Early Puberty in Girls The Essential Guide to Coping With This Common Problem

CHAPTER 1 PUBERTY 101 What most parents understand about puberty is based on their own experience with it. Women typically recall the time of their first menstrual period (we use the term menarche when we refer to this event), and men often remember the grade they were in when they shot up four inches and kept outgrowing clothes and shoes. Some people remember puberty as a stressful time, though many of the stresses were likely more related to the difficult process of separating from one's parents and identifying with one's peers than to the hormonal changes themselves. Some mothers I have talked to who had puberty distinctly earlier than their peers recall feeling different or isolated, particularly if they went through menarche by age 10 and had no friends who had been through it before them. However, most parents I talk to do not have enough recollection of the timing and sequence of events their bodies went through between ages 10-12 and 15-17 for it to be of much help in deciding how worried to be or how to advise their children in the event one of them shows signs of puberty at an early age. To really understand what is or is not happening when a young child exhibits signs of puberty, a basic understanding of the physical and hormonal events of puberty is very helpful. In this chapter, I will describe these events in language that is as nontechnical as possible, while setting the stage for the discussion of the mechanisms underlying early puberty in the chapters that follow. I will start with a discussion of normal puberty in girls, followed by a shorter discussion of normal puberty in boys. The Normal Physical Changes of Puberty in Girls Breasts In order to be sure that a girl has started to undergo puberty, there needs to be breast tissue. This sounds simple and quite obvious, but as I will explain later, it is remarkable how often this fact is ignored. In girls who have not started puberty, one can often detect a tiny amount of tissue under the nipple, the breast bud, which is usually no larger than 1z4 inch in diameter. It is only when estrogen production starts to increase that the breast bud starts to increase in size. One can also see a thickening and darkening of the skin overlying the breast tissue, called the areola, and often a protrusion of the nipple at the center of the areola. Pediatricians rate breast development using the Tanner scale, developed by Dr. James Tanner. The five stages are defined as follows: Stage 1:Prepubertal; no breast tissue present Stage 2:Breast bud stage: a small mound of breast tissue under the nipple, slight enlargement of the areola Stage 3:Further enlargement of the breast and areola but no separation of their contours Stage 4:Areola and nipple form a separate mound above the level of the breast Stage 5:Fully mature adult breast, with only the nipple projecting above the level of the breast When puberty is in full swing, the amount of time needed to progress from stage 2 to stage 5 is between two and three years. However, with early-maturing girls, the progression is often slower, and as I will point out in the next chapter, very young girls can have stage 2 breast development and not progress at all for many years. In slender or nonobese girls, simple inspection is usually adequate for a parent or a pediatrician to tell if a girl has breast development. However, in overweight girls, this is often difficult, since in the sitting position, fat over the chest can look very much like breast tissue. One clue is that when the girl lies on her back, the fat redistributes itself over a wider area and what looks like breast tissue largely disappears. The most reliable method, however, is simply palpating, or feeling for breast tissue with one's fingers. Breast tissue feels firmer and rounder than fat tissue and is located directly under the areola. My general rule is that ifKaplowitz, Paul is the author of 'Early Puberty in Girls The Essential Guide to Coping With This Common Problem', published 2004 under ISBN 9780345463883 and ISBN 0345463889.