Precocious puberty: A growing concern for children’s health and well-being

CHENNAI: Recently, Swathi received a call from her daughter’s school that shocked her: her 8-year-old was menstruating. The kid had gotten her periods, and was terrified at seeing the blood.

Swathi was also worried that her daughter may have a pre-existing medical condition that led to her early puberty. Thankfully, after consulting a doctor, she was informed that precocious puberty is becoming common as the age of puberty is getting lower and lower among girls and boys in recent years.

Doctors noticed that early periods, facial hair, breast development and rapid growth are all common among children as young as 9-10 years. Early onset of puberty in the form of menstruation is a cause of concern, they add.

Menarche, the first time a girl gets her period, represents reproductive potential and the passage from childhood to womanhood.

Why early periods?

‘A Prospective Study of the Age at Menarche in North Indian Girls’ published in 2023 with the National Library of Medicine revealed that mean age of menarche was declining from the worldwide average age of 12 years. It was also noticed that there is an estimated decline in the age of menarche in the 21st Century, which was about 0.41 years per decade.

Increased hormonal production by the pituitary or gonads (testis and ovaries) causes early puberty. Several studies have found that the average age at menarche in most developed nations has declined from 17 years in 1840 to around 12 years in 2000. There are several factors including lifestyle and nutrition that contribute to early puberty.

“There is a drastic change in our dietary habits. Exposure to unhealthy eating habits at a very young age is one of the major reasons for early puberty. The changes are seen as early as eight years in India. A balanced diet during pregnancy is very important, as heavy calories can also impact the child’s growth,” says Dr Indhra Nedumaran, senior consultant, obstetrician and gynaecologist, MGM Healthcare.

Hormone levels

While genetic factors play a major role, a sedentary lifestyle increases the risk of childhood obesity, which leads to hormonal imbalances (particularly thyroid and oestrogen), triggering early puberty. Environmental factors such as exposure to endocrine-disrupting chemicals in plastics, pesticides, and personal care products also alter hormone levels.

“Polyvinyl chloride exposure can also lead to hormonal changes due to secretion of certain glands that impact the onset of puberty. Parents need to keep a check on changes such as breast development, pubic hair growth and other developments to ensure that they can be educated about these changes,” adds Dr Indhra.

As per Indian Academy of Paediatrics, puberty in boys usually begins when they’re around 12 years with a range of 9.5-14 years. Any development before 9.5 years is significant and requires evaluation.

The average age of puberty in Indian girls has decreased from 12-13 years to 10-11 years over the past few decades. For boys, it has decreased from 14-15 years to 12-13 years.

Risk factors

Early puberty can lead to several emotional and psychological issues as children are not physically and mentally prepared to understand the changes in their bodies. It can also lead to growth and development issues. Societal judgments and peer pressure also make it more challenging.

“The body of a girl reaches a certain body mass for the menstruation cycle to begin. Rapid breast development is one of the earliest signs and parents need to be vigilant of these changes. Girls with early puberty are tall for their age but have disproportionately greater bone-age. A girl stops growing after a bone age of 14 years. Over-nutrition when growing up is another factor that needs to be monitored to avoid early puberty,” opines Dr Shriraam Mahadevan, HoD-endocrinology, Sri Ramachandra Medical Centre.

He points out that though environmental factors such as plastics and PVC have oestrogen-like properties upon exposure, the intensity of impact is limited and needs to be studied more. “Girls with early puberty may be emotionally and socially immature, causing confusion, awkwardness, and embarrassment in school and social circles. This affects their behaviour causing low self-esteem and making them vulnerable to exploitation,” he stated.

Medical concerns

Talking about the need for clinical assessment, Dr Shruthi Sreedhar, consultant obstetrics & gynaecology, Kauvery Hospital, says, “We should also test for tumours or genetic disorders that may be responsible for it. Early puberty is more common among girls. As per research, around 20 in 10,000 girls have the tendency to attain early puberty, while it’s only five in 10,000 boys.”

It’s important to test bone maturity, and also take blood tests to understand hormonal levels and other changes in the body. “It requires a multi-disciplinary approach, including an endocrinologist, a paediatrician and gynaecologist, to ensure that there are no abnormalities,” she says.

Emphasising the importance of healthy food habits, Dr Shruthi stresses on the importance of maintaining a healthy weight and consuming a healthy diet. “Hormonal creams or lotions, dietary supplements or medicines that can lead to higher hormonal levels should be avoided,” she states.

Moreover, doctors highlight the need to educate the kids about puberty and menstruation, as those who are unprepared develop psychological concerns. Parents should promote a healthy body image and encourage their wards to have an open conversation about bullying and body shaming.

What is menarche?

Menarche, the first time a girl gets her period, represents reproductive potential and the passage from childhood to womanhood.

Triggers

· Genetic factors

· A sedentary lifestyle increases risk of childhood obesity, which leads to hormonal imbalances (particularly thyroid and oestrogen), triggering early puberty

Risk

· Several emotional and psychological issues

· Children not physically and mentally prepared to understand the changes in their bodies

· Growth and development issues

· Societal judgments and peer pressure also make it more challenging