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Puberty for Parents: What to Expect and What to Watch Out For
Dr. Melissa Carlucci discusses puberty, and signs as a parent one should watch out for.
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Learn more about Melissa Carlucci, MD
Melissa Carlucci, MD
Melissa Carlucci, MD, is a pediatric endocrinologist with WakeMed Physician Practices – Pediatric Endocrinology. Dr. Carlucci earned her medical degree from the Medical College of Georgia, and she completed a pediatrics residency and a pediatric endocrinology fellowship at the Medical University of South Carolina Children’s Hospital. She received a bachelor’s of science and graduated Magna Cum Laude from the University of Georgia.Learn more about Melissa Carlucci, MD
Transcription:
Puberty for Parents: What to Expect and What to Watch Out For
Alyne Ellis (Host): Puberty can be a stressful time for parents and budding teenagers. Hormones are racing and somehow change is brewing, as children begin the touchy process of questioning who they are and how their bodies are changing. But when a child seems to be slow to enter this new physical state, then everyone is really stressed. Here to walk us through the stages of puberty and what can be done if these milestones aren't forthcoming or they come too soon is Dr. Melissa Carlucci, a Pediatric Endocrinologist with WakeMed Children's. This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.
I'm your host Alyne Ellis. Welcome Dr. Carlucci. Let's begin with, what are the signs when a child is entering puberty?
Melissa Carlucci, MD (Guest): Well, it depends upon whether they're a boy or a girl. For girls, you can see breast development, you can see pubic hair development, underarm odor, or underarm hair. For boys, typically you'll see underarm odor or hair, pubic hair, and an enlargement of the penis and testicles.
Host: And are there some emotional signs as well to watch for?
Dr. Carlucci: That's a good question. Anecdotally, yes, you can see some more emotional lability and more emotional issues, but there's no really good studies on that to prove that yes, if a child goes into early puberty, then they have the psychological issues, as well as the physical.
Host: So, by what age should a parent be concerned about the absence of these signs of puberty?
Dr. Carlucci: Well, according to the Pediatric Endocrine Society Guidelines, puberty is considered early, if it starts before eight in girls, nine in boys. And if menses or menstrual cycles start before 10.
Host: So, when is it too late to see these things begin? I mean, like if a child is 12 or 13, you're not seeing these signs, should we be worried?
Dr. Carlucci: Well for delayed puberty, if a girl has not had a cycle by age 16 or boys who have not started any pubertal development by age 15, then we would undertake an evaluation.
Host: So, what should parents do if they suspect their child has experienced either an absence of puberty or they're, it's really delayed?
Dr. Carlucci: The first thing I would do is see their pediatrician so they can be examined. If the pediatrician agrees with the assessment, they will refer them to us. We will take a history. We will physically examine them and decide if further blood work or x-rays or any other studies are needed.
Host: And why would this possibly be happening?
Dr. Carlucci: That's a very good question. Typically, in the vast majority of cases, there is no known cause, it's idiopathic, meaning we don't know. But there are some minor normal variants of puberty that we have seen such as early adrenal gland activation, which is called premature adrenarche or early breast development, which is premature thelarche. Premature thelarche, anecdotally could be linked to estrogen containing substances in food, other estrogens that the body may be exposed to. Specifically soy, lavender oil, tea tree oil. Premature adrenarche, one of the things that we see is are seeing that a lot in girls that have obesity, for some reason, that is causing the adrenal gland to turn on early. So, both of those are benign variants of puberty. They do not predispose to true early puberty. And the reason we are concerned about true early puberty, is if you go through puberty too early, usually it also is too fast and you end up stopping growth too soon. So, most of these children end up being tall as children stopping growing years before they're supposed to and are short as adults.
Host: And what about if it's just delayed in general on the signs,
Dr. Carlucci: Okay. It depends, especially with boys, they can be late bloomers. We call that constitutional delay. In that case, they will get there to where they're supposed to be, it just takes longer. Sometimes puberty is truly delayed because of an issue with the ovary or testicle or the pituitary gland. And part of the complicating factors of that is trying to determine which is which.
Host: So, what can be done medically to support this transition into puberty?
Dr. Carlucci: Well for puberty that is too early, if it truly is central puberty, we can use what's called a GNRH agonist. The hypothalamus, which is the controller gland of the pituitary produces a hormone called GNRH, which is gonadotropin releasing hormone. It is what stimulates the pituitary to make FSH and LH or follicle stimulating hormone and luteinizing hormone. Those are the hormones that act on the ovary or testicle to stimulate puberty. If we give GNRH in a constant manner, that disrupts the signal of FSH and LH to the ovary or testicle, thus basically freezing time and stopping pubertal development.
Host: And what about if someone is too late in entering puberty?
Dr. Carlucci: We can usually that's seen in boys, we can use a short course of low dose testosterone injections. They're given intramuscularly every month and we typically do a six month course to see if we can jumpstart things. Usually we can give three courses of that. And if we still haven't started puberty by then, it starts to look more like the pituitary gland is not sending the correct signal to the testicle.
Host: Is this a common problem for children to either begin or start too late into this period?
Dr. Carlucci: In general, it's becoming more common. Studies have found that the age of puberty, of pubertal start has definitely gotten lower. It's definitely happening earlier. But the age of menarche or the first period has stayed the same. The classic training is that once you, for girls, once you start breast development, you have about two years before you get your period. That is no longer the case. So, the length of puberty has also gotten longer because the start of puberty has become earlier. Why that is, we don't know. Anecdotally it, there could be hormones in food exposure to other sources of hormones, but there's again, no good scientific evidence to look at that.
Host: Is there anything else you'd like to add?
Dr. Carlucci: Puberty issues are definitely psychologically stressing to the child and to the parents. So, we're happy to help out and see both early and delayed puberty in both boys and girls and help out any way we can.
Host: And any advice to parents or kids going through this period?
Dr. Carlucci: Talk with your parents, talk with your doctor and no question is a stupid question. If it crosses your mind, ask.
Host: Well, thank you very much for this helpful information. I'm sure for people who are worried about the signs they are seeing, or not seeing it's extremely helpful.
Dr. Carlucci: Thank you. Thank you for having me.
Host: Dr. Melissa Carlucci is a Pediatric Endocrinologist with WakeMed Children's. To learn more about WakeMed's Pediatric Endocrinology services, please visit wakemed.org. I'm Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thank you for listening.
Puberty for Parents: What to Expect and What to Watch Out For
Alyne Ellis (Host): Puberty can be a stressful time for parents and budding teenagers. Hormones are racing and somehow change is brewing, as children begin the touchy process of questioning who they are and how their bodies are changing. But when a child seems to be slow to enter this new physical state, then everyone is really stressed. Here to walk us through the stages of puberty and what can be done if these milestones aren't forthcoming or they come too soon is Dr. Melissa Carlucci, a Pediatric Endocrinologist with WakeMed Children's. This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina.
I'm your host Alyne Ellis. Welcome Dr. Carlucci. Let's begin with, what are the signs when a child is entering puberty?
Melissa Carlucci, MD (Guest): Well, it depends upon whether they're a boy or a girl. For girls, you can see breast development, you can see pubic hair development, underarm odor, or underarm hair. For boys, typically you'll see underarm odor or hair, pubic hair, and an enlargement of the penis and testicles.
Host: And are there some emotional signs as well to watch for?
Dr. Carlucci: That's a good question. Anecdotally, yes, you can see some more emotional lability and more emotional issues, but there's no really good studies on that to prove that yes, if a child goes into early puberty, then they have the psychological issues, as well as the physical.
Host: So, by what age should a parent be concerned about the absence of these signs of puberty?
Dr. Carlucci: Well, according to the Pediatric Endocrine Society Guidelines, puberty is considered early, if it starts before eight in girls, nine in boys. And if menses or menstrual cycles start before 10.
Host: So, when is it too late to see these things begin? I mean, like if a child is 12 or 13, you're not seeing these signs, should we be worried?
Dr. Carlucci: Well for delayed puberty, if a girl has not had a cycle by age 16 or boys who have not started any pubertal development by age 15, then we would undertake an evaluation.
Host: So, what should parents do if they suspect their child has experienced either an absence of puberty or they're, it's really delayed?
Dr. Carlucci: The first thing I would do is see their pediatrician so they can be examined. If the pediatrician agrees with the assessment, they will refer them to us. We will take a history. We will physically examine them and decide if further blood work or x-rays or any other studies are needed.
Host: And why would this possibly be happening?
Dr. Carlucci: That's a very good question. Typically, in the vast majority of cases, there is no known cause, it's idiopathic, meaning we don't know. But there are some minor normal variants of puberty that we have seen such as early adrenal gland activation, which is called premature adrenarche or early breast development, which is premature thelarche. Premature thelarche, anecdotally could be linked to estrogen containing substances in food, other estrogens that the body may be exposed to. Specifically soy, lavender oil, tea tree oil. Premature adrenarche, one of the things that we see is are seeing that a lot in girls that have obesity, for some reason, that is causing the adrenal gland to turn on early. So, both of those are benign variants of puberty. They do not predispose to true early puberty. And the reason we are concerned about true early puberty, is if you go through puberty too early, usually it also is too fast and you end up stopping growth too soon. So, most of these children end up being tall as children stopping growing years before they're supposed to and are short as adults.
Host: And what about if it's just delayed in general on the signs,
Dr. Carlucci: Okay. It depends, especially with boys, they can be late bloomers. We call that constitutional delay. In that case, they will get there to where they're supposed to be, it just takes longer. Sometimes puberty is truly delayed because of an issue with the ovary or testicle or the pituitary gland. And part of the complicating factors of that is trying to determine which is which.
Host: So, what can be done medically to support this transition into puberty?
Dr. Carlucci: Well for puberty that is too early, if it truly is central puberty, we can use what's called a GNRH agonist. The hypothalamus, which is the controller gland of the pituitary produces a hormone called GNRH, which is gonadotropin releasing hormone. It is what stimulates the pituitary to make FSH and LH or follicle stimulating hormone and luteinizing hormone. Those are the hormones that act on the ovary or testicle to stimulate puberty. If we give GNRH in a constant manner, that disrupts the signal of FSH and LH to the ovary or testicle, thus basically freezing time and stopping pubertal development.
Host: And what about if someone is too late in entering puberty?
Dr. Carlucci: We can usually that's seen in boys, we can use a short course of low dose testosterone injections. They're given intramuscularly every month and we typically do a six month course to see if we can jumpstart things. Usually we can give three courses of that. And if we still haven't started puberty by then, it starts to look more like the pituitary gland is not sending the correct signal to the testicle.
Host: Is this a common problem for children to either begin or start too late into this period?
Dr. Carlucci: In general, it's becoming more common. Studies have found that the age of puberty, of pubertal start has definitely gotten lower. It's definitely happening earlier. But the age of menarche or the first period has stayed the same. The classic training is that once you, for girls, once you start breast development, you have about two years before you get your period. That is no longer the case. So, the length of puberty has also gotten longer because the start of puberty has become earlier. Why that is, we don't know. Anecdotally it, there could be hormones in food exposure to other sources of hormones, but there's again, no good scientific evidence to look at that.
Host: Is there anything else you'd like to add?
Dr. Carlucci: Puberty issues are definitely psychologically stressing to the child and to the parents. So, we're happy to help out and see both early and delayed puberty in both boys and girls and help out any way we can.
Host: And any advice to parents or kids going through this period?
Dr. Carlucci: Talk with your parents, talk with your doctor and no question is a stupid question. If it crosses your mind, ask.
Host: Well, thank you very much for this helpful information. I'm sure for people who are worried about the signs they are seeing, or not seeing it's extremely helpful.
Dr. Carlucci: Thank you. Thank you for having me.
Host: Dr. Melissa Carlucci is a Pediatric Endocrinologist with WakeMed Children's. To learn more about WakeMed's Pediatric Endocrinology services, please visit wakemed.org. I'm Alyne Ellis with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thank you for listening.