Precocious (early) puberty in girls UPDATE 2 IN COMMENTS

[vasc]

I’m normally more active on the Working Moms board but wanted to ask this where there’s a larger audience.

Anyone have experience with early puberty in girls? I’ve got a 7-year-old daughter, 2nd grade. She’s always been very tall for her age (tallest in the class despite a July birthday and technically being chronologically younger). The last three months I’ve noticed her breasts have started developing. She has noticed too. I’m nervous and worried that other signs of puberty might also start early. Google told me about the diagnosis of precocious puberty and I’m wondering if I ought to make an appointment with the pediatrician.

I was not an early developer, but I think my husband and SIL were, so there may be a genetic component. I’m going to ask my MIL for details.

Anyone been down this road before?

[jlt19]

My now 10 year old started with buds early, probably about 2 years ago? There really isn't a reason to see the doctor, as it's normal. I'd recommend checking out the American Girl Doll book, the Care and Keeping of You. It was helpful to explain to her what's happening and what will happen and how everyone is on a different timeline.

And if she's too embarrassed to talk about it, get a notebook where she can write questions to you and you can respond. That's worked well for us and eventually DD just starts talking about it. Now, when it comes to the birds and the bees, she still shuts down, so still not sure how I'm going to handle that....

[abs]

I would see the pedi. 7 really isn't too young but they will probably want to see her and maybe do some bloodwork just to make sure everything is okay.

[minzy]

I would check in with the pediatrician too. We just did a puberty session for my fourth grade Girl Scouts and the nurse practitioner mentioned seeing the doctor if puberty started before 8 or there were no changes at all by 13.

[Deleted]

My step-son was Dx with Precocious Puberty, but he was really young, like 5 I think. I don't really know many details as it was before I met my H, but I know that they were able to treat it and then he ended up going through puberty at the appropriate age. 7 is definitely on the young side imo and I would at least reach out to the pediatrician and see what they have to say.

[AdaraMarie]

Our doctor also says to come in if they start developing breasts prior to age 8. I noticed my younger dd start developing last summer at not quite 7.5 so I took her in to the doctor. They said without other signs of puberty this alone could still be ok and they sent dd for an x ray of her arm to determine if her bones age was in line with her chronological age. If the bones are more developed my understanding is that it is a sign they are nearer to being done growing. My dd's results came back quite a bit younger than her actual age so her doc said not to worry about it unless she started growing pubic hair or having other signs.
I believe if the results came back differently the next step would be a blood test and a referral to a specialist.

[starburst604]

I'm dying right now that I have a 5.5 yr old and this could be happening and normal in less than 2 years!! Maybe because I was so slow to hit puberty and didn't get my period till almost 15. Our pedi mentioned precocious puberty during our 5 yr well check when she noted that DD had a massive growth spurt that put her way ahead of her curve since birth. But no breast buds or public hair, so they will just keep an eye on her growth. My friend mentioned that her newly 6 yr old started getting pubic hair and was going to talk to her pedi about it. My friend said she developed very early herself.

[cleo29]

My youngest started to get breast buds at 8 1/2. She is also tall. My oldest, started 9-10, but now at 11 has legitimate small breasts and will most likely start her period within the year, which is around the same age as me.

[circa1978]

It's maybe worth a call to your pediatrician but I personally wouldn't have been worried by that. I got my period when I was 9, which is normal in my family. I'm positive my breast development started before that. No matter what's happening, I would say keep calm because I'm sure you don't want her to pick up messages/vibe that puberty is bad or something is wrong with her. I never knew any different because my aunt and my mom sat me down when I was 8 or so and told me the deal. I was ready and not scared or upset at all when it did happen.

[Pilsy]

Interesting.

No breast buds here, but my 6-year-old (also extremely tall for her age) has long, dark leg hair and, within the past year, sort of a mustache (to put it simply). I just posted on MMM about my fears she'll be the subject of ridicule.

This is crazy, but she had an issue with labial adhesions, and we've had to use a hormonal cream off and on for years. The pedi assured me it wouldn't have any long-term effects, and I trust her, but I occasionally still ponder whether it has anything to do with all the hair. It looks like this isn't even a sign of puberty, but I definitely associate the two.

[pieinthesky]

My daughter is 8 and when she was 6 our ped referred her to a ped endocrinologist because she thought she might have early onset puberty (tall for age(parents not tall), maybe breast buds some pubic hair/discharge). We saw the endocrinologist and had bloodwork(traumatic for my 6 yo) and xray of her hand. The endo said hormonally she was not in early puberty. The xray indicated she would probably grow to 5'4 which is the same as me. Nothing indicated early puberty.

The endo said getting a period at age 9 is on the normal spectrum for puberty (ARGH!!!!). We've gone back for a couple of check ins and the endo says she shows no signs of abnormality in terms of what is normal for her age.

I was pretty spun out before we saw the endo when she was 6 but now that she is 8 (and starting to need a starter bra). She also has dark leg hair and something of a mustache which I chalked up to her heritage. I'm not worried about puberty. I'm not prepared for it, but I'm also not worried that there are any issues with it.

At your daughter's age, you might mention it to her ped just for confirmation but I didn't read anything about her that would indicate something to be concerned about. Good luck with an almost teen daughter!!!

[Kristinmo]

YES! My daughter was recently diagnosed with this. At her 8 year old appointment I brought up that she recently had gotten some public hair. She referred us to an endocrinologist and did the growth plate x-ray and blood work. Her bone age showed she was 10.5 which meant that she would likely stop growing early. The endocrinologist did some additional blood work and an abdominal ultrasound. The ultrasound was the deciding factor to treat because she was showing ovary development that meant she would get her period in elementary school which I really wanted to avoid. She is doing hormone suppressing shots every 6 months for 2 years. One we stop at 10.5, she will then begin puberty again.

Any signs of puberty before 8 should have a follow-up.

[anonymous]

Feb 5, 2021 12:41:40 GMT -5 Kristinmo said:

YES! My daughter was recently diagnosed with this. At her 8 year old appointment I brought up that she recently had gotten some public hair. She referred us to an endocrinologist and did the growth plate x-ray and blood work. Her bone age showed she was 10.5 which meant that she would likely stop growing early. The endocrinologist did some additional blood work and an abdominal ultrasound. The ultrasound was the deciding factor to treat because she was showing ovary development that meant she would get her period in elementary school which I really wanted to avoid. She is doing hormone suppressing shots every 6 months for 2 years. One we stop at 10.5, she will then begin puberty again.

Any signs of puberty before 8 should have a follow-up.

My son is on his way to this diagnosis. He just turned 8, has some pubic hair and so went off to endo. his bone scan showed age 11! Bloodwork will come back next week. I really wasn’t expecting those bone age results bc my daughter also head early hair but t turned out to be nothing. Good Iuck to your DD.

OP I would definitely go to pedi for this-that is what I did for my DD and they didn’t think it needed a further step. For DS they thought it looked more suspicious. Worth going to get checked out

[wanderingback]

Feb 5, 2021 11:49:35 GMT -5 circa1978 said:

It's maybe worth a call to your pediatrician but I personally wouldn't have been worried by that. I got my period when I was 9, which is normal in my family. I'm positive my breast development started before that. No matter what's happening, I would say keep calm because I'm sure you don't want her to pick up messages/vibe that puberty is bad or something is wrong with her. I never knew any different because my aunt and my mom sat me down when I was 8 or so and told me the deal. I was ready and not scared or upset at all when it did happen.

Yes same for me. I think I might've started my period closer to 10, but I can't remember exactly. I believe I was in the 4th grade. I do remember when I saw my first pubic hair in 1st grade and telling my mom and then there's a picture of me at the pool in 2nd grade and I remember having breast buds. My mom prepared me well for getting my period. 

If a person has the benign causes of early puberty it's definitely a personal decision of whether to treat or not based on all the information the doctor gives you.

If secondary sex charasterics are growing really fast, then that can be a sign that the period is going to start soon.

I think there's still a little bit of gray area in regards to what is considered "normal" to start showing some secondary sex characteristics, but in general yes before age 8 is when people will likely at least take a good history and do a good physical exam, then determine next steps. 

OP, I hope your doctor can guide you all. 

[cereal K]

I have no advice for you (DD is 10, and just started developing buds - pedi says period in about a year and a half!) but I just want to say that it’s ALWAYS okay to call the pediatrician. It’s what they’re there for. Our doc’s nurses on the nurse line are great - I would not hesitate to call and just ask what they think. They’ll def steer you in the right direction!

[caramia]

My 5 year old was just diagnosed with precocious puberty after I noticed breast buds and some pubic hair. She has had brain surgeries & has malformations so it’s not surprising, but the endocrinologist we saw said that these symptoms in a typical child could be a sign of a tumor. I’m not trying to scare you but I would definitely contact your pedi.

We are treating with a hormone suppressant shot every 6 months. The diagnosis was blood work, a wrist X-ray & a physical examination.

[sonrisa]

See the pediatrician.

My youngest started to sweat like a teen while still in preschool (age 4). We started seeing the doctor about precocious puberty. So far (age 7), it's just the sweating but we are still watching it.

[sent]

I asked at our 7 year old well visit last month. DD has always been tall even as a preemie. I showed the doctor that DD has been getting acne on her forehead. I forgot to mention the body odor where I have to apply deodorant on her. I constantly have to remind her to wash her face and her armpits when she showers but I wonder if it's more than that. The doctor's physical exam didn't reveal anything but she said we could get a hand-wrist film and see if that shows anything. If it does, then she said we could do bloodwork.

I need to schedule the X-ray.

[vasc]

Thanks for the input everyone. I scheduled an appointment with the pediatrician and it was this morning. She confirmed that yes, DD was developing breast tissue. That alone wouldn’t be concerning to her, she said, but DD’s height had also gone up 2 inches since July. Those two indicators made her want to order the hand X-ray, which we were able to do immediately after.

I’ve already got the X-ray report in her MyChart, which indicated her bone age to be 8y10m (DD is 7y 7m). Based on the convo with the doctor I think this will be a watch-and-wait scenario. Haven’t heard from the doctor yet.

ETA again: doctor just called and said she’d actually prefer to refer to endocrinology because we also had a family history of early puberty on my husband’s side. So that’s that. Hopefully we can get an appt in 1-2 mos.

[cleo29]

vasc, glad you got some answers.

[vasc]

Wanted to follow up again as we saw the Pediatric Endocrinologist in March and had a follow up today.

P.E. used baseline height/weight from March to officially diagnose Precocious Puberty today. DD just turned 8 and has grown two more inches since March. She’s 99%ile for height, showing further breast development, early pubic hair, and some light discharge.

Sooo…it seems we are going in the direction of treatment with hormone suppression drugs, per physician’s recommendation. Before we left today DD had a second hand X-ray and a blood draw to test for the presence of all the major hormones.

The doctor gave me pamphlets for Lupron (shots every 3 months) or Supprelin (1-year implant in the arm). I need to review what our insurance will cover but I’m leaning towards the Lupron injections.

Anyone have specific insight on those drugs?

[Jalapeñomel]

Jul 19, 2021 12:38:13 GMT -5 vasc said:

?

I’m so glad you’re getting some answers.

I took Lupron to suppress ovulation when I was going through IVF. Clearly, NOT for the same outcome, and this could be completely unhelpful, but I had no problems tolerating it.

I hope this helps your little girl. 🧡

[mustardseed2007]

vasc , my kids are short stature (considered to have idiopathic short stature) and I'm in a facebook group of families with kids who are ISS and we all see endocrinologists. Some of them take either Lupron or have had a Supprelin implant. From what I've read, for girls after age 9 it can be hard to get approved (after 11 for boys) for supprelin because of something having to do with not wanting to lower estrogen levels too much after age 9. Just from seeing discussions on it, it's my understanding it can be more expensive. Supprelin tends to be more common in boys in our ISS group, which makes me wonder if it's b/c the cut off for boys is higher? I'm not sure about that. There is a potential advantage to Lupron in that it's more flexible in that you can start and stop and can start it quicker if you are worried about jumping on it, vs having to schedule a surgery.

However, both treatments are used by kids in that group and I haven't read about actual negative effects with either one.

Also just to add, from being in the ISS group, I have come to learn that although it's common to look at bone age just to gauge what the skeletal structure is doing, it's kind if imprecise and not a great gauge of what is really going on since the bone age development can either stall out or rapidly advance. However, all the other developmental thing that you are seeing are definitely a sign of PP and I'm glad you're in with an endocrinologist who is giving you good options! 

[liverandonions]

I suspect my daughter will be somewhat early to puberty. Shes 8.5 and has very hairy legs and awful B.O. and developed some blackheads and small pimples on her nose. Probably from wearing a mask at school all day but still a potential sign of early puberty. My mom was 9 when she got her period, mine was fairly normal at age 12.5. My daughter sort of favors my niece in her looks, emotional personality etc and she started at 11 so I wonder how similar they will be.

Ive considered the outschool class on puberty with her, but haven’t pulled the trigger yet

[vasc]

DD's blood test results and 2nd hand xray results are back. I spoke to the doctor over the phone today. During the 1st appt in February, she indicated that treating precocious puberty is less recommended after the child has turned 8 (DD just turned 8). At our appointment earlier this month, the same doctor seemed to reverse course, recommending treatment for DD despite her age due to her fast growth. I left feeling like there was a sense of urgency to start treatment. Today over the phone, however, the doctor seemed to flip-flop again, saying that results as far as adult height are not as strong when the patient starts treatment after turning 8 compared to if treatment was started earlier.

Basically, we need to decide how much risk we want to take that DD will grow to be of average adult height without treatment. Protecting her adult height seems to be the main focus of the doctor because if she goes through puberty too fast, her growth plates will close earlier and her overall adult height will be shorter.

I...don't know if height alone is enough for me to seek treatment for her? I'm much more motivated to maybe do a year of treatment simply to postpone her first menses...she's only going into 3rd grade and I just feel like if we have enough reason to justify treatment, and delaying her period is an added benefit, it's worth it. Husband isn't totally sold on that logic though (and even went so far as to suggest I was "period shaming" with negative talk about potentially starting a period as early as 3rd grade, which I was caught off-guard about).

Would love to hear how others made the decision to treat or not.

[Jalapeñomel]

I have no advice except to send support your way.

Navigating these kinds of decisions is hard, and whatever decision you come to will be the right one.

[picksthemusic]

My DD is 10 and we had her tested for this due to early growth of dark underarm hair at age 6. We saw a pediatric endocrinologist, who did labs to make sure her hormones were okay, and did wrist x-rays to see if her growth plates were okay.

Luckily, she was just diagnosed with adrenarche, which is not precocious puberty. She is now nearly 10 with newly developing breasts, which her pedi says is on track for normal puberty.

Good luck!

[raleighnc]

Aug 2, 2021 18:44:53 GMT -5 vasc said:

DD's blood test results and 2nd hand xray results are back. I spoke to the doctor over the phone today. During the 1st appt in February, she indicated that treating precocious puberty is less recommended after the child has turned 8 (DD just turned 8). At our appointment earlier this month, the same doctor seemed to reverse course, recommending treatment for DD despite her age due to her fast growth. I left feeling like there was a sense of urgency to start treatment. Today over the phone, however, the doctor seemed to flip-flop again, saying that results as far as adult height are not as strong when the patient starts treatment after turning 8 compared to if treatment was started earlier.

Basically, we need to decide how much risk we want to take that DD will grow to be of average adult height without treatment. Protecting her adult height seems to be the main focus of the doctor because if she goes through puberty too fast, her growth plates will close earlier and her overall adult height will be shorter.

I...don't know if height alone is enough for me to seek treatment for her? I'm much more motivated to maybe do a year of treatment simply to postpone her first menses...she's only going into 3rd grade and I just feel like if we have enough reason to justify treatment, and delaying her period is an added benefit, it's worth it. Husband isn't totally sold on that logic though (and even went so far as to suggest I was "period shaming" with negative talk about potentially starting a period as early as 3rd grade, which I was caught off-guard about).

Would love to hear how others made the decision to treat or not.

What are the potential risks/downsides of treating? What is her potential adult height without treatment vs. her projected height based on parental height or whatever they use? I don't know a ton about precocious puberty, but someone mentioned an ultrasound of the ovaries to make the final determination. You can always get a second opinion. If the risks are minimal, I would lean towards treating because you won't have a second chance to mitigate the growth restriction. If it's just a general reluctance to mess with hormones, it seems like you are really just trying to restore the natural balance of her hormones. 

Obviously being short isn't usually life-threatening, but it's just one more annoyance to deal with when trying to buy clothes, find a car you like, having to get a stepstool out for everything (just some examples that my 5'2" BFF hates about her height).   
 
And not trying to insult your husband, but I'm assuming he has never had a period. I don't think you are "period shaming" at all - I'll wager the majority of people who have had periods would consider it a benefit to put it off a year or more. It's possible that she could have super manageable, short, regular periods from the beginning, but it's also possible that she could have discomfort/pain, getting her period unexpectedly at school, etc. That combined with the possible growth restriction would definitely push me towards treatment.       

[sonrisa]

Aug 2, 2021 18:44:53 GMT -5 vasc said:

I...don't know if height alone is enough for me to seek treatment for her? I'm much more motivated to maybe do a year of treatment simply to postpone her first menses...she's only going into 3rd grade and I just feel like if we have enough reason to justify treatment, and delaying her period is an added benefit, it's worth it.

That seems like a big added benefit and I would definitely take it into consideration. I know it's a factor I've weighed in getting my own child evaluated.

[fivechickens]

Aug 2, 2021 20:59:02 GMT -5 raleighnc said:

And not trying to insult your husband, but I'm assuming he has never had a period. I don't think you are "period shaming" at all - I'll wager the majority of people who have had periods would consider it a benefit to put it off a year or more. It's possible that she could have super manageable, short, regular periods from the beginning, but it's also possible that she could have discomfort/pain, getting her period unexpectedly at school, etc. That combined with the possible growth restriction would definitely push me towards treatment.       

Yes. Your husband obviously gets a say in his daughter’s health but he has never had a period and rather than shame you about something he has zero experience in he needs to listen and understand that you know more about it. Unless he is a gynecologist.