Every year, 1,300 children enter puberty before they are 8 years old. In reality, this figure could be much higher. “We talk about early puberty when pubertal signs appear before the age of 8 for a girl and 9 for boys,” explains Dr. Julie Auger, pediatric endocrinologist at the “Maison de l’Enfant” in Meurthe-et-Moselle. Over the years, the specialist noticed that more and more young patients and their worried parents were coming to her office.
“To make a diagnosis, several elements are necessarily present. We must note clinical signs such as breast development, an increase in growth rate, often with pubic hair. But that’s not all. This clinical examination must be supplemented by a biological assessment, a pelvic ultrasound which reveals an increase in the size of the uterus and ovarian volume as well as a bone age assessment,” adds Dr Auger. All of these criteria must be met to establish a diagnosis of precocious puberty. In some cases, young girls only have advanced breast development, so monitoring is appropriate.
In boys, an increase in testicular volume represents a sign of concern. Coupled with biological arguments and bone age, it will then be possible to make a diagnosis. But, often, it is later than for girls. “An MRI is necessary to check for the absence of a tumor or brain malformation which is exceptional. It will be carried out after the biology which confirms the central origin of the phenomenon,” underlines the pediatrician.
For each patient, the specialist studies the growth profile before implementing a treatment intended to slow down puberty. The latter allows normal growth to take place and also improves the psychological tolerance of each child. In little girls, the onset of early periods can cause premature growth to stop. “The effectiveness regarding size is real before 8 years. For children who have advanced puberty – between 8 and 9 years old – the results are poorer. The treatment is based on a synthetic drug which acts as a decoy for the hormone receptor. It prevents them from functioning normally,” warns Dr. Auger. The injections are intramuscular, they are monthly or quarterly, to be carried out until the age of 10 years for girls and 12 years for boys. Generally, the main side effect is to cause an increase in appetite.
What causes this early puberty? Currently, there are many avenues, but no scientific validation. “Endocrine disruptors are widely singled out. On a daily basis, we raise massive awareness among families so that they monitor what they eat, what they put on their skin, what they breathe in their homes, what they use as household products, etc. », insists the specialist.
And for good reason, lifestyle is a widely cited culprit in the onset of early puberty. Recently, a study noted that cases had exploded during the Covid-19 pandemic. To reach this conclusion, the researchers compared the incidence of central idiopathic precocious puberty (CIPP) during Covid-19 with that of the previous four years. Between 2015 and 2019, fewer than 10 cases per year were reported, this figure increased to 23 in 2020, then to 30 in 2021. These findings were published in the Journal of the Endocrine Society. “Increasing use of digital devices and reduction in daily physical activity represent possible risk factors,” the study authors suggest. “Our study confirms the increase in precocious puberty diagnoses during Covid-19 and identifies contributing factors such as poor eating and exercise habits, too much screen time and sleep disorders,” summarizes Dr Mohamad Maghnie from the University of Genoa.
Dr Auger also points to the culprits: “This increase in cases could be linked to exposure to the virus, but we have no evidence to confirm this. Lifestyle changes are certainly to blame. Young people experienced restrictive confinement with a change in diet and an increase in body fat. This phenomenon modifies the metabolic profile of children. More sugar and less sport, a dangerous duo. »
To identify the signs of early puberty as quickly as possible, Dr. Auger recommends having children regularly monitored by a doctor and monitoring growth at least once a year. “At the first warning signs, we must consult and not trivialize the situation. »