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Current time:0:00Total duration:10:28

Video transcript

I'm here at Stanford Medical School with Morgan theis and dr. Laura Bacharach and they're going to teach us some things okay so what are we going to learn about today I'd like to talk about precocious puberty seems to be on mind of many parents these days they worry that their child is developing too early they worry their child's going to be too small as a result they worry their child's going to get picked on and they worry they might have done something wrong fed the child the wrong food or expose them to the wrong videos to cause this all to happen okay so could we just talk about what precocious puberty means it almost sounds like they've done something too soon is that is that correct that's exactly true the normal process of puberty in a girl we think use we used to think started around the age of 10 with a little bit of breast development and about six months later the girls would get a little bit of pubic hair and around the age of 12 and 3/4 to 13 they'd get their first period okay in boys we used to think the process was starting a little later at about 11 and a half the boys would get some enlargement of the testes they'd get some pubic hair about a year later and by age 15 or so they'd be mature we have a definition of what's precocious when the signs of puberty b48 integral okay or before nine and a boy okay so eight or less less than a in a girl would be precocious and that's for the breast development which happens for any sign and humor T okay the breasts the pubic hair or the periods would be precocious if it happened before the age of eight in a girl and in a boy mm-hmm before the age of nine now this has become a little bit controversial because there was one very large Pediatrics study that involved over 17,000 girls know that found that as many as 25% of african-american girls would have a sign of puberty before 8 and as many as 7 percent of the white girls had some signs of puberty for age 8 but we're still basically using these guidelines not to say this is definitely abnormal but this is something we're going to evaluate if we see signs of puberty before those age landmarks okay so it sounds like there's a lot of variability it's kind of hard to know on any individual case whether that's it's normal or not but we have to have some kind of threshold for which we're going to work someone up make sure that everything is normal you hit on a really important word and that is variability and a lot of this variability is determined by genetics okay so part of what we always need to know is the timing of development in the family so rated mom get her first menstrual period when did dad get his puberty and growth spurt so that's part of it is genetics and we need to know that take that into account if mom had her first period at 10 and started her breasts at 8 it may be perfectly normal for her daughter if mom's periods were at 14 and her daughter has breast development at 7 and a half it's more worrisome okay okay the second factor that seems to be contributing potentially is the overnutrition of our young people oh yeah and in the particular study that I mentioned to you where they looked at over 17,000 children mm-hmm at least for the white population they could explain the earlier science of puberty as an association with a high body mass index oh so it looked as if if you over nourish your child you may speed along their growth and eventually potentially speed along their onset of puberty I see now this did not hold up as an association in the african-american population so there's other factors going on here but that's something that we take into account but the bottom line is the child may present with some signs of early puberty mom or dad get worried they go to the pediatrician and the pediatrician has to decide what's going on okay now just backing up a little bit is this a problem I mean what's the problem with say a 7 year old girl starting puberty or what are we going to say like an 8 year old boy starting puberty early I imagine there could be some social implications as you mentioned but what are sort of the things we worry about well that's an important question because it comes up not only how far do we go to evaluate them but how far do we go to treatment treat them so one of the concerns parents have relates to their final height okay so if they start their growth spurt early in life and close it off early in life are they going to cheat themselves out of some final height right so height is a concern okay and its impact really depends upon how young the child is a 3 year old going into puberty is definitely going to end up short if we don't do something okay a 7 and a half year old girl is probably not going to be altered by this in terms of height the second concern is definitely what you brought up in terms of a social concern parents worry the child may behave in an older way or may be treated in a way that they're not quite ready for they may get unwarranted attention from people because they look older and there's even potential concern for abuse sexual would be right so those are usually the parental concerns for why they bring the child in the other concern they have is often what am I doing wrong there are a lot of questions about should I have fed by child organic food what about the soap I was using what about the soap operas my child was watching you know they're really concerned about something they might have done and they worry about these additives in our plastics and our teeth sealants etc they worry about evils in our environment okay so things that you address in the visit that you have with them are definitely some of the the concerns that parents inevitably have about what what they could have done differently exactly we start out assessing in a sort of a systematic way the first question we want to know is when did this all start and what did they notice and it's really important to break down the science of puberty because different hormones contribute to the different signs for example in a girl if she's presenting with some body odor some acne and some pubic hair but no signs of any breast development that leads us down the road to worry about what we call her androgens or male hormones if a girl comes in with just breast development but none of the body hair or body odor we think AHA she's been exposed to estrogens and so we get a lot from the physical exam in terms of thinking what hormones to go after okay so even though the definitions of precocious or just any of these you know different phases of development happening too soon the combination that you see is going to direct what you think is going on with them clinically it's that okay it'll make us more or less worried and it will take us down one Avenue or another thinking about what could be wrong what level of abnormality in the hormone system is at work okay can I ask a question just curious so what what are the most common diagnoses that you give to people coming in with their kids that are concerned for precocious puberty the most common diagnosis are variations on normal ah there is a condition called isolated premature adren Archy which is a fancy doctor way of saying the adrenal glands producing their hormones we see pubic hair underarm hair and acne we also can see isolated breast development in little toddler girls that's not concerning so that would just go away yeah typically that begins between six months and two years and goes away but even within the more full-blown cases where we're seeing the breasts and the pubic hair and the girl or the enlargement of the testes and the pubic hair and the boy where it's full-on full-blown puberty it may be idiopathic or not pathological we think that in girls who developed fully 95% of the time even if they have the full puberty it's video Pathak or not pathological whereas in boys about 50% of the time there is pathology so the conditions less common in boys but when it occurs in boys is more worries so interesting ok so it's less common for boys to have any signs of precocious puberty but when it does happen you worry more exactly because it's most more likely to be something bad exactly ok ok so I'm guessing as a endocrinologist once you've sort of ruled out the normal things then you start thinking more about sort of what's going on in terms of all the different hormones that are controlling these things which maybe is something that we'll talk about in a different lecture exam is there any other sort of general things that you wanted to address when just talking about I think the general advice I would give to a parent if they see signs of puberty in their child before 8 in a girl before 9 in a boy they should at least question their pediatrician about it and the pediatrician should do a complete exam and the other factor that needs to be looked at carefully is growth because the child who's truly impurity will have a growth spurt so those are things that parents can be aware of at home and I think it's important that the parent ask the pediatrician about it if they are concerned okay well thank you so much