Pubertal Disorders in Children

Puberty, the process of physical maturation, varies in timing among children.

Girls typically begin puberty between eight and 13 years, while boys start between nine and 15 years. Pubertal disorders can manifest as either precocious (early) or delayed puberty.

Early puberty can lead to children maturing and stopping growth earlier than peers, potentially resulting in a shorter adult height. It may also pose emotional and social challenges.

Delayed puberty is often a natural variation, where a child is a 'late bloomer', and does not usually require treatment. These children will progress normally through puberty once it begins.

Puberty is initiated by the hypothalamus, which releases Gonadotropin-Releasing Hormone (GnRH). GnRH stimulates the pituitary gland to release luteinising hormone (LH) and follicle-stimulating hormone (FSH), leading to sex steroid production (oestrogen in females, testosterone in males) and the physical changes of puberty.

Precocious (Early) Puberty

More common in girls, early puberty can be categorised into:

• Central Precocious Puberty (CPP): Triggered by early hypothalamic GnRH release
• Peripheral Precocious Puberty (PPP): Caused by early sex steroids production from ovaries, testicles or adrenal glands

Delayed Puberty

More frequently seen in boys, delayed puberty often reflects familial growth patterns. However, chronic illnesses like diabetes, heart disease or kidney disease can also delay puberty. Appropriate management of these conditions may mitigate delayed puberty risks.

Physical changes during puberty include:

• Development of secondary sexual characteristics, such as pubic and underarm, breast development in girls, and growth of the penis and testicles in boys
• A growth spurt leading a rapid increase in height
• Changes in body shape and size

Early puberty is characterised by the onset of secondary sexual characteristics before age nine in boys and before age eight in girls. Delayed puberty is characterised by the absence of testicular enlargement in boys by age 14 and the absence of breast development in girls by age 13.

Girls experience breast development and menstrual periods, while boys undergo testicular and penile enlargement, facial hair growth and voice deepening during puberty.

​Precocious (Early) Puberty

Diagnostic tests may include a GnRH stimulation test for hormone levels and a hand X-ray to assess bones maturation.

CPP can be treated with medication to halt pubertal progression. Treatment for PPP varies depending on the cause and may involve medication or surgery, such as in the case of a tumour.

Delayed Puberty

Treatment depends on the underlying cause. Healthy late bloomers typically require reassurance and close monitoring. Hormone replacement therapy with testosterone or oestrogen may be indicated in select cases.

• Begin discussions about puberty around age 8, or earlier if signs of early puberty are present.
• It's crucial to prepare your child, especially girls, for bodily changes and menstruation to alleviate fear or trauma.

Continued clinical research is essential for advancing paediatric healthcare. Our doctors are committed to contributing to the future of child health and medicine through both clinical practice and research.

1. Lim YY, Chan RM, Loke KY, Ho CW, Lee YS (2014). Familial male-limited precocious puberty in neurofibromatosis type I. European Journal of Pediatrics, 173(2):219-22. doi: 10.1007/s00431-013-2141-1