Review by VCU researcher shows girls start puberty younger

A review by a Virginia Commonwealth University pediatrician shows many girls in the United States are entering puberty one to two years earlier than is indicated in pediatric guidelines. Until now onset of breast development was thought to begin as early as age eight, but the new review suggests it actually can start as early as age seven in Caucasian girls and age six in African-American girls.

The review, which proposes a revision of the guidelines, is authored by VCU pediatric endocrinologist Paul Kaplowitz, M.D., and appears in the October issue of the journal Pediatrics. It was sponsored by the Lawson Wilkins Pediatric Endocrine Society. Kaplowitz says new guidelines will decrease the need for diagnostic tests and treatment for six- to eight-year-old early developers.

"The new data reflect a trend in this country that girls are maturing at younger ages," says Kaplowitz. "Under current guidelines, six- and seven-year-old girls with breast development are seen as early developers and may be referred for hormonal treatment to delay the onset of puberty. Our findings indicate most of them should be considered within the normal spectrum of development and receive parental reassurance, not medical intervention."

About 25 percent of African-American girls and eight percent of Caucasian girls have breast development and pubic hair before age eight. Under current guidelines, they fall into a category termed precocious or early puberty. If these early maturers were evaluated under the new pubertal age range, Kaplowitz says only four to five percent of them would be considered early developers and possibly referred for treatment.

The review also indicates that standard treatment for early puberty -- monthly hormonal injections, costing $6,000 to $10,000 a year -- is useful for very young maturers, but may be unnecessary for six- to eight-year-olds. The injections were thought to help prevent short adult stature associated with early puberty. Physicians had believed if girls begin and end their growth surge too early, they may not reach a normal height. But Kaplowitz says there is no firm evidence injections significantly improve adult height in maturing six- to eight-year-old girls.

"Pediatricians need to educate parents, and parents need to reassure their daughter that physical maturation at this age is normal and fairly common today. These girls typically will start menstruating two to three years later, allowing parents ample to prepare them for this event."

Kaplowitz and his colleagues are conducting a follow-up study to find out what is spurring early maturation. Preliminary analysis of the data suggest early maturers tend to be more overweight than girls who begin their development later.

The article was based on a comprehensive review of a 1997 published study, which examined the development of 17,000 girls in this country between the ages of three and 12. Kaplowitz says the proposed guidelines, reviewed by the Lawson Wilkins Pediatric Endocrine Society, represent a consensus statement from the leadership in the field of pediatric endocrinology in the United States.