Plunged into puberty
For a growing number of children, puberty strikes too soon.
Friday, April 25, 2008
Brenda Benjamin doesn’t know who was more scared the day her 8-year-old daughter started her period. The third-grader didn’t realize what was happening at first and her mother had a hard time explaining it to her. "Here’s this little girl who goes off to school and asks me to watch over her stuffed animals and make sure they’re fed, and she has to deal with her period," Benjamin says. "It’s hard to reconcile."
But for an increasing number of children like Emily, adulthood is coming too quickly as their bodies plunge into puberty years early for no apparent reason. According to the Magic Foundation, a non-profit growth disorders support group, 1 in 5,000-10,000 children suffers from the condition known as precocious puberty. Although there is no consensus why more kids have precocious puberty than even 10 years ago, everyone agrees kids in preschool, kindergarten, first and second grade aren’t ready for their bodies to begin sexual development.
"It’s definitely hard to watch your child go through puberty early," says Benjamin. "Having gone through these changes myself at 12 or 13, it’s hard imagining being 8. It happened in such a short time for her. Before April she was a typical 8-year-old girl."
Tracking down the causes
Benjamin doesn’t remember the first time she realized Emily was going through puberty. The small signs, like her body odor after playing outside and underarm hair growth, eventually added up. Soon the dark-haired, slender third-grader was the tallest girl in her class because of a growth spurt that caused her to grow 5½ inches over a few months.
Although Emily may be one of the only girls in her class to go through puberty at such an early age, she isn’t alone. More children, especially girls, are reaching puberty sooner. Out of the 15 to 20 patients Dr. Richard Levy sees everyday, at least one has precocious puberty. According to Levy, a pediatric endocrinologist at Rush University Medical Center, the number was half that 10 to 20 years ago.
The numbers might be going up, he says, because chemicals in the environment have more estrogenic activity. Since some pollutants mimic estrogen, they could stimulate puberty at an earlier age. "Most pollutants in the environment are going to be here for a long time because they stay in the fat stores of animals," says Levy. "We’re at the end of the food chain. It’s like mercury. When we pollute other species, we become polluted."
Some kids like Emily, who was born in India, are born with an increased risk of developing precocious puberty. Children adopted internationally are more likely to develop the growth disorder. And more girls develop precocious puberty than boys. Levy says that he sees three to four girls with precocious puberty for every boy with precocious puberty.
"Something is pushing things a little earlier," says Dr. Elizabeth Littlejohn, an assistant professor of endocrinology at the University of Chicago Department of Pediatrics. "I think it’s a combined effect of better conditions. I think evolution wants the body to move toward reproduction so it’s naturally wanting to start earlier. These are just theories. We don’t know anything for sure, but we know things are moving earlier and it’s got to be something combined with genes and the environment."
Since Emily was adopted from Calcutta, India, at 5-½ months old, Brenda Benjamin didn’t become immediately alarmed when she noticed her daughter’s first signs of puberty. She now regrets that she didn’t take Emily to a doctor sooner.
"You think your child is growing and that it’s fine. But sometimes it’s not always fine. It’s better to be on the safe side and get things checked out."
Deciding what to do
Although it’s hard for kids to begin puberty before their peers, doing something about it can be just as difficult. The Benjamins considered themselves lucky because they were able to schedule a visit with a pediatric endocrinologist within a few days after a pediatrician examined Emily. Weeks of tests follow, including blood tests, MRIs, bone x-rays and ultrasounds needed to diagnose precocious puberty and rule out tumors or problems with the ovaries, adrenal glands or pituitary glands.
Although it can be difficult to watch as kids are poked and prodded to find out if they have precocious puberty, the diagnosis shouldn’t be bypassed. "It can be a long process sometimes, but it’s imperative you shouldn’t proceed without it," says Littlejohn. "You want to make sure it’s not something that should be dealt with."
If a child is diagnosed with precocious puberty and the cause isn’t pathogenic or life threatening, determining how to proceed next isn’t always obvious. Some parents do nothing since precocious puberty poses no major health risks. However, children with the growth disorder have a greater probability of being short because their bones stop growing earlier than usual. Psychological consequences may also be a reason for treatment.
If parents choose to treat precocious puberty, monthly leuprolide injections until the age of 11 or 12 are the usual choice. The shots are a source of fear for Karina Loftus, 7, who was diagnosed with the condition last September after developing breast growth and underarm hair at 4. Every month, Karina and her mother make the trek to Rush Children’s Hospital so Karina can receive the injection to preserve her childhood for a few more years. "No kid likes to take shots, and she absolutely hates them," says Kurnain Loftus. "It’s like her worst nightmare come true."
The Benjamins recently opted to try a new option to treat Emily’s condition—supprelin LA. A small tube that releases the drug was implanted in Emily’s arm while she was under anesthesia. Supprelin LA delays puberty for a year, so Emily won’t need to receive injections every month.
The drugs to treat precocious puberty aren’t cheap. The leurprolide injections and the supprelin LA implant cost about $14,000 to $15,000 a year. Still the Benjamins believe the cost is well worth the result. Emily is now expected to reach between 5-foot-4 and 5-foot-5, rather than 5-foot-1 as doctors estimated before she started taking medication. More importantly, she has her childhood back.
Living with the disorder
Although medications may be able to stop precocious puberty, the long-term effects don’t fade as quickly. Kurnain Loftus worries about how to shield her daughter from embarrassment during the summer since the leurprolide injections don’t stop underarm or pubic hair growth. Should she try Nair or leave it alone? "That’s something I didn’t think I’d have to think about right now," Loftus says.
Brenda Benjamin remembers how hard it was to send her daughter off to third grade with sanitary supplies in her backpack. And since Emily already had such a large growth spurt, she is tall now but it won’t be like that forever. "We have to tell her that you’re really tall now, but several years from now when your friends have a growth spurt, you’re not going to have another one," says Benjamin.
Many families affected by precocious puberty have little support or references available about the rare growth disorder. "It makes it harder. You don’t want your kids to be embarrassed because it (puberty) is a normal thing that just happened earlier. But you don’t want to go out and talk about it and say anything that would embarrass them. There’s a fine line there."
The lack of support was a reason the Magic Foundation decided to start a special division for the condition 12 years ago. "When we got the first call for precocious puberty, a family said ‘We have nowhere to go,’ " says Mary Andrews, the CEO of the Magic Foundation, based in Oak Park. The Magic Foundation’s precocious puberty division now serves 1,830 members throughout the world.
Loftus, who also became involved with the Magic Foundation, often reminds Karina that other children are in the same situation. This consoles Karina who found it hard to go through puberty at an age when many of her peers barely know what it means. More importantly, Loftus tells Karina that one day she will grow up and it won’t matter when she developed.
"You’re going to be OK, right?" Loftus says as she turns to her daughter.
Karina nods her head, looks down at her doll and smiles.
Taking a look back
One woman’s story about growing up with precocious puberty
As a child, Patricia Biesen felt trapped in a woman’s body. She was 5-feet-5 by the third grade, far taller than her classmates. Biesen recalls standing in for an absent teacher in the third grade class photo and using a special desk a janitor found so she could sit comfortably. Biesen began wearing a bra that year and she got her period the next.
"I was teased every day," say Biesen, now 37. "I felt like I was a circus freak. There wasn’t a lot of support or information about what was going on with me. I spent a lot of time going back and forth to doctors and specialists."
Although Biesen was diagnosed with precocious puberty at 5, no treatment options were offered. "They just thought I would grow up and grow out of it," says Biesen.
But it wasn’t that simple. She struggled throughout her childhood and adolescence because of the growth disorder, developing anorexia in eighth grade, which she attributes partially as a result of growing up with precocious puberty. "Starving yourself is one way of being small and petite," she says. "I didn’t realize what was going on, but I was trying to reclaim my childhood."
Now Biesen, a production specialist for Boston Consulting Group and part-time artist, uses art as an outlet to express how she felt as a child with precocious puberty. But her battle with the disorder isn’t over. As an adult she has joint pain and osteopenia, a condition that occurs because of low bone density and increases chances of developing osteoporosis.
Still Biesen searches for the positive aspects of experiencing puberty a few years too early. "In a way, it’s shaped me to be a more empathetic, tolerant person," Biesen says. "On the other hand, it’s made me a shyer person. But the positive outweighs the negative."
Biesen’s advice for children growing up with precocious puberty? "Even what you’re going through will end and it will be OK," she says. "Find support and other people who are going through what you’re going through."
Is it precocious puberty?
Dr. Elizabeth Littlejohn, an assistant professor of endocrinology at the University of Chicago Department of Pediatrics, outlines what to look for:
• A growth spurt of 4-5 inches in a year before age 8 in girls and 9 in boys. The normal growth rate is 2.5 inches in a year.
• Any breast growth before 8 in girls.
• Testes enlargement before 9 in boys.
• Pubic hair or underarm hair before 6 in girls and 8 in boys.
• First period before 9½ for girls.
Littlejohn says not to be overly concerned with mood swings or body odor because they could be signs that the child isn’t cleaning properly or that they are going through a tough time.
If your child has one or more of these symptoms, talk to your pediatrician.
For further information and support, contact The MAGIC Foundation at (800) 362-4423 or (708) 383-0808. The MAGIC Foundation is located at 6645 W. North Ave. in Oak Park.
The Pursuit of Strength
In my series "The Pursuit of Strength," two fighters struggle in the boxing ring. Opponent #1 is "the big girl," who symbolizes the child I was while I was experiencing my growth disorder. Opponent #2 is the "little woman" who is myself as an adult. "The big girl" is dressed in the classic pink party dress. Facial features are diminished because even though this is my personal storytelling, the struggle is universal. It is hard to tell who is going to win; the childhood pain seems everlasting and unbeatable. In the end they both win when I decide to respect both the girl and the woman.
Emmalee Miller is a student at Northwestern University and a Chicago Parent intern.