Friday, July 11, 2014
Inquirer Daily News

Puberty: Early, late or right on time?

Puberty, the life-stage when girls and boys grow in their height, weight and sexual characteristics, is one of the most amazing events that the human body goes through. But how do you know things are progressing appropriately?

Puberty: Early, late or right on time?

Teenagers need to go to their doctors at least once a year so that, amongst other things, their doctors can measure all the things that are changing rapidly. (AP Photo/Mike Wintroath)
Teenagers need to go to their doctors at least once a year so that, amongst other things, their doctors can measure all the things that are changing rapidly. (AP Photo/Mike Wintroath)

One of my patients is unhappy with the timing of her puberty. She is a 12-year-old girl who recently got her first menstrual period. She is feeling overwhelmed because she sometimes has them more than once a month.     

Another one of my patients is also unhappy with the timing of her puberty. She is a 14-year-old girl who feels as though every other girl in the world has gotten her menstrual period except for her.  

Both of these girls are experiencing perfectly normal puberty, the life-stage when girls and boys grow in their height, weight and sexual characteristics. Puberty is the most awe-inspiring, magnificent, well-orchestrated sequence of events that the human body goes through (sorry, but I am an adolescent medicine doctor!). These biological changes result from increases in estrogen in girls (from the ovaries), increases in testosterone in boys (from the testicles), and changes in other hormones, as well. 

What are the usual signs and stages of puberty?

In girls:

  • First, breast buds begin to develop 
  • Pubic hair starts
  • Height spurt (earlier in girls than in boys, which is why many 12-year-old girls tower over boys their own age!)
  • Weight spurt
  • Menstrual periods start

In boys:

  • First, testicles start to grow
  • Pubic hair starts
  • Height spurt and weight spurt
  • Strength spurt

What’s the “normal” age for starting puberty? In fact, there is a lot of variation in the timing of puberty. A child’s development follows his or her own “biological clock.” I could see differences between my own two sons: my younger son was taller at age 14 than my older son was at that age. Pediatricians check a girl for the onset of breast buds and measure a boy’s testicular size to determine if puberty has started. Throughout puberty, we continue to measure further breast stages, testicular volume, amount of hair and its distribution, centimeters of growth per year … you name it, we measure it! 

  • Most girls start puberty between the ages of 9 and 12. The first sign of puberty in girls is usually the development of breast buds.  After a few years (average age 12½) her menstrual periods will start. 
  • Most boys start puberty between the ages of 10 and 13. The first sign of puberty in boys is usually growth in the volume of the testicles.

When is puberty too early (also called precocious puberty)? Although many kids start puberty at about the same age as their mothers did, some moms tell me that their daughters seem to be starting puberty earlier. Although there is evidence that some girls are developing breast buds as early as age 7, the average age of the first menstrual period has not changed for about 50 years. Usually, physicians consider the possibility of precocious puberty when there are breast buds in a girl younger than age 8, and testicular growth in a boy younger than age 9. Other research also suggests that girls who are overweight tend to start puberty early.  

When is puberty too late (delayed)? Usually, physicians suspect delayed puberty when there are no breast buds in a girl by age 13, and no testicular growth in a boy by age 14. Boys who are overweight tend to start puberty later, according to recent research.

My advice:

  1. As a parent, prepare yourself for puberty’s arrival. The changes of puberty happen fast and furious so make sure to keep your refrigerator stocked.
  2. Although there is a lot of variation in the timing of puberty, it is important for the sequence of events to happen in order. If an event occurs too early, too late, or stalls, it may be a sign of a medical problem. One of the reasons that teenagers need to go to their doctors at least once a year is so that their doctors can measure all the things that they measure. 
  3. When talking with our teenagers, it is also important to remember that their emotional and cognitive levels of development may not “match” their physical development yet … so proceed with caution.

As a parent, what have you observed about the timing of puberty in your kids? As a teen, what has puberty been like for you?

Rima Himelstein, M.D. Crozer-Keystone Health System
About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D. St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, M.D., Ph.D Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
Latest Videos
Also on Philly.com:
Stay Connected