SHOCK­ING TREND More chil­dren hit pu­berty as early as age six.

More kids in Sin­ga­pore are ex­pe­ri­enc­ing early pu­berty, some as young as five years old. We find out what’s be­hind this trend and the im­pli­ca­tions for your child’s health.

Young Parents (Singapore) - - Contents -

When Sarah (not her real name) was six years old, she was taller than her peers and had larger than nor­mal breasts.

Her mother sim­ply pinned this down to ge­net­ics and body fat. “We didn’t re­alise th­ese were signs of early pu­berty. We thought she was just grow­ing up too quickly,” said Mrs Lim (not her real name).

Sarah was di­ag­nosed with early, or pre­co­cious, pu­berty dur­ing a Health Pro­mo­tion Board check-up when she en­tered pri­mary school.

When she was re­ferred to a pae­di­a­tri­cian in hos­pi­tal for fur­ther check-ups, Mrs Lim was sur­prised and read up on early pu­berty af­ter the con­sul­ta­tions. She said it was a con­di­tion that was rarely dis­cussed, much less known.

Pae­di­a­tri­cians say they are see­ing more chil­dren like Sarah who are reach­ing pu­berty early, most likely be­cause par­ents are be­com­ing aware of it.

Early pu­berty is when a child’s body be­gins chang­ing into that of an adult too soon. It re­sults in rapid growth, changes in body shape and size, and the devel­op­ment of the abil­ity to re­pro­duce.

At the Na­tional Uni­ver­sity Hos­pi­tal (NUH), where Sarah is a pa­tient, the num­ber of chil­dren who have the con­di­tion has risen from seven in 2009 to 22 last year.

“Pu­berty is like a vol­cano which hasn’t erupted. It is nor­mally un­der in­hi­bi­tion, un­til the child reaches a cer­tain age when the in­hi­bi­tion forces are lifted,” says

Dr Cindy Ho, a con­sul­tant at NUH’s di­vi­sion of pae­di­atric en­docrinol­ogy.


Early pu­berty be­gins be­fore the age of eight in girls and nine in boys.

The two main causes are cen­tral pre­co­cious pu­berty and pe­riph­eral pre­co­cious pu­berty, Dr Ho says.

Much more com­mon is cen­tral pre­co­cious pu­berty, or “nor­mal early pu­berty”.

She ex­plains: “In cen­tral pre­co­cious pu­berty, the whole se­quence kicks in be­cause the switch for pu­berty in the brain gets switched on ear­lier.”

There is usu­ally no identiable cause for this.

Pe­riph­eral pre­co­cious pu­berty, on the other hand, is the re­sult of el­e­vated sex hor­mones – oe­stro­gen in fe­males and testoterone in

males – in the child’s body that were not ac­ti­vated by the brain’s pu­berty con­trol cen­tre.

It could hint at un­der­ly­ing prob­lems in the body, Dr Ho says. Pe­riph­eral pre­co­cious pu­berty could be due to tu­mours in the testes or ovaries that are se­cret­ing the ex­cess hor­mones. It could also be due to ge­netic dis­or­ders in­volv­ing ab­nor­mal hor­mone pro­duc­tion by the adrenal glands.

Dr Chris­telle Tan, a pae­di­atric medicine spe­cial­ist and con­sul­tant at Raf­fles Spe­cial­ists’ Hol­land Vil­lage cen­tre, says: “Chil­dren with early pu­berty should see a pae­di­a­tri­cian to de­ter­mine if the pu­berty is a nor­mal or vari­ant type.”

Early pu­berty can also be caused by ex­po­sure to ex­ter­nal sources of sex hor­mones, such as hor­mone re­place­ment patches used by the child’s fam­ily mem­bers.

Chil­dren who are sig­nif­i­cantly over­weight tend to start pu­berty ear­lier, Dr Ho says. Most of her pa­tients with early pu­berty are six or seven years old, with a hand­ful be­low the age of five.

The ex­pert say there is lit­tle par­ents can do when early pu­berty oc­curs. How­ever, Dr Ho says chil­dren should lead a healthy life­style to re­duce the risk of obe­sity and early pu­berty.

Dr Ali­son Sn­od­grass, a con­sul­tant at KK Women’s and Chil­dren’s Hos­pi­tal’s depart­ment of paediatrics un­der its gen­eral paediatrics and ado­les­cent medicine ser­vice, says good nutri­tion and ad­e­quate sleep are im­por­tant for the nor­mal pro­gres­sion of growth and pu­berty.

She adds: “Early pu­berty oc­curs more com­monly in girls. It is usu­ally phys­i­o­log­i­cal (con­sis­tent with the body’s nor­mal func­tion­ing).

“There may be a fam­ily his­tory of early pu­berty. Girls who are obese also tend to go into pu­berty ear­lier.”

Signs of early pu­berty in girls in­clude breast devel­op­ment, pu­bic hair growth and vagi­nal bleed­ing.

Boys in early pu­berty might ex­pe­ri­ence pu­bic hair growth, en­larged tes­ti­cles and pe­nis, acne and a deeper voice, among other signs.


Be­sides un­der­ly­ing prob­lems, early pu­berty can also have phys­i­cal and so­cial reper­cus­sions for a child.

They may end up grow­ing into short adults, for ex­am­ple. Al­though chil­dren with early pu­berty might ex­pe­ri­ence early growth spurts, their bones ma­ture more quickly than nor­mal.

As a re­sult, they of­ten stop grow­ing ear­lier than usual and may be shorter than av­er­age when they be­come adults, Dr Ho says.

Chil­dren with early pu­berty may be ex­tremely self-con­scious about the changes oc­cur­ring in their bod­ies. And they may not be ma­ture enough to han­dle the emo­tional and phys­i­cal changes that come with pu­berty, she adds.

“Chil­dren may not know how to han­dle mood swings and take care of their per­sonal hy­giene. Th­ese things might be scary to them.”

The changes in the child’s body may also make her vulnerable to sex­ual abuse.

Treat­ment, de­pend­ing on the cause of the con­di­tion and how early the on­set is, might be nec­es­sary to limit th­ese ef­fects.

In­jec­tions con­tain­ing hor­mones to block the pu­berty are usu­ally ad­min­is­tered, Dr Ho says. Th­ese in­jec­tions are usu­ally done once a month or ev­ery three months.

A monthly injection costs more than $200, de­pend­ing on the level of sub­sidy, and treat­ment stops once the kid reaches the nor­mal age of phys­i­cal ma­tu­rity.

Par­ents do not need to be overly con­cerned but, at the same time, they should not ig­nore the signs of early pu­berty, Dr Tan says.

“Par­ents are be­com­ing more aware of early pu­berty and this is seen in the in­crease in the num­ber of pa­tients over the years.”

Al­though there is lit­tle that par­ents can do to pre­vent early pu­berty, they should seek treat­ment for their child.

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