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Breast Buds in Toddlers
Q: My two-year-old daughter has a small breast bud developing on her right side. Is this normal, and do you have any websites or documentation about precocious puberty in toddlers? I have found some things on children in the seven-to-eight year old range, but nothing in toddlers. Please help.
A: The problem that you are describing is actually not uncommon in young girls, and it does not mean that puberty is occurring early (precocious puberty). When a small amount of breast development occurs without the rest of puberty progressing, it is called premature thelarche (Thelarche is the medical term for the onset of breast development). This typically happens in toddlers, usually by age two, though it can occur in preschool-aged children as well. It can occur on just one or both sides.
The cause is not entirely clear but in some girls there seems to be a slight increase in estrogen production for a short period of time. The estrogen is what causes the breast to sprout. In the vast majority of girls who have this, the breast bud will shrink down again over a period of several months, or if it doesn't become smaller, at least it won't continue to enlarge. The other pubertal changes (rapid growth, pubic hair) do not occur.
When I see girls with premature thelarche, I make sure I do a thorough physical examination, looking for anything that would suggest a more serious hormonal problem. If the rest of the exam is normal, then there is no need for any specific tests. It is recommended that the breast changes be monitored closely for several months, meaning monthly or bimonthly visits to the doctor to see if it goes away or continues to progress. If there are abnormalities on the physical exam, or if the breast development continues, then blood tests, x-rays, or an ultrasound of the pelvis may be indicated. Precocious puberty can occur in this age group, but it is very rare.
I recommend that you make an appointment to see your daughter's physician to have this examined. In some children, particularly very chubby children, it may look as though there are breasts, but it turns out to be just excess fat. Your physician should be able to sort this out and determine if anything further needs to be done.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.