Early and late puberty
Signs of puberty before age 8 in girls or 9 in boys, or no signs in the teenage years. What is normal, what needs checking and what treatment does.
When does puberty usually start?
The first sign of puberty is a breast bud in girls and enlarging testicles in boys. This begins between 8 and 13 in most girls and between 9 and 14 in most boys. Periods usually come about two to three years after the breast bud.
Early puberty
Signs starting before age 8 in girls or before age 9 in boys are called early and need checking. The child may suddenly grow fast. This looks welcome at first, but the bones also mature sooner, and growth may stop early.
It is not always an illness. These two situations are usually harmless, but they are diagnosed by examination and need follow-up:
- A breast bud alone in a young girl, with no growth spurt
- Underarm or pubic hair and body odour alone, with no other signs
In girls, most true early puberty has no clear cause. In boys and in very young girls a cause in the brain or glands is more likely, so a closer assessment is needed.
How is it assessed?
The doctor looks at the stage of puberty and the speed of growth. Hormone tests, a bone age X-ray and, in some children, an ultrasound or MRI may be needed.
Treating early puberty
Not every child needs treatment. The decision depends on the child’s age, how fast puberty is moving, bone age, and how well the child and family can cope with the changes. If a cause is found, that cause is treated. For central early puberty there is an injected medicine that holds puberty back until a suitable age.
Late puberty
If there are no signs of puberty by about 13 in girls and 14 in boys, checks are needed. The same applies if puberty has started and stalled, or if a girl has had no period by 15.
The most common cause is late development: a healthy teenager who starts later than others, often with someone else in the family who did the same. Other causes are less common: long-term illness, too little food or very heavy exercise, thyroid or pituitary problems, and some genetic conditions.
Treating late puberty
With late development, follow-up is often enough. If the delay is distressing a teenager, a short course of hormones under a doctor’s care sometimes helps. If a cause is found, treatment depends on that cause.
A note for families
A child who changes sooner or later than friends may feel embarrassed or be teased. If your child has become withdrawn or is avoiding school, say so at the visit.
Frequently asked questions
My daughter is 7 and one breast is slightly raised. What should I do?
A breast bud sometimes starts on one side. Before age 8 an examination is needed, but this does not always mean illness, and sometimes watching over time is enough.
Does treating early puberty reduce fertility later?
Experience so far is that puberty restarts after the medicine that pauses it is stopped. Ask your questions at the visit, because the decision is made for each child separately.
How do I talk to my child about it?
Explain simply and calmly that their body has started changing sooner than others' and that it is not their fault. If they look different from classmates, watch for teasing at school.
The first step is a calm measurement.
Talk to the support team to arrange a visit. If you have your child's earlier heights and weights, find them and bring them along.