Puberty is a difficult time for most young people, causing confusing changes to appearance, hormones and feelings. Starting puberty early can make this time harder to deal with, and for young people with learning challenges, it can be very hard indeed.
As well as the difficulties of mood swings and coping with periods at a young age, children also have to cope with having physical changes, such as breast development or body hair, ahead of their classmates. They may also start to show sexualised behaviour, which might be difficult for the child and others to understand and deal with.
Early puberty results in short stature in adulthood too, as we stop growing once puberty has ended, so the younger (and shorter) we are when puberty begins, the shorter we will be as adults. Most girls with bladder problems find these are much worse, with more leakage, around the time of their period, as the hormones relax the pelvic floor, crucial for keeping the bladder neck closed.
Having the first signs of puberty before ten years for boys or nine years for girls is known as Early Puberty, while under the age of nine for boys or eight for girls, is classified as Precocious Puberty.
Early / precocious puberty is common amongst children with hydrocephalus, and spina bifida with hydrocephalus. The most up to date research found that for children with shunts (but without spina bifida) puberty started early or very early in around three quarters of girls, and two thirds of boys. For children with spina bifida, around half of girls and a third of boys experienced early puberty.
Adrenarche is a normal part of development, which happens when the adrenal glands mature. It occurs before puberty, usually between the ages of six and eight. The glands begin to produce hormones which can cause pubic and other body hair to begin to grow in some children, cause mood swings or tearfulness, and change the smell of sweat to produce ‘body odour’.
The first signs of puberty, include development of breast buds or breast tenderness in girls, and enlargement of the testes, and reddening of the scrotum in boys. It is these changes, rather than the changes associated with adrenarche, that signal the beginning of puberty.
At the moment, we are not too sure exactly how, because we don’t understand fully how puberty is controlled in typically developing children.
The organ responsible for coordinating puberty, and all our hormones which control reproduction, the pituitary gland, is found at the base of the brain, just below the third ventricle. It is thought that increases in pressure in this area, either before shunting, or during shunt malfunction, can change the pituitary, and bring about early puberty.
Early puberty is also seen in children without shunts but with endoscopic third ventriculostomies, which would support this theory.
Timing can be difficult - by the time parents spot the earliest physical changes, puberty is underway. However, the growth spurt that heralds puberty usually begins around six months before puberty begins, so spotting this can provide a bit of time to arrange to see your paediatrician or get a referral to an endocrinologist (a doctor specialising in hormones) to see if puberty could, or should, be delayed.
It is possible to delay precocious puberty for a few years, by giving a hormone similar to the one which kick starts puberty. This blocks the action of the body’s natural hormone, and allows the child to mature and grow as usual, so that when puberty is allowed to begin, the child is better able to cope with the changes.
It may not always be possible or desirable to delay puberty, but getting an opinion could be helpful. So measure your child’s height every few months or if you think growth is especially rapid. You can measure arm span if it is difficult to measure height accurately, and ask for a referral if your child is very young and you think they are about to enter puberty.