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Your child’s primary physician can assess for early pubertal changes. An endocrinologist can consider the need for testing and explain the reason for early puberty.
Early (Precocious) Puberty
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The regulation of puberty involves hormone production in the brain that then stimulates the ovaries and testes. Changes in brain regulation can start this process earlier in some children with SNI. Puberty is considered early if pubertal features appear before eight years in girls and nine years in boys. Pubertal features include underarm and pubic hair, body odor, acne, deepening of the voice, breast development and growth of testes. “Early” puberty is called precocious puberty.
ESP Puberty is triggered in the brain when the hypothalamus releases a hormone to the pituitary gland. This in turn tells the body to begin producing estrogen in girls and testosterone in boys. Some children with SNI have earlier changes in the area of the brain that regulates the start of puberty.
Whether puberty is early or not, it creates new care needs and considerations. Puberty will result in normal male responses, including production of body hair, erections during the day and ejaculation during sleep (referred to as nocturnal emissions or wet dreams). For girls, the onset of puberty will bring body hair, menstruation and breast development. Sexual behaviors in both boys and girls, such as masturbation and touching genitals (private parts), can become a concern for parents, depending on the intellectual and motor ability of the child.
The growth spurts that come with puberty may be concerning for you. A larger child will be more difficult to move and manage, and may put physical strain on caregivers. Many of the same issues that come with trying to prevent bone fractures also apply to your child’s growth. A physical therapist can suggest safe ways to change clothes, diapers and menstrual pads. As your child grows, you can ask about equipment options like patient lifts (e.g., Hoyer Lift) for the home, though this may not work for all homes.
Some problems can worsen during puberty, including seizures, chronic pain due to changes in the nervous system, and general agitation or difficult behaviors. Medications that your child previously tolerated or that effectively treated other problems may be reconsidered or adjusted during puberty. The medical team might also suggest adding a medication to address any mood or behavior changes. They might also offer the option of slowing puberty with medication.
ESP Early puberty can be challenging, as you have to prepare much earlier than you likely expected for the physical and emotional changes that are occurring in your child. You may have concerns about how the hormonal changes could affect your child’s behaviors, growth or sleep. Given that puberty represents the entry to adulthood, your child’s early puberty may also remind you of developmental milestones that will likely not be achieved. This may trigger emotions such as sadness, anger, worry and grief. They are new aspects of the anticipatory grief you likely experienced at diagnosis.
Early puberty often means bone growth ends sooner and that your child will be smaller than most typical children. This knowledge may bring you some relief, especially if you have been concerned about how you will care for your adult-sized child. However, this knowledge may also cause you sadness, as your child may not reach the same height of other children or adolescents.
You may also wonder about the practical matters that come with puberty, like shaving and managing menstruation. Share your feelings with your child’s team. They will suggest strategies for coping with both the emotions and these new responsibilities.
Some families find that all of this change is too disruptive and difficult to manage at home, especially as it affects other members of the household. Enrolling your child in a daycare program, or placement in a residential setting, is an option you may wish to consider. A social worker or advocate can help you explore the options in your community.