Every year during the winter and summer holidays, the volume of patients in the outpatient clinic of the Child Growth and Development Center of the hospital increases rapidly, mainly because of unsatisfactory height or abnormal development of children, such as breast development or even menstruation in girls at the age of 6-7 or just 2-3 years old, etc. People call the appearance of breast development in girls before the age of 8, menstruation before the age of 10, and testicular enlargement in boys at the age of 9 as precocious puberty in children. The incidence of precocious puberty in children has increased from 0.5% to 1.3%, and is still rising.
A normal child grows 5-7 cm per year, while a child with precocious puberty, such as a 7-year-old child, can grow 9-10 cm per year, but he may stop growing by the age of 12-14, or even earlier, eventually leading to a short stature in adulthood. Another part of precocious puberty in children may be the clinical manifestation of tumors in the cranial brain, ovaries, adrenal glands, etc., which may endanger the child’s life if not treated in time.
In addition: psychologically, children with precocious puberty feel uncomfortable about their physical changes and often feel that they are different from their peers and have psychological problems such as low self-esteem. At the same time, true precocious puberty can make children have the ability to have children at an early age, which can lead to early love and even social problems such as pregnancy of young girls and sexual crimes of young boys.
How can we tell if a child is sexually precocious?
The age of onset of sexual development in children is significantly earlier, and it is now widely believed that girls who present secondary sexual characteristics before the age of 8 and boys before the age of 9 can be clinically judged as precocious.
What are the adverse effects of precocious puberty on children?
1, the impact on adult height: true precocious puberty regardless of gender, bone age is often significantly more than the actual age, so bone maturity is often too fast and early healing, resulting in “early growth and late growth” will eventually affect the adult height;
2, psychological impact: premature body shape changes, menstruation, ejaculation, etc., due to the difference with peers, the child’s psychological impact, resulting in low self-esteem, helplessness, etc.;
3, due to the young age, especially girls, will not protect themselves, easy to be violated.
4.It eventually leads to early aging (especially obvious in girls).
What are the typical symptoms of precocious puberty in children?
Girls with precocious puberty often first notice breast enlargement and tenderness. With the development of the disease, the breasts further increase in size, vaginal discharge increases, and the affected child also grows pubic hair and axillary hair, and vaginal bleeding symptoms appear, mostly irregular vaginal bleeding at first, gradually transitioning to menstruation. The first sign of precocious puberty in boys is the enlargement of the testicles, followed by the growth and thickening of the penis and erection, and later the growth of pubic hair and beard, voice change, and even sperm emission.
If you have a precocious child, how do you choose to seek medical attention?
Two principles: one is not to blindly seek medical attention, and the other is not to wait.
1, do not blindly seek medical advice, it is best to choose a hospital with a pediatric endocrinology specialty, for children with early development.
(1) Firstly, assess: whether it is precocious;
(2) Secondly, to clarify what causes the early development;
(3) Then the need for intervention is evaluated. The whole process is very complicated. The requirements for hospitals and doctors are very high, and they are not capable of handling general hospitals and doctors.
Therefore, it is equally important to choose a hospital and doctor, and not to seek medical help blindly. 11-year-old Ming Ming, 147 cm, the shortest in his class, had a slow increase in height in the past six months, and had been menstruating for 1.5 years, and after taking a bone age, his bone age was 14 years old (11 years older than his biological age), and when I told him that Ming Ming’s height was not more than 150 cm, the parents shouted: Impossible! The father is 173 cm, the mother is 161 cm, how can the daughter be more than 150 cm? It turned out that the child had menstruation before she was 10 years old and had been to the hospital: the doctor told them: the child is developing early now, no problem! But. Due to blind medical care, the final child short stature do cost.
2, do not wait: folk have a viewpoint, think: children originally have “early growth” “late growth”, some early development does not matter! In fact, this is a misconception: if a child grows too early (early maturity), it will usually lead to a small space for future growth, and eventually adult height is short.
Therefore, when the child is 6-8 years old near puberty, parents must pay special attention, if there are symptoms of early development, must take the child to the doctor, because the golden period of growth and development of children is only a few years, if you miss this best period of treatment, the child may not be able to grow taller, and eventually lead to short stature, short stature on the child’s future life, employment, marriage and other effects are very big, and Premature development may also lead to many psychological problems in children, such as low self-esteem and early love.
If precocious puberty is detected early, the doctor can design a reasonable treatment plan according to the child’s specific situation so that the impact of precocious puberty on the child can be reduced to a minimum.
What are the common clinical examinations in the diagnosis and treatment of precocious puberty?
Tests for precocious puberty include: gonadotropin-releasing hormone stimulation test, bone age check, and
Utero-ovarian adrenal BUS, cranial MRI (all boys with true precocious puberty and girls under 6 years old), others such as liver and kidney function, HCG test, etc. Among them, gonadotropin-releasing hormone stimulation test aims to determine true precocious puberty versus pseudo-precocious puberty. And the significance of predicting bone age means that the present height of the affected child can be used to estimate the final height, guide the medication and observe the efficacy. Therefore, bone age has crucial clinical value in the diagnosis and treatment of precocious puberty in children, and doctors will ask for bone age check regularly during the diagnosis and treatment.
The purpose of precocious puberty treatment.
1.Control and slow down the development of secondary sexual characteristics of the affected children and slow down the rate of maturation.
2. To inhibit the acceleration of bone maturation caused by the increase of steroid sex hormones and to prevent the early healing of the epiphysis and eventual short stature in adulthood.
3.Provide psychological guidance to the child to adapt to the social environment and restore the child’s psychological behavior consistent with his or her actual age.
Common methods of treatment for precocious puberty.
Different etiologies are treated differently. For children with clear idiopathic true precocious puberty, there are two main types of therapeutic drugs at present, one is gynecological tablets, Danazol, etc. The other is the application of the hormone GnRH analogue GnRHa at the hypothalamic level, which competitively inhibits its own secretion of GnRH. Both types of drugs eventually inhibit the development of gonadal tissue due to their ability to reduce the release of FSH and LH. At present, the main clinical use of GnRHa treatment (prescribed by the guidelines for the diagnosis and treatment of precocious puberty) has achieved better results. Commonly used GnRHa: Daphylline, Inhibiton, Dabigat, etc.
What is the duration of treatment with GnRHa for precocious puberty?
Usually more than 1-2 years, foreign reports want to height growth satisfaction, the course of treatment need to reach 4-5 years, when the basic healing of the bone or height has reached family expectations, you can stop the drug follow-up.
What are the side effects of the drug for precocious puberty (GnRHa)?
No significant side effects have been reported, but attention should be paid to allergic reactions caused by the slow-release agent, and regular review of ovaries and uterine BUS for the presence of polycystic ovaries.
What is the effect of the drug (GnRHa) for precocious puberty?
1.Prevent the onset of menstruation;
2.Stopping breast development or disappearance of breast nodules;
3.The biggest advantage is that it can effectively block the bone age (BA) is greater than the actual age (CA), so the BA/CA ratio is large, and its ratio decreases after treatment with GnRHa, so that the CA catches up with the BA, and the final height of the child in the long term follow-up will be higher than the final height predicted by bone age at the beginning of treatment. After treatment with GnRHa, the lifelong height of children can increase by 3.5-6.5 cm according to various reports, with a maximum of 10 cm, so GnRHa is the most ideal drug for the treatment of true precocious puberty at present.
Is physical exercise beneficial to promote height growth in children with short precocious puberty?
In addition to medication for children with precocious puberty, there are other auxiliary methods: such as physical exercise, active physical exercise is a physiological stimulus to promote the secretion of growth hormone, the daily table teenagers in the growth and development stage also need to carry out physical exercise, precocious puberty with short children is particularly important, there are statistics, precocious children using GnRHa treatment process, give a certain amount of exercise, such as jumping rope, adhere to half an hour a day. For example, jumping rope, adhere to half an hour a day than a group of non-skipping rope predicted height significantly higher, but physical exercise emphasizes the need to achieve a de facto exercise load, otherwise it is difficult to work.
In addition, exercise can increase bone mineral density, promote the deposition of calcium and phosphorus in the bone matrix, promote the metabolism of bone. Sports that can promote height growth are swimming, high jump, basketball, badminton, volleyball, etc. In addition, the localized exercise is “touch high jump”, these exercises not only promote the secretion of growth party hormones, and stretch the limbs, promote the growth of epiphyseal chondrocytes, all children who want to grow taller, may wish to try this most simple and All children who want to grow taller may want to try this easiest and economical method with absolutely no side effects.
What issues should parents pay attention to when educating and raising a child with precocious puberty?
Many girls with precocious puberty are found to have abnormal signs in the bath, such as deepening of nipple pigmentation, breast bulge like buds with tenderness, or short pubic hair, etc. Some are found to be late, and some children often do not live with their parents, but are brought up by grandparents or others and are easily overlooked.
Therefore, parents should be concerned about the child’s growth and development, once found should take the child to a specialist hospital for relevant examination, for early diagnosis of premature sexual children, parents should first understand some related medical knowledge, know that the child’s precocious sexual development is just physiological development ahead of time, there is no need to panic, and can tell the child this knowledge and reasoning, to relieve the child’s mind worries, tell him not to be shy, and do not have The first thing you need to do is to get rid of the feeling of inferiority.
For girls who have menstruation, teach them to pay attention to physiological hygiene during menstruation and to know how to protect their breasts, genitals and other parts of the body. When carrying out treatment, tell the children why they need treatment, to increase their confidence in overcoming the disease, and to actively cooperate with the treatment. Parents should pay special attention to not saying in front of their children “What if you can’t grow taller? What if you can’t find a job?” This will increase the child’s psychological burden, making the child’s psychological burden, so that the child produces a depressed inferiority complex, to the treatment brought about by the impact.
Do children with precocious puberty need to follow up with doctors regularly?
Once the signs of precocious puberty are found, the child should immediately go to the hospital to consult a specialist to clarify the cause and diagnosis, and get early treatment. For children with true precocious puberty treated with gonadotropin-releasing hormone analogs, it is necessary to bring the child to the physician for follow-up visits at least once every 3 months, and once a month if possible, to observe under
1.Changes in sexual characteristics: whether breast size and areola pigmentation are reduced in girls, whether testicle size and penis size are reduced in boys, whether menstruation and seminal emission disappear, whether pubic hair and axillary hair, beard and acne are reduced, etc.
2. Height change: At the beginning of treatment with gonadotropin-releasing hormone analog (GnRHa), growth acceleration was controlled, and after six months of treatment, growth was inhibited because the drug inhibited the gland and at the same time may have inhibited the secretion of growth hormone. Doctors should continuously adjust the drug dose according to the height growth of the child, so that the child maintains a height growth of not less than 4 cm per year, generally 4-6 cm, which means that the child maintains a lower level of growth rate before normal pubertal development.
3, laboratory tests: including plasma estradiol, testosterone, FSH, LH testing and uterine and ovarian ultrasound, etc. More importantly, every six months the left whole hand bone age X-ray radiographs to observe whether the bone age maturation is delayed, the most satisfactory effect is that the bone age is half as slow as the actual age growth, that is, half a year to increase 2.5-3 months of bone age, a year to increase 6 months of bone age, so as to achieve the age catch-up, for the growth potential.
4, adverse reactions in treatment: such as fever, headache, local skin allergy behavior. In the treatment of precocious puberty with GnRHa, once the average height growth is found to be less than 3-4 mm/month during the follow-up observation, the dose should be reduced or a combination of growth hormone can be tried.
What is the significance of predicting lifetime height in children with precocious puberty?
The main purpose of predicting lifetime height in children with precocious puberty is to better guide clinical treatment. First of all, before treatment, if the base height is significantly higher than that of children of the same age at the beginning of development, the growth rate of height and the growth rate of bone age are still balanced, or the momentum of sexual maturation is not strong, that is, the process of sexual maturation is slow, and the level of ovarian secretion of estrogen is relatively low, the adult height of these children may not be impaired, and the prediction of height by bone age can indicate that their adult lifetime height is basically normal, so it is not necessary to consider the use of gonadotropin-releasing hormone analogs (Gn). Therefore, treatment with gonadotropin-releasing hormone analogs (GnRHa) may not be considered.
Instead, treatment with GnRHa is required. In the treatment, every six months, the hand and wrist X-ray annual measurement of bone age and height prediction, if with the course of treatment, more than once predicted height growth, suggesting that the treatment effect should continue; if the initial predicted height growth, and later no longer grow or growth is not obvious, there may be two reasons, one is the treatment dose is large, should try to reduce the dose of GnRHa, the second is GnRHa in the gonadal suppression at the same time, the growth axis The second is that GnRHa inhibits the gonads while the growth axis is also involved, so a combination of growth hormone therapy can be tried.
Finally, if the skeletal radiographs suggest that healing is approaching, there is little potential for further growth, and there is little difference between the predicted height and the current height, it is time to stop treatment.
The lifelong height of precocious children to adulthood, for example, using foot length prediction, using parental height as a target height to measure the child’s current height prediction, etc. Now domestic and foreign scholars believe that the most accurate method is to use bone age to predict lifelong height, because human height is directly related to the degree of bone development and maturity, and the early and late healing of epiphysis. The difference between children with precocious puberty and normal children lies in their early development of sexual characteristics and early epiphyseal healing, so it is more accurate and reasonable to predict their lifelong height by bone age, while other methods have more errors.
The B-P method uses the standard atlas method, which is based on a series of skeletal maturation x-rays of the hand and wrist, and each atlas yields the corresponding bone age. The TW2 method is based on the different levels of maturity of round bones and long bones in the wrist X-ray, and the bone age reading is found from the table. For children with precocious puberty, the bone age must be determined by taking X-rays every year to predict height, so that the effect of treatment can be observed and the next step of treatment can be guided.
What are the conditions under which the height of a child with precocious puberty will be impaired?
The final height loss of a child with precocious puberty depends mainly on the following conditions.
①Basic height at the beginning of development.
(2) The rate of maturation (which can reflect the rate of bone age growth).
③The rate of height falloff.
The balance between bone maturity and height growth (if bone maturity is faster than height growth, it affects lifelong height). On the contrary, those with slow sexual maturation and relatively low gonadal secretion of sex hormone levels may not be impaired or slightly impaired in adult height. In addition, hereditary growth potential has an impact on the lifetime height of children with central precocious puberty.
Does a girl’s height stop growing after menarche?
Once a girl reaches menarche, parents come to the hospital with great concern, “Is it possible that the child will not grow any taller?” If parents find that their child’s breasts are enlarged and secondary sexual characteristics appear, they will rush to the hospital and ask the doctor to prescribe some medicine, hoping to inhibit the child’s development, or at least slow it down a bit and delay the menarche as much as possible, with the ultimate goal of making the child grow taller.
We say that these parents’ ideas are not unreasonable, because the onset of menarche means that the child’s height acceleration period has passed, but height is still growing slowly, after 2-3 years, and height growth has stopped after development has stopped, with an average growth of 5-7 cm. Sexual development and physical development during puberty are parallel, and menarche is an important sign of the development of sexual function, which occurs in the middle of puberty, after the growth spurt and the full development of secondary sexual characteristics, so people often use menarche as a sign to observe changes in height and weight.
One year to one and a half years before menarche, height and weight increase sharply, when menarche comes, height and weight increase are already in the deceleration period, the amount of height growth after menarche varies with the early and late age of menarche, according to the results of the tracking observation of normal girls in Shanghai in 1985, the average height of each age group with early menarche was lower at that time, and the amount of growth after menarche (about 8 cm); while the average height of each age group with late menarche, the average height of growth after menarche was less (about 2 cm). It is believed that height at menarche is closely related to adult lifetime height, which corresponds to 95% of lifetime height, and can be used for height prediction.
Some statistics show that the bone age of girls at menarche is equivalent to 13.5-14 years old, so to know how much your child can grow after menarche, you can ask an experienced specialist to predict by bone age.
In conclusion: children’s development and height are closely related, parents who are very concerned about their children’s height should be mindful and take their children to a regular hospital for the appropriate assessment once they find that their children have a tendency to develop (especially girls under 8 years old and males under 9 years old, who show signs of development)! Timely detection of problems, timely solutions to ensure that the child has an ideal height in the future!