The Age of Puberty

Male Speaker: It seems today sometimes girls start to get a little pubic hair and their nipples get budded and the kids may be 7 or 8 years old. Is that a problem because the kid get a period at very young age. Is that a problem? Dr Henry Anhalt: A colleague of mine recently published a paper that spoke to the fact that children tend to be entering puberty earlier today they may have in past decades. Male Speaker: What is the normal age for a girl to go for pubescence? Dr Henry Anhalt: What we have defined as normal and of course it’s important to understand that definitions like this are arbitrary. We must pick a certain age, a low age we would consider development to be early. However, that is not synonymous with disease. For even if a child begins to develop early, it is important to realize that most, if not the majority will in fact be a normal variation. With that said the defining times for the earliest onset of development in girls is age 8 and that includes the development of pubic hair or breasts and in boys, age 9, the development of pubic hair and testicular enlargement. On the other end or on the late side, we would consider the absence of any development at the age of 12 or 13 in a girl and 13 or 14 in a boy to be considered abnormal. Despite the fact that many of us have observed the early onset of pubic hair and body odor in many children as young as 3, 4, and 5 years of age, the first age of the period, what is called menarche, seems to be quit stable for the last 3,000 years at approximately 12.25 years. So, even though we are beginning to see some of the signs of puberty occurring earlier than we have used to see them we are not seeing the actual change in the day the first period. Some of the reasons behind this may include excess exposure to fat in the diet, excess body weight and excess risk of developing diabetes in children may receive this kind of development. So, it may be that these signs although associated with puberty really aren’t true puberty, but rather signs if you will of potential risk of the development of problems like diabetes and early heart disease later on in life. Male Speaker: If a girl does reach her first period, when do the height stops as that was off also? Dr Henry Anhalt: Typically, girls experience a growth spurt early in the pubertal process. They experience breast development and that usually coincides with a spurt in growth, which attributes approximately 10% to 15% of final height to that child. Typically, girls will experience a period fairly late in puberty and at that time they are almost at their final adult height. It is quite possible that a child after experiencing their first period may grow an inch to an inch and a half but essentially the growth is complete by the time the first period happens. In boys, however, they tend to go through most of their pubertal changes prior to their growth spurt and that their growth spurt occurs fairly late in the pubertal process. Male Speaker: A very common question to pediatricians, they get a brand new little baby girl and they see blood coming from the girl’s vagina. Is that mean a girl is going to have a period? Dr Henry Anhalt: This phenomenon of little bit of bleeding from a newborn’s vagina is quite common and really has to do with a withdrawal of estrogen or female hormone that the baby is exposed to while in the mother’s uterus. That uterus is a rich environment filled with circulating hormones and when the baby is abruptly withdrawn from the mother’s environment, the exposure to estrogen is also abruptly withdrawn and there may be a buildup, a little bit inside the baby’s uterus, which is ultimately shed when there is that bleeding that occurs shortly after birth. Male Speaker: We also sometimes in a baby boy or girl, there is a little bit of formation of the breast or budding and sometimes there is a little whitish discharge. How come? Dr Henry Anhalt: Quite commonly, in about 65% to 80% of newborn girls in particular, there will be the development of breast tissue between the ages of 6 months and approximately 2.5 years. We typically see about 2 to 3 children per week, who come in with that same complaint. It is important that families are reassured that in the absence of any real changes in the body or in the nipple consistent with true estrogen action on the body as we would see in early puberty, this represents a little mini-puberty that normally girls go through that if you will primes and tests the system out for it later on in years when the child will in fact go through true puberty. We observed these children, we rarely get laboratory testing, we will see a child back in 3 to 4 months and if there is no significant change, typically this tissue will regress, if not completely mostly and parents will be reassured of the same.