Information for parents and children about precocious puberty.

1. Precocious Puberty By: Elizabeth Ariana Vivi Janet Megan

3. What is Precocious Puberty? Section 1

4. Definition Puberty The process of changing from a child into an adult capable of reproduction Occurs between ages 10-14 for girls, and ages 12-16 for boys Precocious Puberty Puberty that begins before age 8 for girls and before age 9 for boys Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002152/

5. Causes For the majority of children, no underlying medical problem and no identifiable reason for the early puberty. 2 Types of Precocious Puberty Central Peripheral Sources: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002152/ http://www.mayoclinic.com/health/precociouspuberty/DS00883/DSECTION=causes

6. Central Most common form of precocious puberty Puberty process starts too soon, but the pattern and timing of the steps in the process are normal Source: http://www.mayoclinic.com/health/precociouspuberty/DS00883/DSECTION=causes

7. Rare Causes of Central Precocious Puberty Tumor in brain or spinal cord Brain defect present at birth Injury to brain or spinal cord McCune-Albright syndrome Genetic disease, affects bones and skin color, causes hormonal problems Congenital adrenal hyperplasia Group of inherited disorders, causes abnormal hormone production by adrenal glands Hypothyroidism Condition where thyroid doesn’t produce enough hormones Central Source: http://www.mayoclinic.com/health/precocious-puberty/DS00883/DSECTION=causes

8. Peripheral Less common Occurs without the hormone in your brain that usually causes puberty to start (Gn-RH) Caused by the release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland Source: http://www.mayoclinic.com/health/precocious-puberty/DS00883/DSECTION=causes

9. Other Causes Little evidence, but these may be contributing factors to precocious puberty: Environmental Factors Increase in hormones found in food Exposure to household toxins (BPA) Obesity ~106 lbs is the weight when puberty starts Leptin, a hormone involved in puberty, is secreted in fatty tissue (more fatty tissue=more leptin=earlier puberty) Sources: http://med.umich.edu/yourchild/topics/puberty.htm http://www.ourstolenfuture.org/NewScience/reproduction/Puberty/potentialcauses.htm

10. Other Causes Social Factors Girls growing up in stressed families reach puberty earlier Girls growing up without fathers Media: Some suggest increasingly overt sexuality in popular media may stimulate earlier puberty (but no solid proof yet) Source: http://www.ourstolenfuture.org/NewScience/reproduction/Puberty/potentialcauses.htm

11. How to Measure Puberty Doctors utilize Tanner Stages to assess the advancement of puberty. There are 5 Tanner Stages for each sex. Each stage corresponds to specific changes in secondary sex characteristics. Source: Carel & Leger, 2008.

12. Tanner Stages Source: Carel & Leger, 2008.

14. There appears to be more girls than boys who experience precocious puberty.

15. In a study of Danish children, 0.2% of girls underwent precocious puberty, compared to about 0.05% of boys.Source: Carel & Leger, 2008.

16. When to Consult a Doctor Boys: Girls: Age: < 8 years old Physical Features: - breast growth  Tanner Stage 3-5  If at Tanner Stage 2, there must be other features (e.g. a recent growth spurt). Age: < 9.5 years old Physical Features: - secondary sex characteristics  Tanner Stage 2 - 5 Source: Carel & Leger, 2008.

17. Precocious Puberty and Height Individuals who experience puberty at a younger age and do not receive treatment for it tend to be shorter in stature as adults, relative to the rest of the adult population. These men tend to be 7.9 inches shorter than average. These women tend to be 4.7 inches shorter than average. Sources: Carel & Leger, 2008; Nield, Cakan, & Kamat 2007.

18. Emotional Responses to Precocious Puberty Both boys and girls may develop strong emotional reactions to precocious puberty. In particular, studies have shown that many girls feel anxious about the changes that their bodies are undergoing. The emotional consequences of precocious puberty warrant as much attention as the physical. sources: Carel & Leger 2008; Nield, Cakan, & Kamat, 2007 Sources: Carel & Leger 2008; Nield, Cakan, & Kamat, 2007.

19. How an Individual Can Cope with Precocious Puberty Section 2

20. Educate Yourself About the Changes Understand the biological aspects Source: http://kidshealth.org/parent/medical/sexual/precocious.html?tracking=P_RelatedArticle

21. Things to Consider As the physical appearance of an individual matures, one must realize possible changing social norms and expectations. Source: http://kidshealth.org/parent/medical/sexual/precocious.html?tracking=P_RelatedArticle

22. Realize that there are a variety of body types — big, small, and everything in between. Try not to compare yourself with those around you Avoid those with negative outlooks; surround yourself with those who care about you Talk to someone you trust, they could offer suggestions and make you feel a little less alone Source: http://kidshealth.org/parent/medical/sexual/precocious.html?tracking=P_RelatedArticle

23. Avoid those with negative outlooks; surround yourself with those who care about you.Talk to someone you trust, they could offer suggestions and make you feel a little less alone. Source: http://kidshealth.org/parent/medical/sexual/precocious.html?tracking=P_RelatedArticle

24. Everyone goes through puberty, don't be embarrassed to talk about it with your parents, older siblings, or your friends. You may be surprised to find out that they have many of the same thoughts and questions as you do. Source: http://kidshealth.org/parent/medical/sexual/precocious.html?tracking=P_RelatedArticle

25. Treatment Choices Section 3

26. Usually treatment consists of providing gonadotrophin-releasing hormone (GnRH) analogues. Usually results in a decrease in growth Combining growth hormone (GH) to GnRH treatment results in a higher final height in girls Possible Treatments and Outcomes: Source: Tuverno et al., 2001.

27. Rare cases Male-Limited precocious Puberty (testotoxicosis) Long Term Results: Usually treated with cyproterone acetate or ketoconazole • Results in decrease growth velocity • Bone age/chronological age ratio decreased after therapy • Testosterone levels significantly lower in patients who were treated with ketoconazole then with cyproterone acetate Both treatments had similar outcomes without vital side-effects • Both treatments showed limited efficacy in reaching normal adult height Source: Almeida et al., 2008.

28. How Parents Can Help Section 4

29. Talk to Them: Give your child a simple, truthful explanation about what's happening. Explain that these changes are normal for older kids and teens, but that his or her body has started developing a little too early. Keep your child informed about treatment and what can be expected along the way. watch for signs that teasing or other difficulties associated with precocious puberty may be affecting your child's emotional development. Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

30. Warning Signs of Effects on Emotional Development poor grades problems at school loss of interest in daily activities depression Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

31. How you cope with the issue can also determine how successfully your child will cope. Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

32. The goal is to prevent kids from dwelling on sexual development or developing a poor self-image or low self-esteem. Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

33. Try not to focus your comments on appearance; instead, offer praise for achievements in school or sports and support your child's participation in other activities. Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

34. The important thing to remember is that kids with precocious puberty can be treated. Doctors can help them preserve their adult height potential as well as limit the emotional and social difficulties they may face from maturing early. Source: http://kidshealth.org/parent/medical/sexual/precocious.html#

35. Give your child with precocious puberty love and support! Source: http://kidshealth.org/parent/medical/sexual/precocious.html#