What is central precocious
puberty (CPP)?

CPP is when puberty starts sooner than it should.1,2

Everyone goes through puberty. It’s a normal part of growing up. But when a child goes through puberty sooner than normal, it’s called early puberty, or central precocious puberty (CPP).

CPP is triggered when the brain tells the pituitary gland (a bean-shaped gland located at the bottom of the brain) to release “puberty” hormones called gonadotropin-releasing hormone (GnRH) too soon. The result is that girls start producing estrogen, boys start producing testosterone, and sexual development begins.3

What are the signs & symptoms of CPP?

Hear Karen Klein, MD, Pediatric Endocrinologist, discuss signs of early puberty.

Diagram shows both the pituitary and hypothalamus in the brain.
What causes CPP?

Hear about the causes of early puberty from Peter A. Lee, MD, Pediatric Endocrinologist.

Some common facts
about CPP2,4

CPP affects an estimated

CPP affects one in every 5,000 – 10,000 children in the U.S.
CPP affects one in every 5,000 – 10,000 children in the U.S.

children

CPP is 4 to 10 times more
common in girls than in boys

CPP, or central precocious puberty, is ten times more common in girls than boys.

CPP is 4 to 10 times more
common in girls than in boys

Normal Puberty Development

Learn about puberty in girls and boys by clicking through the common signs below.

The typical age range for puberty to begin in girls is between 8 and 13 years old. In girls, CPP is when puberty starts before age 8.5
  • CPP Normal Puberty
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14

Age

Common signs of puberty in girls6-10

  • Breast development
  • Breast buds, a small lump under one or both nipples, begin to appear. The area may become tender and sore.

  • Menstrual periods
  • A few months before their first period, or menarche, some girls experience a clear or white vaginal discharge. The first period will likely be mild, with only a few drops of blood or spotting. However, the amount of blood and duration of periods vary from person to person.

  • Pubic or underarm hair
  • Light, straight hair appears in the pubic area, but eventually turns darker, curlier, and coarser in texture. Approximately two years after pubic hair appears, hair appears on the underarms.

  • Oily skin/acne
  • At puberty, sebaceous glands underneath the skin become more active and may clog pores, leading to acne.

  • Adult body odor
  • This starts at puberty because of an increase in hormones. To regulate its temperature, your body sweats. When the sweat mixes with the bacteria on your skin, it causes body odor.

  • Sudden growth spurt
  • A dramatic growth spurt may make children going through puberty look gangly, but they will continue to fill out soon after.

How development is measured

Tanner Stages for Girls

Learn about the 5 stages of breast and pubic hair development in girls.

Growth Chart for Girls

See what the average height is for girls based on age.

Remember, just because you’re seeing early signs of puberty doesn’t necessarily mean your child has CPP.

The typical age range for puberty to begin in boys is between 9 and 14 years old. In boys, CPP is when puberty starts before age 9.1,4,5
  • CPP Normal Puberty
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14

Age

Common signs of puberty in boys9-12

  • Testicle & penis enlargement
  • The testicles almost double in size at the beginning of puberty, followed by growth of the penis (first in length, then in width).

  • Erections
  • During puberty, erections occur more frequently and for no apparent reason (and often at inconvenient times). Over time, they become less frequent.

  • Voice change
  • During a boy’s growth period, his voice box, or larynx, also grows. While at first a boy’s voice may crack, once the larynx stops growing, the cracking will stop and the voice will deepen for good.

  • Facial hair
  • Hair usually starts growing first on the upper lip, then on the cheeks, and finally, the chin.

  • Muscle growth
  • During puberty boys fill out, so by the late teens, their body composition is only 12% fat.

  • Pubic & underarm hair
  • Light, straight hair appears in the pubic area, but eventually turns darker, curlier, and coarser in texture. Approximately two years after pubic hair appears, hair appears on the underarms.

  • Oily skin/acne
  • At puberty, sebaceous glands underneath the skin become more active and may clog pores, leading to acne.

  • Adult body odor
  • This starts at puberty because of an increase in hormones. To regulate its temperature, your body sweats. When the sweat mixes with the bacteria on your skin, it causes body odor.

  • Sudden growth spurt
  • When puberty begins, children may look gangly. As puberty progresses and they experience a growth spurt, they will continue to fill out.

How development is measured

Tanner Stages for Boys

Learn about the 5 stages of genital and pubic hair development in boys.

Growth Chart for Boys

See what the average height is for boys based on age.

Remember, just because you’re seeing early signs of puberty doesn’t necessarily mean your child has CPP.

Interactive Growth Tool

Use the Interactive Growth Tool to compare the stages of puberty in normal development with the signs you see in your child.


Compare signs in girls Compare signs in boys
Continue
How old is your child?
How tall is your child?

What signs of puberty do you see in your child? (Choose all that apply.)

Get results
Age
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

You have selected no signs of puberty in your child

Growth Chart for Girls
Growth Chart for Boys
Height

Adapted from CDC Growth Charts: United States; Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion; 2000.

CPP can affect adult height.1,3

Children with CPP may go through an early growth spurt and be taller than their peers. This is because their bones mature quicker than normal. Unfortunately, they often stop growing earlier, too. If CPP is not treated, they most likely will not reach their projected adult height.

The complications of CPP

Hear about complications of CPP from Karen Klein, MD, Pediatric Endocrinologist.

If your child is showing signs of puberty too soon, see your pediatrician to get a diagnosis as soon as possible.

CPP can be treated.3,14 But, left untreated, precocious puberty can have long-term complications.1,2,14 Only a qualified healthcare provider can diagnose CPP and help you find a treatment that is appropriate for your child. That’s why it’s important to see your child's pediatrician now. The sooner you know for sure, the sooner your child can get the treatment he or she needs.


References: 1. Kletter GB, Klein KO, Wong YY. A pediatrician’s guide to central precocious puberty. Clin Pediatr (Phila). 2015;54(5):414-424. 2. Partsch CJ, Sippell WG. Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens. Hum Reprod Update. 2001;7(3):292-302. 3. Mayo Clinic Staff. Precocious puberty: symptoms and causes. Mayo Clinic website. http://​www.mayoclinic.
org/​diseases-conditions/​precocious-puberty/​symptoms-causes/​syc-20351811. Published November 17, 2017. Accessed March 21, 2018. 4. Muir A. Precocious puberty. Pediatr Rev. 2006;27(10):373-381. 5. Carel JC, Léger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377. 6.  American Academy of Pediatrics. Physical development in girls: what to expect. HealthyChildren.org website. http://​www.healthychildren.org/​​English/​​ages-stages/​​gradeschool/​​puberty/​​Pages/​​Physical-Development-Girls-​What-to-Expect.aspx. Updated November 21, 2015. Accessed March 21, 2018. 7. Cleveland Clinic. How to talk to your adolescent girl about her body. https://​my.clevelandclinic.org/​health/articles/​9537-how-to-talk-to-your-adolescent-girl-about-her-body. Cleveland Clinic website. Accessed March 21, 2018. 8. Mayo Clinic Staff. Preparing your child for menstruation. Mayo Clinic website. https://​www.mayoclinic.org/​healthy-lifestyle/​​​tween-and-teen-health/​​in-depth/​menstruation/​art-20046004. Published August 24, 2017. Accessed March 21, 2018. 9. American Academy of Pediatrics. What causes acne? HealthyChildren.org website. http://​www.healthychildren.org/​​English/​​health-issues/​​conditions/​​skin/​​Pages/​​What-Causes-Acne.aspx. Published November 21, 2015. Accessed March 21, 2018. 10. Preventing body odor. WebMD website. http://​www.webmd.com/​​skin-problems-and-treatments/​preventing-body-odor. Updated July 15, 2017. Accessed March 21, 2018. 11. American Academy of Pediatrics. Physical development in boys: what to expect. HealthyChildren.org website. http://​www.healthychildren.org/​​English/​​ages-stages/​​gradeschool/​​puberty/​​Pages/​Physical-Development-Boys-​What-to-Expect.aspx. Updated November 21, 2015. Accessed March 21, 2018. 12.  Physical development, ages 11 to 14 years – topic overview. WebMD website. http://​children.webmd.com/​tc/​physical-development-ages-11-to-14-years-topic-overview. Accessed March 21, 2018. 13. Girls and puberty. WebMD website. https://​teens.webmd.com/​girls/​facts-about-puberty-girls#3. Updated March 20, 2016. Accessed March 21, 2018. 14. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004;10(2):135-147.