By Dr. Catherine Gant

Puberty describes a collection of physical and emotional changes a child experiences as he or she makes the transition into adulthood. All ages given below are averages and are for guidance only. The actual age at which each child achieves each stage will depend on familial factors and the height and weight of the child. There is a huge variation in the normal population in ages at which various stages of puberty are gained.

Obese children tend to be a bit taller and enter puberty earlier. Slim small children often have a later puberty.

Puberty can be delayed by illness, weight loss, and excessive exercise. If the parents both had a late or early puberty then the child often does as well.

If you have any concerns about your child please contact your GP, they have a lot of experience and early consultations can relieve anxiety and allow any potential problems to be picked up and treated.

Growth starts with the hands and feet, then the limbs and finally the trunk. Weight is gained a few months afterwards so the pubertal child often looks gangly.

GIRLS

• Breast buds develop at 8 to 13 – often asymmetrically initially.
• Menstruation starts 2 to 2 Ѕ years later when the girl is growing fastest.
• Pubic hair appears at an average age of 11 Ѕ.
• First periods are often irregular and painful and heavy, this should settle down with time.
• 90% of girls have menstruated by age 13.
• Growth spurts start at an average of 11 Ѕ and growth stops at around 16. Weight gain follows after the increase in height.

BOYS

• Testicular enlargement starts at around 9 Ѕ. The penis, scrotum and testicles all gradually increase in size. The left testicle usually hangs lower than the right.
• Boys often get mild breast swelling during puberty. If less than 4 cm across it usually disappears spontaneously. If the boy is overweight diet and exercise can help reduce this embarrassing sign.
• At 12 to 13 the testicles enlarge and the penis lengthens.
• At 14, the penis broadens.
• Pubic hair first appears at 12 Ѕ.
• The growth spurt starts at 13 Ѕ and growth stops at 18.

PRECOCIOUS PUBERTY

This is more common in girls. Girls who are tall and with a bigger than average weight for their age often enter puberty early. They often have an advanced bone age and precocious puberty may run in the family. This is called constitutional precocious puberty. The age of puberty is getting lower in the Western world probably because of better nutrition.

Isolated breast development may occur in very young girls. This is quite common and can be normal.

Precocious puberty may also be caused by brain disorders affecting hormone production, ovarian cysts and other gonadal masses, previous radiation and genetic factors.

DELAYED PUBERTY

Less than 3% of girls have no breast development by age 13 years. Less than 3% of boys have a testicular volume less than 4 ml at age 14 years.

Delayed puberty is usually constitutional and is commoner in children with a delayed weight height and bone age. There is often a family history of delayed puberty.

Excessive exercise and poor nutrition (as in anorexia) also cause delayed puberty. Other causes include abnormal hormone production, brain disorders, genetic syndromes, and defective gonads.

SOCIAL

Adolescents need guidance about AIDS and sexually transmitted diseases. A lot of adolescents do not use contraception during their first sexual encounter and the rate of teenage pregnancy is rising. Other issues that the adolescent will need to cope with are alcohol, drugs and developing sexual relationships. It is important that the adolescent has a responsible adult to talk to about these issues, not necessarily the parents. Canny parents will foster these friendships in late childhood and early adolescence on their children’s behalf, so that there is always someone to talk problems through with.

Read this interesting article from the independent newspaper about why girls are entering puberty earlier in the Independent.