Patient Care

Pubertal Disorders in Children

What are Pubertal Disorders in Children?

Puberty occurs when a part of the brain called the hypothalamus releases Gonadotropin-Releasing Hormone (GnRH). This hormone stimulates the pituitary gland (a small gland at the base of the brain situated between the two ears) to release two other hormones: Luteinising Hormone (LH) and Follicle-Stimulating Hormone (FSH). LH and FSH then stimulate the sex organs (gonads) to produce sex steroids (oestrogen in females and testosterone in males) that cause physical changes during puberty.

Every child goes through puberty at a different rate and stops growing in height towards the end of puberty.

Puberty starts between the ages of 8 and 13 years in girls and 9 and 15 years in boys. Children with pubertal disorders may have precocious (early) or delayed puberty.

Precocious (Early) Puberty

Early puberty is more common in girls compared to boys.

Early puberty can be categorised into Central Precocious Puberty (CPP) and Peripheral Precocious Puberty (PPP). CPP occurs when the hypothalamus releases GnRH which activates puberty earlier. PPP is caused by early production of sex steroids (oestrogen and testosterone) from other organs such as ovaries, testicles or adrenal glands.

Children with early puberty mature and stop growing at an earlier age compared to their peers and can be shorter than expected as adults. Early puberty can cause emotional and social problems for children who are ahead of their peers.

Delayed Puberty

Delayed puberty is more common in boys than girls.

It is usually caused by the growth and development pattern in a family. However, medical problems can also cause a delay in the pubertal onset. Some people with chronic illnesses like diabetes, heart disease or kidney disease may go through puberty at an older age because their illnesses can make it harder for their bodies to mature. Proper treatment and better control of many of these illnesses may reduce the chances of delayed puberty.

Puberty can be delayed for several reasons. Most often, it is simply because your child is a late bloomer and it usually does not require any kind of treatment. Although the onset of puberty is delayed, these children will progress through puberty normally when it ensues.

‚ÄčIt is important to start talking about puberty to your child early, for example when he or she is around 8 years old. It might even have to be earlier if your child has evidence of early puberty and the school has not started on puberty education.

It may be scary to your child when he or she experience changes in his or her body. The sight of blood during your daughter's first menses may be traumatising for her. Hence parents need to inform their child, especially girls, about how his or her body will change and what to expect.

What are the signs & symptoms of Pubertal Disorders in Children?

The physical changes during puberty include:

  • Development of secondary sexual characteristics such as growth of pubic hair and hair under the armpit, breast development in girls and growth of the penis and testicles in boys
  • Growth spurt which leads to a rapid increase in height
  • Changes in body shape and size

Early puberty is defined as the appearance of any sign of secondary sexual characteristics in boys younger than 9 years and in girls younger than 8 years of age. Delayed puberty is defined by the absence of testicular enlargement in boys by age of 14 years or breast development in girls by age of 13 years.

During puberty, girls will have breast development and vaginal bleeding while boys will have enlargement of the testicles and penis, facial hair growth and a deepening voice.

How is Pubertal Disorders in Children diagnosed?
Precocious (Early) Puberty

A blood test (GnRH stimulation test) may be done to measure hormone levels and an X-ray of the hand may be obtained to see if the bones are maturing too fast.

What are the treatment options for Pubertal Disorders in Children?
Precocious (Early) Puberty

CPP can be treated with injected medication to prevent further pubertal progression. The treatment for PPP depends on the cause and may involve medication or surgery, for example if there is presence of a tumour.

Delayed Puberty

Treatment of delayed puberty generally depends on the underlying cause. If a child is healthy but simply a late bloomer, reassurance and close monitoring are all that is needed. Sex hormone replacement with testosterone or oestrogen may only be indicated in selected cases.

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