- When a child shows signs such as breast bud development, testicle and penis enlargement, pubic and underarm hair, adult body odor, or acne before the age of 8 in girls and 9 in boys, they may be starting puberty sooner than normal. This is called early puberty and may be central precocious puberty (CPP).
- Precocious puberty does tend to run in families, so if a parent or a sibling has gone into puberty early without an underlying cause, the chances are increased.
- If your child is diagnosed with central precocious puberty, or CPP, it is not your fault. Nothing you or your child have done caused CPP. When there is no known cause, it is called idiopathic CPP. Most often, the cause cannot be identified. Less often, CPP stems from a more serious problem, such as a tumor or trauma.
- In girls, central precocious puberty, or CPP, is when puberty starts before age 8. In boys, CPP is when puberty starts before age 9.
- Signs of puberty such as pubic hair growth can be triggered when the hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland (a bean-shaped gland located at the bottom of the brain) to release hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The result is that girls start producing estrogen, boys start producing testosterone, and sexual development begins.
- The first sign of puberty in girls is usually breast buds. The breast bud is a lump under the nipple. The second sign in girls is often pubic hair followed by the menstrual period.
- For boys, the first sign of puberty is usually enlargement of the testicles and scrotum. They nearly double in size. The second sign is pubic hair. Boys tend to have a growth spurt next.
- Everyone goes through puberty. It’s a normal part of growing up. But when a child shows signs of puberty before the age of 8 in girls and 9 in boys, they may be starting puberty sooner than normal. This is called early puberty, or central precocious puberty (CPP).
- Typically, pubic hair growth begins after age 9, but it can depend on many factors, such as ethnicity. Ask your child's pediatrician to do a full physical examination and answer all your questions.
- Typically, breast bud development happens after age 8, but it can depend on many factors, such as ethnicity. Ask your child's pediatrician to do a full physical examination and answer all your questions.
- The pediatric endocrinologist may perform some or all of the tests below to diagnose early puberty. They will also do a full physical exam.
Bone age test of hand and wrist
An X-ray of the left hand can help determine your child’s bone age. It is then compared to standard growth charts to establish whether the bones are growing too quickly.
This test measures the level of hormones in your child’s bloodstream.
GnRH stimulation test
This test helps distinguish central precocious puberty, or CPP, from other possible causes of early puberty.
Pelvic and adrenal ultrasound
This checks the development of your child’s ovaries or testicles, and adrenal glands.
MRI or CT scan
These tests show if any brain abnormalities are causing the early start of puberty.
- Your child’s pediatrician is the first step to get a diagnosis. He or she knows your child’s medical history. The pediatrician will review your child’s and family’s medical history and do a full physical exam. To make an official diagnosis, your pediatrician refers you to a pediatric endocrinologist. Pediatric endocrinologists are specialists who focus on the treatment of hormone-related conditions in children.
- Remember, you know your child best. It is OK to ask your pediatrician as many questions as necessary to get the information you need to help your child. If your pediatrician isn’t sure if your child has central precocious puberty, or CPP, ask for a referral to a pediatric endocrinologist.
- If a child is diagnosed with early puberty or central precocious puberty, it is possible to delay the production of sex hormones that trigger puberty using a gonadotropin-releasing hormone (GnRH) agonist. GnRH agonists work by helping the pituitary gland ignore signals from the brain so the gland stops sending hormones that stimulate the ovaries and testes.
- Once the child has reached a more appropriate age for puberty, GnRH agonist therapy is stopped, and the child will continue through puberty similar to his or her peers. The amount of time a child is on treatment will depend on his or her unique growth and development.
- Central precocious puberty, or CPP, can affect adult height. 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.
- When a child starts puberty, they can feel emotional changes as well as physical ones. If a child begins puberty too early, they may not be ready for these changes. The child can feel very self-conscious or embarrassed about these changes because their friends and peers are not experiencing the same changes. The child’s self-esteem can be affected. The child may suffer from symptoms of depression or anxiety. They can also be at greater risk of behaviors not appropriate for their age.
- The most common treatment for CPP, or central precocious puberty, is called a gonadotropin-releasing hormone (GnRH) agonist. GnRH agonists work by helping the pituitary gland ignore signals from the brain so the gland stops sending hormones that stimulate the ovaries and testes.
- Once your child is diagnosed with central precocious puberty, or CPP, it is important to talk to your pediatric endocrinologist about treatment options for your child as soon as possible. Half of all children with CPP see the doctor too late for treatment to have an impact.* The amount of time a child is on treatment will depend on his or her unique growth and development. The pediatric endocrinologist may also tell you that not all children require treatment.
*Based on an online survey of 141 US pediatric endocrinologists from June 6 to July 14, 2017.