Carol Thompson had planned to
buy her daughter Jessica a Barbie doll for her seventh
birthday; instead, they went bra shopping. Their next
stop was a long-awaited appointment with a specialist
to discuss Jessica's early puberty. This scenario's all
too familiar to Calgary pediatrician Dr Peter Nieman,
who's seen a rise in early puberty cases among his patients.
"It's a development which will be enjoying more attention
in future," he says. Dr Denis Daneman, a pediatric endocrinologist
at Toronto's Hospital for Sick Children, agrees. "There
has been an increase since 20 years ago, but not in the
last five or so years," he says.
The early puberty phenomenon has
generated a lot of ink since it was first described
by Dr Marcia E Herman-Giddens, a researcher in maternal
and child health at University of North Carolina, back
in 1997. Her oft-cited Pediatric Research in Office
Settings (PROS) study found that compared to earlier
studies, white girls are reaching puberty about one
year earlier and black girls two years earlier than
was previously documented.
These findings caused such a stir
that Dr Herman-Giddens felt the need to publish a commentary
in Pediatrics in April, in part to "address misconceptions
and misinterpretations of the PROS data." Pediatrics
has published three articles on the trend so far this
year.
WHY
IS THIS HAPPENING?
What's causing the increase? Is it hormones, diet, the
environment? Unfortunately it's still impossible to
answer with certainty. "No research has been done on
bovine growth hormones as a factor," says Dr Herman-Giddens,
"although the other natural hormones found in cow's
milk may be involved."
There are some other clues. "Animal
studies point to plastics, phyto-estrogens such as those
found in soy products, and endocrine disruptors which
mimic estrogen such as those in pesticides and fire-retardants,"
she says. Nutrition and diet may also be culprits. "Obesity
is one of the major contributing factors," adds Dr Nieman.
LONG-TERM
EFFECTS
Dr Daneman is concerned about the long-term effects
on kids, such as stunted growth and a higher lifetime
risk of breast cancer in females, probably because of
longer exposure to estrogen. But adult lifestyle choices,
such as breastfeeding, exercise and proper diet can
counteract these risks.
Apart from the physical risks,
the whole thing's pretty tough emotionally for kids.
"In young boys, higher testosterone levels may cause
them to act out sexually," says Dr Daneman. "Girls may
get unwanted attention due to increased breast size."
The condition occurs more often in girls than boys,
about 10 to one.
DON'T
PANIC
The bottom line? It's not necessary to send all your
worried mothers to an endocrinologist. "Boys of less
than nine or 10 should be referred, but every girl of
seven to eight years old with a bit of breast tissue
should not be referred," says Dr Daneman. But several
factors should definitely raise alarm bells, namely
puberty at a very young age (under seven years old),
abnormally rapid rates of development, and the presence
of other symptoms like headaches, dizziness and vomiting.
Children with mismatched signs of puberty, such as menses
but no breast development, should definitely see an
endocrinologist, who will test bone maturity and pituitary
function.
And when intervention is necessary,
there are a number of therapies that can help your young
patients. "Lupron or other hormone drugs have been working
very well for 25 years," says Dr Daneman.
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