Introduction
“I won’t go to school mom. I have a big pimple on my face!”
“Dad, I think I’m growing mustache and my biceps are starting to shape up!”
“That guy/girl is so cute.”
These are some lines we might have used during our teenage years – a time when major physical and emotional changes start to happen in our bodies. At first, we were not aware of these changes. But as time pass by, we start to notice them. Girls get all fidgeted when their hips widen, breasts develop and menstruation starts. On the opposite end, boys get excited when their voice deepens, muscles tone up and facial hairs start to appear. These are signs that we are leaving our playful “childhood life” and will enter a new and critical stage towards adulthood – puberty.
Main body
Much of the major adjustments physically, emotionally, and mentally start to happen when we reach puberty or more commonly called the adolescent stage (Dowshen 2005) Upon reaching this age, humans undergo rapid growth of muscles and bones, changes in body shape, and development of the reproductive system.
Some of these changes manifest differently in both genders. Puberty begins when a part of the brain, called the hypothalamus, releases gonadotropin-releasing hormone (GnRH) to the pituitary gland (a small bean-shaped gland found at the base of the brain). The GnRH signals the pituitary gland to release more hormones, the luteinizing hormone and follicle-stimulating hormone (FSH).
The latter causes ovaries to produce estrogen for females and the testes to produce testosterone for males. The production of such makes the body undergo physical changes. (Mayoclinic) As an effect of what is physically happening, adolescents also begin to undergo psychosocial maturation. (Blondell 2005) They begin to have groups that are of the same age, spend more time with them, and discuss topics that deal with their hobbies, interests, people, and events.
These things normally take place between 8 to 16 in girls and between 9 to 14 in boys. (Mayoclinic) However, in some cases, puberty starts to happen at an earlier age. (Ridley 2007) This event is called precocious puberty.
By definition, precocious puberty (La: pubertal praecox) is an early onset of puberty. (Niche) It is an early development of sexual characteristics in girls before 8 years old and in boys before 9 years old. (Kaplowitz 2007) In other contexts, precocious is used more broadly to describe the “early appearance of any of the physical features of puberty even if the complete brain-directed process in not occurring.” ((NICHD) Scientists have various explanations as to why precocious puberty happens to some children.
Most cases of diagnosed early puberty, especially in girls, are idiopathic, meaning there are no causes found. (keepkidshealthy) Other cases of precocious puberty are classified as either central precocious puberty or peripheral precocious puberty (Mayoclinic) both differ in the body part where the problem starts.
In central precocious puberty, the secretion of the GnRH by the hypothalamus starts too early. The pattern and the timing of the other process take place in a normal condition.
Most of the children with this case are found with no medical problem history. In some rare cases, causes might be a tumor in the brain, an infection such as meningitis (inflammation of the meninges), a defect in the upon birth (hydrocephalus), exposure to radiation, brain injury, an obstruction of blood flow to the brain, abnormalities in the thyroid glands and genetic diseases such as McCune-Albright syndrome (causes hormonal problems) and Congenital adrenal hyperplasia (abnormal hormone production by the adrenal glands). (Mayoclinic)
On the other hand, peripheral precocious puberty is not triggered by the early release of the GnRH. (healthsystem.virginia.edu) It is usually caused by problems of the ovaries in females and the testes in males or the adrenal and pituitary glands. These problems are often associated with tumors and external exposures to estrogen and testosterone such as creams, ointments, or hormone tablets. (Mayoclinic)
There are also certain risk factors that might increase the chance of having precocious puberty. Studies show that girls have a higher chance of developing at an early stage. In 200 patients evaluated in one hospital, Central precocious puberty (CPP) occurred 5 times more often in girls than in boys. Idiopathic CPP occurred 8 times more often. (Kaplowitz)
The race is also a risk factor considered. In 1997, a study of 17,000 US girls aged 3-12 conducted from 1988-1994 by Hermann-Giddens and data from the National Health and Nutrition Examination Survey (NHANES) showed that black girls develop a year earlier compared to white girls.
They estimated that sexual precocity is exhibited in 25% of black girls and 8% of white. (Kaplowitz) On the other hand, in a study of 2,000 boys lead by Marcia-Hermann Giddens, 38% of African-American boys and 30% of Caucasian boys showed signs of sexual development by age 8. (Ridley 2007)
Aside from sex and race, obesity is also a seen as a potential factor for precocious puberty. (mayo clinic) A recent study of 254 girls by Lee et al (in Kaplowitz 2005) found that higher BMI at 3 years old and the increase in BMI at the same age were both positively associated with early onset of puberty in females. However, there is still no clear association between obesity and early puberty in males.
Doctors must do clinical tests before diagnosing precocious puberty because, in some children, signs of maturation normally start at an earlier age. Breasts development in girls younger than 3 and the appearance of pubic hair younger than 7 years can sometimes resemble precocious puberty but are nonprogressive.
This means that the other signs of puberty do not develop and such physical development is just a variant condition. (medicine) Basically, when all the signs of puberty start before 7 years old in girls and 9 years old in boys, most likely it is considered precocious. Such signs include growth of pubic and underarm hairs, acne, and adult body odor. For girls, the most reliable sign that she is already releasing estrogen is breast enlargement which could be unilateral or asymmetrical.
Gradually, the breast diameter, the areola darkens and the nipples become prominent. A genital examination may reveal a pastel pink appearance of the vaginal mucosa from a deep-red color in pre-pubertal girls. For boys, the earliest sign is the enlargement of the testes. Increased testosterone levels also result in penis growth, reddening, and thinning of the scrotum. Children also experience rapid bone development thus making them grow fast.
As a result, they often stop growing earlier than usual and will not reach their height potential. At first, they tend to look taller than the other children of their age. However, in later years, they would be shorter than average as adults. (Mayoclinic)
To correctly diagnose precocious puberty, pediatric endocrinologists first review the child’s medical history followed by series of tests. Such tests include bone x-rays, usually of the wrist and hand, to determine the chronological age of the child’s bones or if the bones are quickly growing. Another is by injection of GnRH hormone and then taking blood samples. If the child has central precocious puberty, the LH and FSH levels will increase.
To test if tumors or other abnormalities are present, doctors do Magnetic resonance Imaging (MRI) of the brain or of the thyroid glands. Other clinical tests include abdominal ultrasound, specifically in girls, to detect ovarian cysts or tumors. (Mayoclinic) It is also used to assess blood flow through various vessels. (healthsystems.edu)
Treatments are also available once precocious puberty is diagnosed. It depends on whether or not there are underlying causes, the child’s condition, or the child’s level of tolerance for specific medications or therapies. (health system. Virginia)In the case of idiopathic precocious puberty, treatment is focused on inhibiting the release of the GnRH by the hypothalamus. The patient is usually prescribed synthetic long-acting agonist GnRH such as leuprolide. (Mayoclinic)
With this treatment, it is expected that puberty will regress, decrease the rate of bone growth, and return to the normal hormone level. This treatment requires frequent visits to the doctor to monitor growth and development. This is done until the age of 11 or 12 for girls and 12 or 13 for boys when normal puberty starts to happen. (keep kids healthy) In cases where tumors or cysts are found, doctors might do a surgical removal in order to make the organs affected function normally.
The third treatment option is to do nothing. The decision to treat or not to treat has to be arrived at with all of the information and must be made by the doctor and parents. (www.asbha.org.au) It is just important to note that effective treatment must begin early in puberty.
Children suffering from precocious puberty often experience difficulty in coping with the changes they are undergoing since it is happening at a much younger age. The effects manifest in how a child responds to his/her social environment. One particular social problem is that the child develops low self-esteem he/she might feel different from his/her peers. (Mayoclinic) For example, a five-year-old girl would normally be with her peers playing stuff toys or dollhouses.
However, if a five-year-old girl who has precocity develops breast and start her menstruation which other girls her age does not experience, she would feel awkward and uncomfortable with her sexual changes and tend to shy away from such activities to avoid further teasing that her playmates might give her. The sense of being different coupled with the hormonal change-induced emotional mood swings will make the child feel more self-conscious. (healthsystem.virginia.edu)
Since she no longer fits with the other three-year-olds, the tendency for her is to find a peer group that is much older than she is. Another problem might surface because the older group might not accept her. (Green 1996) He/She will not be given the chance to enhance their social interaction skills which would pose problems when they reach adulthood.
Another effect of early puberty is the depression that the child undergoes. Since the feeling of being different blankets their personality, they are covered with sadness because they cannot do the things that they want to do such as playing. Depression often leads to many circumstances that will be harmful to the child’s development.
They may do things like running away from home or start having vices at a very young age. Other causes of depression include eating too much and spending more time being alone. Although children might not verbally say what they feel their actions manifest the extreme confusion that they are feeling.
The change in the hormone levels of children with precocious puberty might also affect their behavior. This is similar to what is felt by normal children, however, at a later age. Girls would become irritable and moody. They easily get angry if conditions are not favorable to them. Their emotions are unstable and can be expressed differently.
For children below the normal adolescent age, this is harder to control. The tendency is too explicit tantrums such as shouting out loud or throwing things on the floor. In contrast, some would cry easily for no reason at all. Aside from this, precocious puberty can make girls able to conceive at a very young age since their ovaries are already releasing viable eggs and hormones. On the other hand, boys show signs of aggressiveness.
They could engage in bullying activities that might lead to fistfights with other kids. Both sexes, but are more prominent in boys, may have an increase in libido leading to increased masturbation or engaging inappropriate sexual behaviors at a young age. Girls, however, with a history of early puberty have a slightly earlier age of sexual activity initiation.
Other problems could arise with the behavioral change both in girls and boys. These include performing poorly in school and loss of interest in daily activities. (Dowshen 2005) They tend to be less competent academically since they are more focused on dealing with physical changes. They also experience increased stress levels because of the physical and hormonal changes that they are not prepared to face.
Other effects are not readily manifested. Some of it will appear when the child reaches adulthood. Some studies show that the earlier the child starts her period, the higher risk she might have to develop breast cancer. This is probably due to prolonged estrogen exposure. The highest average risk for breast cancer is in non-Hispanic white women, where it is 1 in 8 or 12.5%. Altogether, there is a 16.25% risk of girls who will have breast cancer when their menstruation starts before 12 years old. (Greene 1996)
The family, especially the parents, also suffer when their children have precocious puberty. They struggle to fight their emotions seeing that their young child already exhibits unusual physical and behavioral changes. Parents also wrestle with painful decisions such as whether or not they would give their children injections of drugs.
Some medicines, such as Lupron, suppress hormones but have 26 possible side effects. (Ridley 2007) Parents also exert greater tolerance, patience, and continuous emotional and physical nourishment to support their children. They have to take practical steps to “minimize their children’s risk for early puberty and encourage a healthy lifestyle.” (Ridley 2007) Such parental activities might also be stressful to the parents.
Some steps are suggested to lessen the chances of children having precocity. Controlling and eliminating some environmental elements could help minimize the risks. One is to avoid meat, milk, and dairy products containing growth hormones because they can trigger the development of bones and muscles.
Instead of ingesting such, parents should buy natural products. Organic fruits and vegetables help the body to function normally and make cell reproduction stay active and develop at the right time. Another way of controlling the type of food intake is by minimizing soya, which mimics estrogen, especially in girls. A low-fat diet, especially food containing vitamins A, C, E, and zinc protects them from breast cancer. Also, encouraging children to eat well and exercise daily could greatly help in order to prevent obesity and have a healthy lifestyle.
Another suggested way to control precocious puberty is preventing children from chewing on plastic toys. Plastics with polyvinyl chloride (PVC) might expose children to mutagens, or cancer-causing agents. It might expose children to endocrine-disrupting chemicals. This includes vinyl shower curtains and toys with packaging that bear the number “3” indicating they’re made with PVC. (Ridley 2007)
It is also important that the child have a support group that will strengthen her and lessens the effects of early puberty. Parents must be constantly aware that the moment precocity signs are showing an appointment with healthcare practitioners must be made so that immediate tests and medication can be done.
Doctors help in making children understand the situation they are in including the dilemma they will face. They should also continuously monitor the situation to make the child feel at ease. Together with the doctor, the parents however have a greater responsibility. Giving their child a simple, truthful explanation about what is happening would extend a helping hand to them. Also keeping the child informed about his or her treatment will prepare him/her for what is expected to happen along the way.
Parents should also watch for signs that teasing or other difficulties associated with precocious puberty may be affecting the child’s emotional development. They should constantly talk with their children allowing them to express their feelings and resentments. Parents often tend to give suggestions of do’s and don’ts and give judgmental comments. However, they should just carefully watch, listen and help them put their feelings into words.
In a way, parents should try to create a supportive environment for the child that instead of focusing on the physical appearance, they should praise the child for the achievements in school or sports and encourage them to join and participate in other activities. (Dowshen 2005) Since early puberty is more prone to girls, parents can also teach their child the habit of regular breast self-examination. Exposing and being with their children in strenuous exercise such as running and gymnastics could greatly help.
Aside from doctors and parents, psychological counseling can help cope with the situation. (Mayoclinic) Sometimes, parents will also have difficulty adjusting to their child’s needs. Qualified counselors can help the family or even the child to better understand and handle sudden outbursts of emotions, issues, and challenges that accompany early puberty. Coping with such medical conditions can be very challenging but it does not have to be done alone. (Mayoclinic)
There are rare cases of precocious puberty in children under 5. Pregnancy and child delivery also remains rare because extreme precocity is treated to “suppress fertility, preserve growth potential and reduce the social consequences of full sexual development in childhood.” (www.incrediblebirths.com)
One such rare instance of pregnancy at an early age is the case of Lina Medina. Lina is the world’s youngest confirmed mother giving birth at the age of 5 years, 7 months, and 21 days. (Wikipedia.org) She was born in Peru on September 27, 1933. She hadn’t turned 5 years old yet when the shamans in her village were alarmed because of the growing belly she was having. One shaman performed a ritual trying to “diagnose” what was happening.
At first, they thought that she was just possessed with a bad spirit and an exorcism ritual must be performed. The shamans asked permission from her father Tiburcio. Upon approval, Lina was subjected to Inca rites in the south American cordillera. However, to their dismay, none of these procedures worked. Tiburcio, carrying her child on the back, walked for two days through valleys and hills intensively looking for a real doctor. As they got to the town of Pisco, 70 kilometers away from their village, they found Doctor Gerardo Lozada. Dr. Lozada was surprised to see the size of her belly.
At first, he thought it was a growing tumor. He then administered preliminary tests. The girl’s clinical tests showed that it was not a tumor but an eight-month baby that she is carrying. This greatly astonished Dr. Lozada forcing him to immediately call the police to arrest Lina’s father.
The policemen immediately imprisoned the father as he was pointed as the main suspect of the rape and pregnancy. But after a few days, he was set free because of a lack of sufficient evidence. One of Lina’s brothers, a mentally disabled boy replaced him in the prison cell. He was also released because there was no direct link to him either.
In the meantime, Dr. Lozada took Lina to Lima and confined her in a clinic while he sent an emissary to Antacancha to compile more information about her. He found out that before she was 4, Lina already exhibited breast and pubic hair development and had her menstruation. Her neighbors told stories that “Lina’s mother would just carry her to the river and wash her off whenever this happens.”
During Lina’s confinement, Doctor Lozada organized everything to perform a caesarian section. Together with him, Dr. Busalleu (surgeon) and Dr. Colretta (anesthetist) were there to help him. Finally on May 14, 1939, ironically a Mother’s Day, Lina gave birth to a healthy and strong 2.7 kilograms, 48 centimeters long baby boy. He was named Gerardo, after Dr. Lozada. (www.pyrophoitos.blogspot.com)
The news of a Peruvian 5-year old giving birth to a baby immediately spread all over the world. During this time, the mother and her son were taken care of at the clinic. Officers, artists, diplomats, merchants, and politicians visited and filled their rooms with gifts. Lina was given education by teaching her how to read and write.
On the other hand, some “childhood attitudes are exhibited by Lina herself. Reports show that she was seen taking the toys away from her baby boy. Many years later, Dr. Juan Falen explained that Lina has precocious puberty. People from other countries saw the potential money opportunity from Lina’s unusual puberty. Many offered her juicy money. One such offer was a 4000 dollar a month plus expenses if the girl traveled to New York for a year to be exhibited as freaks in the World Fair.
The family refused the offer. Other proposals include an allowance for life for both from Oscar Benavides, then president of Peru. The family signed an agreement with the Seltzer Company allowing the latter to study the case. However, the mother and son never saw one penny. (telegraphindia.com)
Lina’s son Gerardo was raised in the belief that Lina was her sister. However, he found out the truth at the age of 10. He died in 1979 of a bone marrow disease. There was no clinical evidence that it was related to his extraordinary birth circumstances. Lina on the other hand married Raul Jurado at the age of 33 and had another son in 1972. She, with her husband, still lives today in a poor suburb in Lima while their son lives in Mexico. She is 73 years old now and has only one ambition: that the government compensates her for the house they demolished.
Conclusion
Although this phenomenon happened many years ago, one thing is left unanswered. Who is the father of Gerardo Medina? Lina refused to answer this question when she was asked about it. Up until now, she keeps it to herself and has long refused requests to rake up the past. (telegraphindia.com) In 2002, Lina’s name barely brushed the surface of media attention again when she refused to do an interview with Reuters. (Krech 2007)
Precocious puberty still needs more researches and studies. The future generation hopes to find the cure in the hands of skeptical and talented scientists we have today.
References:
Antoniazzi, F.; Zamboni, G.; “Central Precocious Puberty – Current Treatment Options;” Pediatric Drugs 2004, Vol. 6, No. 4, pp. 211-231.
Diabetes and other Endocrine and Metabolic Disorders. 2004. University of Virginia Health System. Web.
Dowshen, S. 2005. Precocious. Kidshealth organization. Web.
Iron Queen. 2007. Web..
Kaplowitz, Paul B. 2007. Precocious Puberty. Web.
Greene, A. 1996. Precocious Puberty. Web.
Lina Medina – World’s Youngest Mother – Precocious Puberty. Incredible births. Web.
Lina Medina. 2008. Wikimedia Foundation Inc. Web.
Mayo Clinic Staff. 2007. Precocious puberty. Children’s health. Web.
Precocious Puberty. 2001. Keep Kids Healthy LLC. Web.
Shiver, E. 2007. Precocious Puberty. National Institute of Child Health and Human Development. Web.
“Six decades later, world’s youngest mother awaits aid“ 2002. The Telegraph (Calcutta, India). Web.