Growing Pains: What is Precocious Puberty and How to Treat it

The COVID-19 pandemic and its lockdowns have contributed to a sudden increase in the incidence of precocious puberty over the last two years.

Precocious puberty is when a child attains puberty, signified by changes in the body, much earlier than normal. It is defined when puberty begins in girls younger than eight years old, or boys younger than nine years old.

Causes of Precocious Puberty 

The more common cause of precocious puberty is an early release of GnRH from the brain, also called central precocious puberty. The exact reason for this is not known in most cases but in rare cases, it may be caused by tumours, defects or injuries to the brain due to various medical causes.

Peripheral precocious puberty is less common and occurs due to problems in the ovaries, testicles, adrenal glands or pituitary. In both girls and boys, tumours of the adrenal or pituitary gland can cause precocious puberty. It can also occur due to external sources of estrogens, such as through creams or ointments. An unhealthy diet and sugar-sweetened soft drinks are associated with the risk of this condition. 

Though the exact cause is difficult to identify, certain factors increase a child’s risk of having precocious puberty. The risk is higher in girls, African Americans, obese children, and patients who have received radiation therapy to the brain. 

Symptoms of Precocious Puberty and Why It is an Issue 

Some signs include rapid growth, acne, development of pubic or underarm hair and body odour. Girls may exhibit breast growth and have their first period. Boys have enlarged testicles and penis, facial hair and deepening of the voice. If your child shows any of these symptoms, do make an appointment with the paediatrician for a thorough evaluation. 

One may ask why precocious puberty is such a big deal, as a child would develop these features in a few years. However, the symptoms of precocious puberty come with their own set of social and emotional problems. Girls and boys at that tender age are extremely self-conscious of the changes happening in their bodies. Early development of sexual characters can affect their self-esteem and even cause depression.

Apart from social and emotional issues, the other concern is that children with precocious puberty stay shorter than the normal height they would have attained. This is because they tend to grow quickly and be tall earlier than their peers. However, because their bones mature faster than normal, they tend to stop growing earlier. As a result, they stay shorter than average as adults. 

Treatment of Precocious Puberty 

You can stop the symptoms of precocious puberty from progressing with early identification and appropriate treatments. Though development that has already occurred cannot be reversed, the right remedies can allow your child to grow normally till the right age for puberty. 

You can also take a few steps to reduce your child’s risk of the condition. Ensure they have a balanced and healthy diet and maintain a healthy weight. This also involves a good amount of exercise and outdoor time. The increase in cases during the COVID-19 lockdowns have attributed to children not getting enough exercise and being bound to the couch or digital devices.

Also, be mindful about keeping them away from external sources of estrogen and testosterone. These include dietary supplements and prescription creams for adults. While there is no scientific evidence that the consumption of milk, dairy products, and meats is associated with precocious puberty due to the naturally occurring steroids present in them, it never hurts to be balanced about what you eat. Too much of something is never a good thing! 

The earlier the treatment for precocious puberty is started, the more effective it is. Both Western and Traditional Chinese Medicine (TCM) differ in their approach to treating the condition. However, both agree that the key lies in starting treatment early. 

Western Medicine 

The doctors will evaluate your child to ascertain the exact cause of precocious puberty. In the case of central precocious puberty, the decision to treat will be taken depending on the child’s age and the pubertal changes seen. Treatment may include medicines called GnRH agonists. They are available in various formulations, which can be inhaled through the nose or injected into the muscle or skin. It is safe, with no serious side effects.

In the case of peripheral precocious puberty, treatment is aimed at removing the source of sex hormones in the body and may involve surgery. Depending on the exact cause, the child may also get treatment with medicines. It is important to monitor the developmental changes, growth and bone maturation while on treatment. 

Traditional Chinese Medicine 

While explaining the TCM view, Physician Lim Sock Ling says, “The main pathogenesis of precocious puberty is Kidney yin Deficiency and Liver Stagnation that transforms into Liver fire. We target the root cause using syndrome differentiation and treat by nourishing the Kidney yin, relieving Liver Stagnation and clearing Liver fire.” Various formulations have been tested in clinical studies and have reported good effects. These include Zhi bai di huang pills (知柏地黄丸), Zi yin xie huo granules (滋阴泻火颗粒) and Zi shen qing gan granules (滋肾清肝颗粒). 

Acupuncture treatment has also shown benefits in girls with precocious puberty. Physician Lim recommends the acupoints san yin jiao (SP6, 三阴交) and gui lai (ST29, 归来). “San yin jiao is the intersection point of the Liver, Spleen and Kidney meridians and is often used to nourish yin“, she explains. Both the points are used to treat reproductive endocrine diseases and regulate the level of sexual hormones.

“TCM therapies are generally safe in children but I would still recommend seeking professional advice instead of self-medicating”, she cautions. 

If you see your child developing faster than normal, do not worry. Treatments are available in both Western and TCM. Just ensure you seek help early.