Puberty usually makes headlines for hitting kids at younger and younger ages,
but late puberty continues to have an impact. For a teen boy who isn't
getting taller or developing like others his age, or a girl embarrassed
that – unlike her friends – she isn't menstruating and her body isn't
maturing, delayed puberty feels like a big deal.
If a girl hasn't had some changes of puberty by
13, or a boy hasn't had changes by 14, that's considered delayed
puberty. It's challenging for many kids who just want to fit in, and
concerning for parents who wonder about potential social effects and
possible medical causes. Doctors can sort out the reasons behind puberty
delays, provide perspective and explain the pros and cons of treatment.
[See: 10 Concerns Parents Have About Their Kids' Health.]
Kids' bodies grow in fits and spurts, driven by
hormonal changes. The hormones that primarily drive puberty – estrogen
for girls and testosterone for boys – are produced in the ovaries or
testes. Glands in the brain, called the pituitary and hypothalamus,
direct the release of these hormones. In boys, signs of puberty include
enlargement of the testicles, gains in muscle mass and growth of facial
hair. Girls develop breasts, start their periods and develop body hair.
Sexual urges kick in.
Medical issues such as brain or ovarian tumors, testicular injuries and Type 1 diabetes may disrupt puberty. A rare genetic condition
called Kallman sydrome can delay puberty far into adulthood if
undiagnosed. Turner syndrome, another genetic condition, affects ovary
development in girls. However, it's an exception when a medical
condition is the culprit. Usually, kids are healthy and don't require
any treatment for delayed puberty. "Most commonly, the cause is not one
that's a threat to a child's health," says Dr. Donald Zimmerman, head of endocrinology at Ann & Robert H. Lurie Children's Hospital of Chicago.
For parents concerned about either early or late puberty, Zimmerman says, the first step is talking to the family doctor or pediatrician,
who will evaluate the child's general health and take a commonsense
approach. The doctor will account for factors like breast growth and
pubic hair formation, and will examine the child's growth chart to
determine puberty timing.
RELATED CONTENT
7 No-Fail Responses to Your Child's Questions About Sex
Malnourishment is a surprisingly common cause of delayed puberty in younger high-school children, Zimmerman says, particularly in athletic girls who
are extremely active. "They're expending an enormous number of
calories," he explains, but not eating enough to make up for it. Helping
girls develop a healthy eating plan that meets their nutritional needs can put them back on track for puberty.
Usually, the delay is "constitutional," which
simply means it's a variation of normal puberty, one that may run in the
family. If parents remain concerned, they can be referred to a pediatric endocrinologist – a specialist in children's growth and hormone disorders.
Late Bloomer Forever?
For Neil Smith,
hearing he was a "late bloomer" or "late developer" from one doctor
after another, having his complete lack of puberty dismissed as a "late
start" and being told to "wait and see" was the story of his youth.
It wasn't until his early 20s that Smith, now 47
and a biomedical scientist in Worcester, U.K., found out he had
Kallmann syndrome, a rare genetic condition that causes late or absent
puberty. An estimated 13,000 people in the U.S. and 2,500 people in the
U.K. have the condition.
Smith talks frankly about his symptoms. He was
always very small and by age 16, had no growth of his testicles or
penis, or any pubic hair. "You look the same as you always had through
childhood," he says. "It's obvious that's something's not quite moving."
People with Kallmann syndrome frequently lack a
sense of smell. That, Smith says, makes fitting in even harder in a
world of teens who are highly conscious of personal hygiene and image.
As an adult, Smith had a growth spurt. He is now
nearly 6 feet tall. Hormone treatment has helped his sexual maturation
to some extent. "Early detection and treatment is very important with
this condition," he says. "It can help with a lot of the psychological
issues of being left behind at puberty."
Each Kallmann syndrome story is different, Smith
emphasizes, with people experiencing a broad spectrum of severity and
symptoms. He wrote about his case in a medical journal and connects with
and advocates for others who share the diagnosis. Kids with late
puberty should be assessed by an endocrinologist, he says: "'Late
developer' or 'late bloomer' is not a valid diagnosis."
[See: 5 Rare Diseases You've Never Heard of (Until Now).]
Parents tend to worry more about late puberty in sons than daughters, says Dr. Diane Stafford, assistant clinical director of the endocrinology division at Boston Children's Hospital.
Height is one reason. Timing of puberty is substantially different
between boys and girls, she says, with girls typically beginning their
growth spurts two-and-a-half years earlier. "That difference becomes
magnified when you have boys who also have delays in puberty," she says.
Girls can be deeply bothered by delayed puberty,
too. Extreme late puberty can cause a lot of psychosocial distress in
girls who haven't developed breasts, started menstruating or gone
through growth spurts like female classmates around them, Stafford says.
RELATED CONTENT
Sneaky Signs of Childhood Anxiety
"I do a lot of counseling with families,"
Stafford says. "My job, first of all, is to determine whether there's
pathology. And whether there's a problem that we need to deal with that
is causing early or delayed puberty." Taking X-rays of the hand and
wrist can help doctors determine the child's bone age and predict his or
her height as an adult. Blood tests pinpoint hormone levels and can
narrow down the causes of delayed puberty. And doctors may test a kid's
sense of smell to rule out Kallmann syndrome.
If there's no underlying medical condition or
potential health consequences from early or delayed puberty, then it's
time for an in-depth conversation about the implications of delayed
puberty for that child and how parents can support their son or
daughter.
[See: 9 Sports Injuries That Sideline Kids.]
For families considering treatment for boys with
delayed puberty, testosterone therapy is a possibility. Most often,
injections are given in low doses for a limited period of several
months. Temporary side effects could include acne or irritability.
Although girls are less likely to pursue
treatment, estrogen pills or skin patches are options if they do.
Treatment for constitutional delays last about four to six months. Using
patches rather than pills may minimize any potential risk for blood clots
related to estrogen treatment. Girls whose delayed puberty is related
to underlying medical conditions may require long-term treatment with
more than one type of hormone replacement.
Physicians hesitate to induce puberty in kids
earlier than their bodies would normally send them there, Stafford says.
"So the discussion has to be around where we expect them to go, based
on family and based on their pattern of growth, but also when they're
going to get there," she says.
Boys who are willing to wait for their growth
spurt might be slightly taller in the long run than boys who start
testosterone treatment to induce puberty, Stafford says. Others might
prefer to see an earlier boost in their growth and muscle mass. She
helps them understand the tradeoffs and make a decision that works for
them.
Most of all, it's about normalizing the
situation and helping kids realize that there's nothing wrong with them,
Stafford says: "I see too many kids whose parents have made them
anxious about differences that are inherent parts of normal human
variation."
No comments:
Post a Comment