Growing up a bit too soon

EARLY PUBERTY

Consult a doctor to rule out problems that could be linked to early puberty

EVELINE GAN, eveline@mediacorp.com.sg

AT AN age when most kids’ worries rarely go beyond homework and playtime, nine-year-old Liza Ang has to grapple with a very different set of problems.

They include having to put up with unsightly armpit hair and learning how to use a sanitary pad: She started menstruating early this year.

Understandably, Liza’s earlier-than-usual sexual development left her mother, Mdm Emily Peng, baffled and anxious.

“Obviously, I was shocked. I noticed that she was showing signs of puberty months earlier but I didn’t think she would get her period so early,” said the 48-year-old sales coordinator, who added that Liza’s older sister got her first period only after she turned 13.

Liza isn’t alone in her early growing-up woes.

In 2004, a nine-year-old Singaporean girl gave birth to a boy after she was impregnated by a schoolmate. The baby was eventually put up for adoption.

However, she isn’t the youngest known mother. The youngest recorded birth mother is five-year-old Peruvian, Lina Medina, who gave birth to a baby boy in 1939.

Most girls typically experience menarche — their first menstrual period — around 12, but it can sometimes happen as early as age nine.

Said Dr Sadhana Nadarajah, a consultant at the reproductive medicine department of KK Women’s and Children’s Hospital: “Medically speaking, menarche when the girl is nine is early but normal. There are some girls who experience menarche even earlier, at seven or eight.” She sees approximately one such case every two months.

What is abnormal is when puberty occurs before a girl turns eight, according to Associate Professor Lee Yung Seng, a senior consultant at National University Hospital’s (NUH) University Children’s Medical Institute’s paediatric department. The department sees about two to three such cases each month.

“In girls, puberty can occur as early as eight to 12 years, and nine to 13 in boys. Anything that occurs earlier is considered precocious puberty,” said Assoc Prof Lee.

WHAT CAUSES EARLY PUBERTY?

While no one knows for sure what causes early puberty (see box for warning signs), both doctors Today spoke to said better nutrition could be one of the reasons. Studies have also linked obesity to early puberty.

In very rare instances, when girls grow up too quickly, Assoc Prof Lee said there may be an underlying medical cause, such as brain or ovarian tumours.

“For boys who go through early puberty, there is a higher likelihood of an underlying sinister cause,” he added. This includes diseases such as tumours in the brain or testes.

That is why it is important to consult a doctor to rule out other medical problems, added Dr Sadhana.

Another medical concern for those who go through early puberty is that they may stop growing at an earlier age.

Said Assoc Prof Lee: “They may go through a phase of rapid growth initially as their bones are maturing much faster due to the effects of the surging sex hormones. But that also means the growth plates (which help the long bones grow longer) also mature faster, and will close earlier.”

TOO YOUNG TO KNOW WHAT’S GOING ON

Early puberty can be an emotional nightmare for both parents and child.

“Seven- or eight-year-olds may not have the maturity in thought to be wary about their sexuality. Some girls may also be psychologically disturbed when they are already menstruating, while the majority of their friends are not,” said Dr Sadhana.

Assoc Prof Lee added that early puberty may also lead to an inappropriate attraction to the opposite sex at a very young age.

For Mdm Peng, Liza’s childish lack of self-consciousness is especially worrying and tough to handle.

“Liza is still a child, but she doesn’t seem to feel any shyness. She refuses to bring a (sanitary) pad to school even though I’ve told her that she might need it. Whenever she gets her period, I also have to keep checking to see if she’s got her pad securely in place,” said Mdm Peng.

For concerned parents, early puberty can be suppressed medically through drugs, said Dr Sadhana. That is, if it’s not linked to any underlying medical condition.

But parents can also opt out of treatment.

“After investigations and no sinister causes are found, the parents can decide — with advice from the doctor — if they want to treat the child.

“If they feel that the child can cope and the predicted final height is acceptable, they can opt to let nature take its course,” said Assoc Prof Lee.

The warning signs.

Your child may start developing pubic or underarm hair, acne, body odour or go through a growth spurt (in height).

Boys become “more manly” as their voice deepens and facial hair develops. Their testicles and penis also enlarge.

It is also not unusual for girls to start developing breasts way before they get their first menstrual period.

From TODAY, Health – Tuesday, 19-May-2009