Do environmental chemicals or hormones in meat or milk trigger early puberty?
DOC A lot of people want to blame environmental chemicals, but there isn't any solid evidence that they have any effect. There have been a few international studies suggesting that increased levels of industrial chemicals, such as phthalates, may play a role in early puberty, but there haven't been any data from the U.S. As for hormones, I have yet to find a scientific article linking milk from cows treated with growth hormones to precocious puberty.
In this era of super-sexy young stars and age-inappropriate clothing, do some girls see early maturation as positive?
PSYCH Being older has status for kids: They admire older kids and want to be like them. So there's little doubt that many girls envy those who look more mature. And at least some mature-looking girls will feel superior to their smaller classmates. But just because an 8-year-old girl likes "looking sexy" doesn't mean she's comfortable with the attention she may be getting from older boys or men. As an early maturer tries to fit in with the kids who look like her but are several years older, she's more likely to end up doing things like using drugs or alcohol, or becoming sexually active, than are other girls her own age.
How often does precocious puberty require medical treatment, and what does that entail?
DOC Only a small percentage of children referred for early puberty require hormone suppression—and they're the ones who are youngest and progressing rapidly. For instance, I reviewed 90 girls experiencing early puberty for an article in The Journal of Clinical Endocrinology and Metabolism, and only three were treated. Therapy involves a series of monthly injections of the drug Luprondepo, a slow-release hormone that regulates the pituitary gland. Depending on the age when it starts, it can last from one to four years. The annual cost is at least $10,000, which insurance often covers.
Do girls tend to be upset or bewildered by early puberty?
DOC The first period usually occurs at the later end of puberty—a minimum of a year and a half after the first signs of breast buds. So if a girl gets her period at 9, she's been going through puberty since age 7. Most girls who are adequately prepared by their parents—that is, told what to expect when they get their periods-are fine.
Still, it's difficult for an 8- or 9-year-old to be getting periods, because she doesn't have peers to talk with about the situation. By the time she's 10, there are other girls going through the same thing.
PSYCH Older boys and men tend to be more interested in mature-looking girls, which can be both flattering and frightening. But even if girls are flattered, they're still vulnerable to being sexually exploited. Even if a girl looks older, at age 7 or 8 she's just a child. She's still learning how to make change for a dollar, not how to protect herself from the advances of an older boy or man. For some girls, the start of puberty can also trigger dysfunctional eating as they try to control their growth.
How should parents discuss the topic with their kids?
DOC When parents are anxious discussing sexual issues, their anxiety rubs off on the child. Such parents should share a book, such as The Care & Keeping of You (American Girl), or have the child speak with a trusted adult who is comfortable with the subject.
PSYCH It's always a good idea to ask questions—to see if a child is being targeted in any way, is feeling different, or is gravitating toward older kids. But these questions have to be subtly embedded in more general discourse, perhaps during a leisurely discussion at dinner. This has to happen in an atmosphere that lets conversation flow. You'll learn more about your child's life from talking to her at dinner ("Who are you eating lunch with at school these days?" "What was the best part of your day?") than from direct questions like "Is there anything you want to talk about?"
