Development of signs of sexual maturity that occur well before age eight in girls and age nine in boys. Some children have shown pubertal changes as young as age three or four years. In otherwise normal U.S.-born children, there is generally no identifiable cause in girls, but in about 50% of boys there is an underlying medical problem, such as a hormone-secreting tumor. In adopted children, early puberty is recognized and reported most often in girls, although careful studies indicate that boys are also at risk.
Precocious puberty is seen in some U.S.-adopted children, especially those with central nervous system abnormalities such as cerebral palsy or FETAL ALCOHOL SYNDROME. However, early puberty is reported most often in children adopted from other countries and who have shown dramatic catch-up growth after adoption.
In one study reported in Archives of Disease in Childhood in 1998, Italian researchers studied 19 girls adopted to Sweden from developing countries, (15 children were from India) and who were referred to a specialist for the onset of early puberty.
The researchers reported that the children showed signs of "chronic undernutrition" at the point of adoption. They divided the girls into children adopted before the age of four and children adopted after age four. The age at adoption had little association with the age at the onset of puberty (six and one-half to seven years), but the girls adopted younger were somewhat taller.
Hormonal treatment to suppress the precocious puberty was not very successful, in part because many girls were referred when the puberty was too advanced.
The theory suggested by some researchers for an early puberty in some children adopted from other countries is that the abrupt change from deprivation and malnutrition to relative affluence and psychological security may have triggered the body into launching into an early puberty. Thus, the altered diet of the girls in the study could have exacerbated puberty.
Said the researchers, "Before adoption these girls were mostly on a low protein, low energy, vegetarian diet, which changed to a balanced enriched diet after adoption . . . Improved nutritional conditions increase insulin-lie growth factor 1, which would stimulate both the maturation of ovarian follicles and their oestrogen production, and also the hypothalamic secretion of gonadatrophin releasing hormone, favouring sexual maturation."
Girls who are adopted from other countries before age three are less likely to experience an early puberty than girls adopted after that age. In addition, girls who show a dramatic growth spurt within two years of adoption are more likely to experience an early puberty.
Sometimes a seeming early puberty is not "precocious" but is actually appropriate. For example, a child's age may have been underestimated because of deprivation or small size.
Early puberty can be difficult for a child and family to deal with. The child may be more sexually mature than her classmates or older siblings, causing teasing and resentment. Parents may have their own difficulties coping with puberty that occurs early. The child may be expected to behave more maturely than his or her chronological age. Many children adopted from a background of abuse or neglect may be emotionally very immature, exacerbating the problems of dealing with puberty.
Treatment. Medications to suppress menstruation in children with early puberty do not halt the pubertal maturation and do not change a too rapid maturation of bone growth. Very young children (under age five) with precocious puberty may gain some benefit from drugs to directly suppress the pituitary gland in the brain, thus giving the child more years to grow in height. An early puberty could otherwise put an early halt to increases in height.
Experts such as pediatrician Jerri Ann Jenista, M.D., say that children with even subtle signs of early puberty, such as acne, body odor, pubic or underarm hair, should be evaluated by an experienced pediatric endocrinologist to
Early recognition provides the probability of the best outcome, says Jenista.
Jerri Ann Jenista, M.D., "Understanding and Dealing with Early Puberty," Adoption/Medical News 2, no. 2 (February 1996): 1-4.
Raffaele Virdis, et al., "Precocious Puberty in Girls Adopted from Developing Countries," Archives of Disease in Childhood 78 (1998): 152-154.
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©2000 by Christine Adamec and William Pierce, Ph.D. Reprinted from The Encyclopedia of Adoption, 2nd Edition (2nd Edition) with permission of Facts On File, Inc.
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