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

Kaplowitz, Paul

Softcover

ISBN 10: 0345463889 ISBN 13: 9780345463883

Verlag: Ballantine Books, 2004

Inhaltsangabe

A comprehensive guide to early puberty in girls by a leading pediatric endocrinologist offers advice for parents on how to address the physical and emotional challenges that might affect daughters, discussing such topics as early puberty controversy, misconceptions, and current clinical findings. Original.

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Aus dem Klappentext

<b>The definitive book about early puberty in girls―what it is, how it happens, when to be concerned, and how it should be treated.<br><br></b>In recent years, the issue of early puberty in girls has become a well-publicized topic. But the messages from the medical establishment and the media have been confusing and often conflicting. Now Dr. Paul Kaplowitz, a pediatric endocrinologist who has treated children for more than twenty years, has written a comprehensive and completely accessible book on the subject―the perfect guide for parents concerned about their daughters’ premature development. Inside, they will find the answers to many questions, including<br><br>• <b>What are the hormonal and physical changes of normal puberty?</b> Breast development, pubic and underarm hair, body odor, menarche <br>(a girl’s first period), and the pubertal growth spurt<br>• <b>How do we know if puberty is starting too early?</b> The age and circumstances under which a girl can mature too soon; why this is occurring earlier than in the past, and why that age is earlier for African American girls<br>• <b>What effects does the early onset of puberty have on the behavior and emotional health of young girls? </b>From anxiety and withdrawal to worries about stunted growth, earlier periods, and earlier sexual activity<br>• <b>Is it because the environment or our fats cells?</b> An in-depth look at the potential culprits: chemicals and hormones in the environment, family relationships, stress, and increasing obesity<br>• <b>To treat or not to treat?</b> The six essential questions whose answers will determine whether treatment is necessary for your early-maturing daughter<br>• <b>How should a family prepare for a visit to a specialist?</b> Important tips for getting the most out of a visit to a pediatric endocrinologist<br><br>Dr. Kaplowitz also details extensive case histories that will help parents understand the real issues that may appear in girls’ lives. Reassuring, authoritative, and thoroughly detailed, <i>Early Puberty in Girls</i> is a must-have book for every parent of a young girl.

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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 1Ž4 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 if the diameter of the breast tissue held gently between the thumb and index finger is over 1Ž2 inch, it is likely that the breasts are starting to enlarge. However, it often takes a few months of observation to be sure.

Pubic and Underarm (Axillary) Hair

The greatest source of confusion among both parents and primary-care physicians is the meaning of the appearance of pubic hair in a young child. We are talking here about not the fine, light-colored hair similar to what may exist on other parts of the body, but dark and (if it is long enough) curly hair on both sides of the opening of the vagina and eventually above the vagina (an area called the pubic symphysis). We also use the Tanner scale for describing the extent of pubic hair growth as follows:

Stage 1:No pubic hair

Stage 2:Sparse growth of long, dark hairs, straight or slightly curled, along the sides of the opening of the vagina

Stage 3:Hair is darker and curlier and now spreads thinly over the pubic symphysis

Stage 4:Hair is thicker and looks like what one would see in an adult, but covers a much smaller area

Stage 5:Hair is adult in quantity and type, distributed like an upside-down triangle

It is important to understand that growth of pubic hair has nothing to do with estrogens made by the ovaries. It is due to male-type hormones made in the adrenal glands, which we refer to as adrenal androgens. The adrenal glands are small but vital glands that sit just above the kidneys; they also make cortisone (a hormone that is essential to life) and a salt-retaining hormone.

Because in many children pubic hair appears at the same time as other signs of puberty, there is a widespread belief that pubic hair equals puberty. The truth is that pubic hair can appear several years before other signs of puberty (e.g., breasts) or can appear at a later time. Axillary hair is thought to reflect the same hormone changes that cause pubic hair, though in most girls detectable axillary hair will appear three to six months after pubic hair.

What regulates the ability of the adrenal glands to increase androgen production is still not clear, but we know that the hormones that stimulate the ovaries to make estrogens are not involved. In the past, most girls were said to develop pubic hair between ages 8 and 12, but more recently its appearance between ages 5 and 8 has become increasingly common.

Body Odor

Another sign thought to be characteristic of puberty is development of an adult-type body odor, originating entirely in the underarm area, or what physicians call the axilla. Although this phenomenon as it occurs in children has received little scientific attention, I have concluded after years of talking to parents that the development of body odor, like pubic hair, is closely related to the increase in adrenal androgen secretion. This is because the timing of the onset of body odor is usually close to the time of appearance of pubic hair. Sometimes parents report detecting the odor three to six months before any pubic hair is evident. How adrenal androgens might influence the nature of what comes out of our axillary sweat glands is not clear, nor is it clear what the role of axillary odor in human reproduction might be. It may have evolved as a way for humans to recognize when another member of the species is close to reproductive maturity.

Pubertal Growth Spurt

One of the most dramatic changes occurring during puberty is the rapid growth that typically becomes apparent within a year after the appearance of breast tissue and is directly related to increased estrogen and growth hormone production. Prior to puberty, the normal rate of growth is about 2 inches per year, but this increases to about 4 inches per year during the most rapid phase of the pubertal growth spurt. In many girls, this occurs sometime between ages 10 and 12, but there is a great deal of variability. Men may recall that...

Details zur Ausgabe

• Verlag: Ballantine Books
• Erscheinungsdatum: 2004
• Sprache: Englisch
• ISBN 10: 0345463889
• ISBN 13: 9780345463883
• Einband: Taschenbuch
• Auflage: 1
• Anzahl der Seiten: 198
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar