Pediatric and Adolescent Puberty Problems

Pediatric and Adolescent Puberty Problems



Puberty begins when your daughter’s body begins producing increased amounts of certain hormones, leading to physical and emotional changes. In girls, changes include breast development, pubic hair growth, a growth spurt, and finally the start of menstrual periods. Girls grow and develop at different rates, and the normal onset of puberty is sometime between the ages of 10 and 13.

Expanded Overview

Puberty problems occur when these processes and changes don’t occur at the typical time in your daughter’s development. These problems may include:

  • Delayed puberty, in which breast and pubic hair development hasn’t started by age 13
  • Precocious puberty, which begins too early – before age 7 or 8 in girls
  • Contrasexual pubertal development, in which females develop male characteristics
  • Premature thelarche, when a girl experiences breast development without other signs of puberty
  • Premature adrenarche, when pubic hair appears without any other signs of puberty

Puberty problems can have a variety of causes, including:

  • Heredity
  • Genetic disorders
  • Problems with the pituitary or thyroid glands and the hormones they produce
  • Eating disorders or excessive dieting/weight loss
  • Excessive exercise
  • Chemotherapy and/or radiation
  • Ovarian tumors and removal of the ovaries
  • Other underlying medical conditions or injuries


If your daughter is experiencing puberty problems, her symptoms may include:

  • Lack of breast development by age 13
  • Lack of pubic hair by age 14
  • More than 5 years between breast development and first period
  • Delayed period that hasn’t started by age 15
  • Breast growth, period, pubic hair, and other signs of puberty occurring before age 7 or 8

Tests and Diagnosis

If your child’s doctor suspects problems with your daughter’s puberty development, he or she will conduct a physical exam – including breast and pelvic exams, when necessary – and take a complete medical history.

The doctor may also order diagnostic tests, including:

  • An X-ray of the hand and wrist to determine bone age
  • Blood tests to measure hormone levels or check for chromosomal abnormalities
  • An MRI or CT scan to rule out abnormalities in the brain, pituitary gland, or adrenal glands
  • An ultrasound to examine your daughter’s ovaries 


If your daughter’s doctor discovers a problem with the onset or progression of her puberty, her treatment will depend on symptoms and the underlying cause of the problems.

Treatment may include:

  • Observation through regular check-ups
  • Hormone therapy
  • Surgery to correct anatomical issues
  • Counseling to help your daughter – and your family – deal with the social and emotional challenges of delayed or early puberty


What are some possible puberty problems?

Some girls experience delayed puberty, precocious (early) puberty, breast development without other signs of puberty, or the development of male characteristics.

What causes these issues?

Puberty problems cam stem from a variety of causes, including heredity, genetic disorders, problems with the pituitary or thyroid glands and the hormones they produce, eating disorders or excessive dieting/weight loss, excessive exercise, chemotherapy and/or radiation, ovarian tumors, or other underlying medical conditions or injuries.

How will my daughter’s puberty problems be treated?

If your doctor suspects your daughter’s puberty issues will resolve on their own, he or she will observe your daughter through regular check-ups. Other treatment may include hormone therapy, surgery for anatomical corrections, and counseling for related social and emotional issues.


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