Too much too soon: ‘Precocious puberty’ can have grim cause

Precocious is an adjective people have used to describe me ever since I can remember. I didn’t wear cool adult clothes like Manny on "Modern Family." I didn’t star in a major movie before I was 10 years old like Dakota Fanning. Still, I had to be pretty mature for my age to outsmart the racist bullies in school.

What happens if your child is precocious– in puberty?

Precocious puberty means a child goes through that rite of passage at an early age, earlier than the normal standards. In Denmark from 1999 to 2001, precocious puberty occurred each year in about 20 of 10,000 girls and in fewer than 5 of 10,000 boys.

What changes during puberty?

In a landmark study in 1969 and 1970, Drs. W. A. Marshall and J. A. Tanner described the changes of puberty in five stages: Stage I: only fine pubic hair that’s pretty unnoticeable (kind of like Dr. Phil’s balding head– and mine!). Stage II: a sparse amount of long, straight or curly, slightly pigmented hair at the base of the penis or along the labia. Stage III: pubic hair becomes more robust, curly, coarse, and dark. Stage IV: hair similar to an adult’s, but hasn’t hit the inner thighs (so no bikini wax needed). Stage V: pubic hair covers the whole pubic region including inner thighs. Boys’ genitals: in Stage II, testicles start to enlarge, and scrotum skin becomes thicker and redder. Stage III, the penis grows in length as the testes continue to mature. Stage IV, penis grows in both length and width including the glans (head) of the penis, and more maturation of scrotum and testes. Stage V is full development.

In girls, Stage II starts with breast buds and areola enlargement. These continue to enlarge in Stage III, but it isn’t until Stage IV that the areola and nipple form a mound over the breast. Stage V: the areola recedes to project the nipple. And of course, the menstrual period usually occurs last, after pubic hair development.

Mind you, Marshall and Tanner’s observations were related to English boys and girls; the average onset of puberty was 11 years for girls and 11.5 years for boys. Today, it’s more like 9 and 10, respectively. African Americans tend to go through puberty earlier than Caucasians and Hispanics. So what’s the norm?

In 1999, the Lawson Wilkins Pediatric Endocrine Society (LWPES) recommended a workup of precocious puberty in white girls who have breast and/or pubic hair development before seven years of age and in black girls before six years. However, that misses a lot of kids who might have a pathologic reason for precocious puberty, so some physicians argue for a full evaluation at ages 7-8 in girls and 8-9 in boys.

About half of children who enter puberty too early have a medical condition that includes things from brain or reproductive organ tumors to endocrine disorders.

Of course, any cancer needs to be treated. Depending on the cause of abnormal precocious puberty, hormones are administered to treat the condition to allow the child to grow taller (puberty leads the epiphyseal plates of the bones to “close shop” and stop growth).

McCune-Albright Syndrome is a rare disorder that affects girls more than boys. It has a triad of precocious puberty, large brown spots on the skin, and abnormal bones.

Being precocious can have its drawbacks, like all the actors of "Different Strokes." Kids usually want to grow up fast, but then they lose something— like their innocence.

Precocious puberty I’m sure is no different.
Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, Email him with your questions.