Jul 29, 2008, 12:22 PM
Increasing worry of parents for early puberty of their children
Puberty is an unsettling stage in anyone’s life, but if it appears at the age when a child is still playing with her dolls, it can be very worrying indeed.
Dr. Hassan Azadeh, our health adviser, senior lecturer at the University of the Gambia and a senior consultant in Obstetrics and Gynecology dilated on this topic, in an interview with The Point, following a series of other articles published in the newspaper.
The Point- At what age do girls and boys start with their puberty?
Dr. Azadeh - Puberty usually occurs during adolescent, and when kids develop physically and emotionally to become young men and women. This often starts to happen, no earlier than 9-10 for girls and 10-12 years for boys.
Over the centuries, there has been a steady decline in the onset age for puberty. In Victorian time, it was about 15 for girls and older for boys. Earlier than this, records show that youths between the ages of 17 and 18 were often still to bit puberty, because their voices had not yet broken.
The generally-accepted international standards of normal puberty for girls were set by a study of 200 females in a British orphanage in 1960’s, which established that 12 years and six months for girls was the average age at which period began. Similar studies of boys concluded that 14 years was the average age of sexual maturity for them.
Puberty involves huge physical; emotional and hormonal changes as the body prepares for reproduction. There is also rapid growth and weight gain and the appearance of body hair and for many, an unwelcome crop of acne. Girls develop breasts and begin to have menstrual periods, while boys begin to produce sperms and their voice becomes lower pitched.
So far, there is no real agreement among doctors about whether we are just seeing a continuation of this decline in the average age at which puberty occurs, or whether it is a part of a more worrying environmental trend towards children growing up too quickly.
However, most agree that if breasts and pubic hair development happen before the age of eight or nine in the case of girls, or signs of puberty manifest themselves in boys under ten, it is “abnormal.” However, the onset of singes of puberty before age 7 or 8 in girls and age 9 in boys- can be physically and emotionally difficult for children, and can sometimes be the sign of an underlying health problem.
There is also evidence that children with early sexual development become sexually active earlier. There are also thoughts whether early childhood could have a knock on effects, which makes them susceptible to adult health problem, such as cancer and heart diseases.
In Briton and in some other European countries, it is now more or less established that up to at least one in sex children fewer than ten is affected. Indeed, there are some recent studies that show that school girls as young as six are entering already puberty. There are also a few studies from some African and Asian countries reporting similar early childhood development in puberty and early sexual maturity too.
Whatever the cause, growing number of children are being deprived of childhood and are turning physically into mini-adults at an increasingly, young age. But without the emotional maturity to deal with these changes, they are vulnerable to exploitation.
The Point - What are the signs of early puberty?
Dr. Azadeh - In girls, the commons signs include any of the following before the ages of 7 or 8:
Pubic or underarm hair development
Rapid height growth- a growth “spurt”
Onset of menstruations (periods)
"Mature” body order
In boys, the signs of early puberty before 9 years of age include:
Enlargement of testicles or penis
Pubic, underarm, or facial hair development
Rapid height growth –a growth “spurt”
"Mature” body odour
Similarly, some girls and boys may experience early growth of pubic and/or underarm hair that isn’t associated with early puberty and may require evaluation to rule out “true” early puberty or other health problems.
Going through puberty early can also be difficult for a child emotionally and socially. For example, girls with early puberty may be confused or embarrassed about physical changes, such as getting their periods or having enlarged breasts well before any of their friends. But the hardest part may be teasing that children with the condition – especially girls may experience.
Even emotions and behaviour may change in children with early puberty; girls can become moody and irritable. Boys can become more aggressive and also develop a sex drive inappropriately for their age.
The Point - What are the causes of early puberty in girls and boys?
Dr. Azadeh - The onset of puberty is normally by the Hypothalamus (the area of the brain that helps control the function of some glands), in particular a gland call pituitary to release hormones that stimulate the ovaries in girls or testicles in boys to make sex hormones.
Sometimes, the early puberty stems from a structural problem in the brain- brain injury due to head trauma, an infection such as meningitis, or a problem in the girls ovaries or thyroid gland that triggers the onset of puberty ahead of schedule – but this is usually isn’t always the case.
In about 5% of boys, early puberty is inherited. Starting puberty early can be passed on from the father to the son. But less than 1% of girls affected by early puberty have inherited the condition.
*More girls experience early puberty which is very much linked with their lifestyle, diet and in particular in girls who are overweight (obese) in their very young age, especially in 6 – 9 years old.
*Others attribute largely to nutritious improvement, food containing more vitamins, minerals, proteins, fat and other ingredients. But the most harmful are foods containing hormones, such as in chicken, meats and even in some fruits and vegetables growing in some industrial countries.
*An Italian study confirmed that the stress of family breakdown alters the balance of growth hormones and other chemicals in the body, speeding up a child’s physical development. This includes the absence of biological fathers which maybe one of the common causes as girls whose fathers had left home started their periods earlier, due to the psychological trauma they undergo.
*Early puberty has also been linked to watching too much of TV, movies and playing TV games in very young age. There are evidence that children, who watch three hours TV in a day produce less of the sleep hormone and the sleepless condition create physical and mental stress, and as a result children develop a misbalance in their sexual hormones.
The Point - How is early puberty diagnosed?
Dr. Azadeh - I strongly recommend every parent who observes any signs of early puberty and/or any sexual maturity in their children before the age of 7-8 to seek advice from a medical professional. The signs include, in girls early breast development, rapid height growth, menstruation (periods), excessive developing acne, in boys enlargement testicles or penis, changing voice or pubic or underarm hair.
The physical changes boys and girls go through during puberty are usually evidence to a doctor during an examination. To confirm a diagnosis of early puberty of your child a doctor may order blood and urine tests to detect elevated of sex hormones or possible an x-ray of your child bones too.
There might be also necessary for further testing, such as scanning can help to role out specific causes of early puberty, such as a growth in the girl’s ovaries, or boy’s testicles. Fortunately, all of the above motioned diagnostic facilities are now available at RVTH, including MRI scan (magnetic resonance imaging) for affected children to be appropriately diagnosed by specialists.
The Point - Is there any preventative medicine available possibly to prevent the development of early puberty or perhaps even to treat children who are already affected?
Dr. Azadeh - Not surprising the drug industries has developed quite a few different drugs for prevention and also for possible treatment of premature puberty. The mean effects of these drugs are to block the early production of growing hormones, but the medical professionals are not happy to admit powerful drugs, normally used to treat cancer, be routinely prescript for young children.
A spokesman for drug industry says the drugs licensed to treat girls, who reached puberty before their ninth birthday and boys who reached puberty before the age of ten, claimed it had not been on the marked long enough to report what the take up had been.
The Point - What is your own personal opinion about this worrying development in our young girls and boys even here in The Gambia?
Dr. Azadeh - As a medical professional, and in particular being also professionally Gynecologist for over 32 years, I am very familiar with the facts on early puberty and early maturity in young children. I met quite a number of children, also here in The Gambia in my long years of medical practice, in particular girls with similar conditions brought to me by their parents.
As I strongly recommend, one should seek medical advice by medical professionals for performing an appropriate diagnosis for underlying health problems and for possible treatments. In particular, girls in very young age with an early menstrual period, development of their breasts or suffering from obesity and in boys of rapid height growth, enlargement of their testicles or, and developing early facial hairs.
In The Gambia, we and our children are extremely lucky to live in an environment without toxic and harmful industrial chemicals which have been so far highlighted, as the commonest cause for hormonal changes in very young children. But this does not mean that we should also ignore some other motioned causes, such as obesity and the possibility of early pregnancy.
Most recent studies in the UK (2005) have shown that 148 girls, aged 13 or younger become pregnant from which 62 present were diagnosed as early sexual maturity. We are also facing the common teenage pregnancy here in The Gambia, either through unwanted pregnancy or marriage of very young girls.
Today, kids are exposed to so much information about sex and relationships on TV and the Internet, and by the time they approach puberty, they may be familiar with some advanced ideas. And yet, talking about the issues of puberty remains an important job for parents, because not all of child’s information comes from reliable sources. Don’t wait for your child to come to you with questions about his or her changing body — that day may never arrive, especially if your child doesn’t know it’s OK to talk to you about this sensitive issue.
Ideally, as a parent, you’ve already started talking to your child about the changes our bodies go through as we grow. At toddler ages, kids have questions and most of your discussions, probably come about as the result of your child’s inquiries.
It’s important to answer these questions about puberty honestly and openly — but don’t always wait for your child to initiate a discussion. By the time kids are 8-years-old, they should know what physical and emotional changes are associated with puberty. That may seem young, but consider this: some girls are wearing training bras by then and some boys’ voices begin to change just a few years later.
The Timing with Boys and Girls
With girls, it’s vital that parents talk about menstruation before they actually get their periods. If they are unaware of what’s happening, girls can be frightened by the sight and location of blood. Most girls get their first period when they’re 12 or 13-years-old, which is about two or two and a half years after they begin puberty. But some get their periods, as early as age 9 and others get it as late as age 16.
On average, boys begin going through puberty a little later than girls, usually around age 10 or 11. But they may begin to develop sexually or have their first ejaculation without looking older or developing facial hair first.
I am certain that the medical professionals here in The Gambia are happy to advise parents on the normal and abnormal onset of early puberty and early sexual maturity, also to perform the appropriate diagnosis as the diagnostic facilities at RVTH, MRC and some health and medical centres are available.
Further information and advice are offered at BAFROW, Gambia Family Association (GFPA), Lamtoro Medical Centre and numerous other NGOs and private clinics. Also on the Health Section of The Point Newspaper or call West Coast Radio live health show every Tuesday from 6-7pm. You can also send your questions through email on firstname.lastname@example.org, or call Dr. Azadeh on 7774469, 3774469 week days from 3-6pm.