Early Bloomers

Are young girls and boys today reaching puberty prematurely—and what can parents do to slow the process?

For Emily de Reyna, the first signs of womanhood came mysteriously early. At age 4, the New York preschooler began to develop breasts. By 6, she had underarm hair, body odor and monthly mood swings. Before she graduated from kindergarten, the possibility of an early menstruation loomed.

Warned that Emily’s premature puberty could result in a host of health woes, including stunted growth, psychological problems and increased risk of certain cancers, her parents faced a painful decision: either take a wait-and-see approach and face the consequences, or give Emily monthly injections of a hormone suppressant that would stall for time.

“In my eyes, I could not have my kindergartner going through puberty,” says Emily’s mother, Denise de Reyna, who reluctantly opted to put Emily on medication. “She had already lost some of her childhood, and I would be sadder if she had lost more.”

Developing Trend

According to researchers, physicians and parent advocacy groups, stories like Emily’s are growing more common, as the average age of the onset of puberty declines. Healthcare providers and parents are grappling with what to do about it. In February, the U.S. Environmental Protection Agency and the National Institute of Environmental Health Sciences published a sweeping multi-study review in the journal, Pediatrics, concluding, “Data are sufficient to suggest” that girls are indeed getting their periods and developing breasts far earlier, and that environmental factors likely play a significant role.

Researchers noted that premature puberty can have serious public health consequences, including a greater risk of breast cancer in girls and heightened risk of testicular cancer in boys, plus higher risk of Type 2 diabetes, metabolic syndrome and cardiovascular diseases. In addition, children who enter puberty earlier face a host of psychological struggles, and are at risk of “early sexual debut and potential abuse.”

The report was the latest in a series of studies to spotlight a disturbing trend to which anyone visiting a public swimming pool or shopping mall can attest: kids are growing up faster than ever.

According to a study published last year in the Journal of Adolescent Health, the average age of a girl’s first menstrual period has declined from 13.3 years, in women born prior to 1920, to 12.4 years in those born after 1980. Another landmark study of 17,000 girls, published in Pediatrics a decade ago, found that 1 percent of Caucasian girls and 3 percent of African-American girls now begin developing breasts and/or pubic hair by age 3. By 8, roughly half of African-American girls and 15 percent of Caucasian girls show signs of sexual development. Overall, African-American girls currently begin puberty between ages 8 and 9; Caucasian girls by 10—as much as a full year earlier than they did in the 1960s.

One federally funded study of more than 2,000 boys in 2001 suggests that they, too, are maturing earlier. Thirty percent of Caucasians, 38 percent of African-Americans and 27 percent of Latinos show some genital development by age 8. Average age for the appearance of pubic hair is between 11 and 12.

Societal Response

In order to quiet parental fears and prevent unnecessary treatment with potentially dangerous medications, authorities in the pediatrics community have responded to the trend by lowering the age defining ‘normal’ puberty. They say that parents need not be concerned if a girl of 8 or 9 develops pubic hair or breasts. So, today, puberty is deemed ‘precocious,’ or early enough to warrant medical attention, only if it occurs before age 7 in Caucasian girls, age 6 in African-American girls, or age 9 in boys.

But others have taken a more thoughtful approach. They are urgently calling for more research to determine the cause of the trend and what, if anything, can be done about it. “To me, it is a critical and crucial public health issue,” says Marcia Herman-Giddens, adjunct professor of public health at the University of North Carolina, Chapel Hill. She was lead author of two of the key studies cited.

“An 8-year-old girl with breasts still wants to be playing with dolls,” observes Herman-Giddens. “In a sense, these kids lose their childhood.”

Search for a cause

While some cases of early-onset puberty—particularly in boys—can be attributed to anatomical problems, like a tumor on the pituitary gland, the vast majority of cases remain unexplained. But a growing body of research suggests that our sedentary lifestyle and obsession with super-sizing may be to blame.

“During the same time that this trend has been taking place, we have had an epidemic of obesity in this country,” says Paul Kaplowitz, Ph.D., a medical doctor, chief of endocrinology at Children’s National Medical Center in Washington, D.C. and author of Early Puberty in Girls: The Essential Guide to Coping with this Common Problem.

Many studies already have documented a link between being overweight and early onset of menstruation. Kaplowitz has found that being just 10 percent overweight increases the chances of early breast and pubic hair development. He believes the fat cells’ production of the hormone leptin, which regulates appetite, but which is also a critical player in the biochemical cascade that prompts puberty, could play a role.

Another recent study, presented at The Endocrine Society’s annual meeting, suggested that women who eat a very high-fat diet during pregnancy may also influence the timing of their child’s puberty—prompting it to come early.

Sherrill Sellman, a naturopathic doctor and author of What Women Must Know to Protect Their Daughters from Breast Cancer, blames a variety of factors, and believes the medical community should be doing a better job of investigating them. “We are accepting the problem, rather than raising the alarm,” Sellman says.

Number one on her list is the group of ubiquitous, hormone-mimicking chemicals now present in our environment, which show up in everything from plastics in toys to pesticides on foods. “These chemicals are perceived by the body as hormones and programmed into children’s systems at a vulnerable time,” she says. “In some cases, they are hardwired at birth.”

For years, Sellman and others like her were largely ignored when they warned of the impact certain chemicals could have on timing for the onset of puberty, but a flood of new science has begun to prove them right.

In April, a report by the National Toxicology Program of the National Institutes of Health called into question the safety of bisphenol A (BPA), a common ingredient in polycarbonate plastic water bottles, sippy cups and baby bottles. The report noted that when laboratory rats were exposed to BPA, they experienced a host of health problems, including unusual timing of puberty.

The report prompted many companies, including Nalgene, to pull its BPA products off the shelves. Parents nationwide began to take a closer, more suspicious look at plastics.

Another study, in Puerto Rico, which has seen alarmingly high rates of breast development in young girls, found that girls who developed earlier were three times more likely to have high blood levels of phthalate esters. These chemicals are commonly found in plastic toys, food packaging and cosmetics.

Another study of Michigan children, who had accidentally been exposed in utero to polybrominated biphenyls (common fire retardants), reported that the girls ended up menstruating one year earlier than the control group. Yet another study pointed to estrogen-mimicking compounds found in the hair products of African-American women as a factor in hastening the puberty of their children.

In addition to chemicals and obesity, experts have implicated hormones in milk, meat and soy. Others hypothesize that a girl raised in a home with a man other than her biological father, such as a stepfather, can physiologically react to his chemical scents, called pheromones, setting her own hormonal cascade into motion. Some point to the increased sexualizing of children in television and print advertising. Many say that more stress and less exercise are culprits.

“In the animal industry, to hasten puberty, they keep the animals confined, they feed them really rich diets, and they grow really fast. That is exactly what we are doing to our children,” observes Herman-Giddens.

Slow the Future

While it is important to identify the causes of early puberty, we also must ask what it means for the future, caution children’s health advocates. Since publication of the first of her many studies on the subject, Herman-Giddens says that she has been flooded with letters and emails, both from parents who have watched their children suffer ridicule at school and from young women looking back on tormented childhoods.

Parents say it can be baffling for a preschooler to make sense of a changing body and hormone-fueled mood swings, or for a second-grader to have to remember to put on deodorant or bring a pad to school.

“It can be psychologically traumatic,” Herman-Giddens notes. She points to research that connects early puberty with depression, teenage pregnancy and drug and alcohol abuse. “They are just alone and terrified,” she continues. “Imagine being an 8- or 9-year-old, going about your daily life, having older boys or men hit on you and having no clue how to deal with it.”

When it comes to recommending treatment, Dr. Kaplowitz makes a careful distinction: There is true precocious puberty, a full-blown pituitary cascade that also sets rapid growth and bone maturation into motion too soon (leading to stunted growth later). Then, there is the more benign appearance of an isolated sign, such as breast growth.

He’s seen some girl patients whose breasts began to grow at age 6, and then stopped, as well as many who had pubic hair at age 6, but didn’t develop breasts until years later. Less than 10 percent of girls referred to him for signs of early puberty require medication.

“Sometimes pediatricians worry enough that it makes the parents panic,” Kaplowitz comments. “The important thing for parents to understand is that most girls who have early breast or pubic hair development do not have a condition that is dangerous and requires treatment.”

So what should a shocked and worried parent do? Both naturopathic and conventional physicians say that once full-blown puberty has begun, regardless of the age, it’s hard to put the brakes on it without medication.

On the other hand, for less severe or less advanced cases, Sellman counsels that several holistic approaches can work to slow or reverse early sexual development in children. These include naturopathy, traditional Chinese medicine, homoeopathy and chiropractic, as well as changes in diet and environment.

After Stephanie Dillard’s frightened kindergartner called her into the bathroom to show her the hair that had begun growing on her pubic area, Mom swept her off to a pediatric endocrinologist, who told her that her daughter did not require medication and sent her home. But the news offered little consolation.

“They never could tell me why it was happening,” she says. “They just told me to keep an eye on her.” Acting on Sellman’s advice, Dillard switched the family to an organic, hormone-free diet, and helped her daughter lose some excess weight. She also gave her liver-cleansing supplements to rid her body of any latent hormones or chemicals. “As a parent,” she remarks, “I wasn’t going to just sit idly by and say, ‘We’ll see what happens.’”

Denise de Reyna, Emily’s mom, now volunteers with the nonprofit Major Aspects of Growth in Children Foundation (MAGICFoundation.org), a parent support group that helps other parents handle their children’s early development. At age 11, Emily is now healthy and thriving. Owing to the medication her mom was so reluctant to put her on five years ago, she has yet to begin menstruating.

“I think she is one of the success stories,” Denise de Reyna says. “In fact, my daughter thinks she is the greatest thing since sliced bread.”

Lisa Ann Marshall is an award-winning journalist who writes regularly for newspapers and magazines.

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