that your child may be exploring their body through masturbation,” she adds.
Whether early on or not, educating kids on puberty is required, and all the more in a country like India, where reproductive and sexual health are hardly discussed, which can make kids look for information from untrusted sources. Hence, “discuss puberty—and the feelings that come with its changes —as openly as possible. Parents might feel embarrassed discussing these sensitive topics, but kids often are relieved to have them take the lead once in a while,” says Dr Sethi. Hence, for the parents, “it helps to brush up on the subject. So, before you answer your child’s questions, make sure you get answers to your own. If you’re not quite comfortable talking about puberty, practise what you want to say first. Let your child know that it may be a little uncomfortable, but it’s important to talk about it,” she adds.
