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Precocious puberty

Children are hitting puberty earlier than ever before. What's causing it and do we need to start worrying? Mehak Agarwal, now 13, was banned from having milk when she was 8. Her friends found it strange, their parents found it bewildering. Sanchita Sharma writes. No kidding: reasons for onset of early puberty

health and fitness Updated: Apr 14, 2013 01:07 IST
Sanchita Sharma
Sanchita Sharma
Hindustan Times
Sanchita Sharma,hormones,oestrogen

Mehak Agarwal, now 13, was banned from having milk when she was 8. Her friends found it strange, their parents found it bewildering. "When other parents were purging soft drinks from their homes, I was getting rid of milk and plastics," says her mum, dermatologist Shehla Agarwal.

What made milk taboo in the Agarwal home were the hormones lacing it, among them oxytocin given to cows and buffaloes to make them produce more milk, and growth hormones given to poultry, goats and dairy animals to add to weight. Since oxytocin mimics the activity of oestrogen, the female sex hormone, it causes girls as young as 8 to show signs of puberty, which in girls involves developing breast, pubic hair and the first period, in that order.

Agarwal's obsessive elimination of all endocrine-disrupters started when Mehak's 9-year-old friend started her periods in Class 3. "Not only was the child not prepared to handle it physically and emotionally, but neither was the school," says Agarwal, whose daughter is now a Class 9 student at DPS Vasant Kunj.

Environmental triggers
Exposure to pesticides and their byproducts -- such as DDE (a breakdown product of DDT) and PCBs (polychlorinated biphenyls) -throws the body's hormonal system out of whack and make children overweight and attain puberty faster. Though DDT is a banned pesticide, it's freely available in India for mosquito control and many dairy farmers rub it on cattle skin to repel mosquitoes. Add to these other hormone-altering chemicals found in the environment -among them Bisphenol A (BPA), used in plastic - and you have girls as young as 8 and boys aged 8 attaining puberty that makes them sexually mature years ahead of their chronological age.

Obesity also plays a role, with the hormone leptin, produced by body fat, signals the brain to begin puberty. "In fertile races like Indians and Africans, the onset of puberty is probably programmed to be early and with improved nutrition, circulating levels of energy-availability markers such as leptin and insulin are high, allowing the puberty to start even earlier," writes VV Khadilkar in the journal, Indian Pediatrics.

While pseudo-oestrogens trigger earlier development in girls, they do not delay sexual maturation in boys, who are hitting puberty - marked by genital changes - at age 10. Just a decade ago, genital changes started between ages 11 and 12, pubic hair growth between 12 and 13, with full sexual maturity at 15 to 16. It's even earlier in over-nutritioned societies. US data from 4,131 boys aged 6-16 years showed boys matured at ages 9 and 10, six months to two years sooner than a decade ago.

The new norm

Nine years, says gynaecologist Dr Tripat Choudhary, has almost become the new normal for onset of menarche (menstrual periods) in urban India. "With better nutrition, lots and lots of girls today start their periods at nine and it should not cause concern. Sure, it raises some health risks, but also increases your reproductive life, along with heart-protective benefits offered by oestrogen," she argues. Girls who get their period after age 13 having a one-third decreased risk for breast cancer compared with those who do at a younger age.

But if signs of puberty start before nine, an evaluation by an endocrinologist is recommended to rule out other risks such as a tumour in a reproductive organ or other physical factors that may have triggered the brain to erroneously produce oestrogen. "Also get your child screeened if she has symptoms including headaches, abdominal pain, and weight loss, or if the growth spurt associated with puberty is missing," says Choudhary.

Agrees Dr Alka Sehgal, associate professor in department of gynecology at Government Medical College and Hospital, Chandigarh: "Now puberty happening at the age of 10 is no more a surprise, a big change from girls hitting puberty around 13 two decades ago."

The only approved treatments are the drugs Gonadotropin-Releasing Hormone, GnRH, and Luteinizing Hormone-Releasing Hormone, LHRH, both given by daily injections or at intervals of every three to four weeks. These drugs freeze hormonal changes responsible for precocious puberty till an appropriate age, currently 11 for girls and 13 for boys. They also help reverse the changes that already have taken place.

Mind the gap
Apart from the breast cancer risk, most of the serious risks are psychosocial. "Now there's a bigger disparity between a child's physical maturation and psychosocial maturation. It's not unusual to meet 11-year-olds in relationships worrying about break-ups. Even if children are developing earlier than in the past, they are not socially and psychologically mature enough to handle it," says Dr Samir Parikh, director, Mental and Behavioural Sciences, Fortis Healthcare.

Easy access to adult content both online and in popular media also plays havoc with already jumping hormones. One of Dr Parikh's patient is Abhay Gupta (name changed), 10, whose father walked in on him watching porn. A glance at his internet history showed the child had been visiting porn sites regularly. "He confessed to watching porn for at least an hour a day because his friends were doing it," says Dr Parikh.

Stress, be it home-life or peer pressure and bullying at school, further accelerates puberty, with studies showing that girls who live with a stepfather are entering puberty earlier than girls who live with their biological fathers.

Apart minimising exposure to obvious triggers, parents need to monitor their children a little more closely to know when to have "the talk." "For protecting them from chemicals and stressors is not enough. Psychologically equipping them to step into the adult world is the best thing you can do for them," says Dr Parikh.

(Inputs from Vishav Bharti and Prateek Walia in Chandigarh)

First Published: Apr 13, 2013 22:17 IST