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Premature Puberty

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: My daughter is only seven years and three months old and already she has underarm hair and pubic hair and her breasts are starting to develop. She is very tall for her age (4'5"). Does it mean that she may have her period next year? It really worries me because she will not have time to enjoy her childhood, and also she may not grow tall enough. I have heard that after their first period, kids will not grow more than a few inches.

A: While it is true that girls start to show signs of puberty earlier than in the past, the changes you describe for your daughter seem too early. I recommend that you take her to her physician to have this evaluated further.

There are certainly some girls who have unusually early breast development (premature thelarche) or premature development of underarm and pubic hair (premature adrenarche). Most girls who have either of these are healthy, and they don t continue on through the other stages of puberty until they reach the appropriate age (most girls start their periods within a year of when their mother started). There is a medical problem called 'precocious puberty', however, and girls who have this will have early breast and pubic hair development, and continue on very rapidly to having periods. They also will have the growth spurt that is typically associated with puberty. Since you have described all three of these changes, I think it is important to have your daughter evaluated to make sure she does not have precocious puberty.

There are a number of causes of precocious puberty, most of which are quite treatable. It would be helpful, particularly for psychological reasons, to prevent a girl from starting her periods at seven or eight years of age. Also, as you suggested, growth in height slows down significantly once a girl starts her period. A girl who started her period at seven or eight would likely end up extremely short.

If your daughter is overweight, it may be that she does not truly have breast development, but just excess fat tissue. Her doctor can help to sort this out by examining her. If there is any concern about early pubertal development, there are blood and xray tests that can help to clarify whether her development is abnormal.

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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.

Please note: This "Expert Advice" area of should be used for general information purposes only. Advice given here is not intended to provide a basis for action in particular circumstances without consideration by a competent professional. Before using this Expert Advice area, please review our General and Medical Disclaimers.


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