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Article title: Puberty: NWHIC
My 6 year old
daughter has developed a strong body odor and (or) pubic hair. Isnít she
too young? Should I take her to a pediatrician?
My daughter is almost sixteen, she started showing signs of breast development two years ago but she has not yet started having periods. All of her friends started years ago. Should we worry?
My 9-year-old daughter has developed a lump in her breast, but it is only on one side. Is this normal?
How do I know if my daughter should see a doctor about a breast lump?
Called premature adrenarche, it is caused by the early maturation of the adrenal gland resulting in increased androgen secretion. Adrenal androgens cause pubic & armpit hair to develop and it is often accompanied by a notable increase in body odor. These signs do not indicate premature puberty (which would be marked by the beginnings of breast development). In general, puberty in early adolescence should progress normally. Premature adrenarche does not require treatment but an examination by the pediatrician is advisable to rule out any hormonal or enzyme imbalance, or problem with the adrenal grand. The cause of premature adrenarche is not known. It is more common in African American and Hispanic girls and in obese girls (early adrenal development can also happen in boys)
You can reassure your daughter that she is normal. There is a wide range of normal in the onset of puberty and menstruation. The average range for the onset of breast budding (early breast development) is from age eight to thirteen years. The development of pubic hair follows several months later and the first period (menarche) usually occurs between age ten and sixteen-and-half years. The average time for the first ovulation is about ten months after the first period. Also, puberty that begins earlier or later than average is not as uncommon as some may think.
Many factors effect when a girl will begin puberty; including heredity, ethnicity, body type, nutrition, life style, and environmental toxins.
Girls whose mothers started menstruation early have a greater chance that they, too, will start early. African American girls enter puberty, on average, one-and-half years earlier and have their first period eight-and-half months earlier than Caucasian girls. Some studies indicate that Mexican American girls enter puberty a few months later than average, though this finding is not as conclusive. Taller or larger girls usually start at the early end of the average. A well rounded, nutritious diet can cause young, healthy bodies to develop earlier, though still within the average range. Some studies indicate that environmental toxins can slow development and thus slow the onset of puberty. Lack of adequate nutrition can also have an adverse effect.
Therefore, if your daughter is healthy and is eating a nutritious diet do not be concerned if she does not begin her periods at the same time as her friends.
If, however, she has reached age sixteen-and-half, or meets the profile of someone expected to start early (i.e. heredity, body type, etc.) Or if your daughter is suffering undo anxiety about the delay, you should consult her physician to rule out any problems.
What you see as a lump is probably normal breast development. Breast development is usually the first sign of puberty, beginning between eight and fourteen years. It is common for one breast to begin to develop first. The second breast may not begin for up to six months after the first. You and your daughter should not be concerned.
The standard measure for pubescent breast development is called the Tanner stages. This scale identifies five developmental stages. In stage one a slight elevation of one or both nipples appears. Stage two is the breast bud stage characterized by elevation of the breast and nipple into a small mound. The diameter of the areola will also increase. It is likely that your daughter is entering the breast budding stage. The final three stages will produce more enlargement and definition of the breasts' shape until they reach full maturity at stage five.
Abnormal breast lumps in adolescent girls are uncommon. The first question that may come to a parent's mind is, "Can this be breast cancer?" The answer is, probably not. Less than 0.1% of all patients with breast cancer are under age twenty.
Though the majority of adolescents who see their doctor for a breast lump have normal breast tissue, other conditions do sometimes arise. The most common is benign fibrocystic change. A fibrocystic mass may or may not cause some pain or discomfort. If a cystic mass is suspected and persists the physician may recommend a fine needle aspiration. This is normally a quick office procedure. More than fifty percent of all women will have fibrocystic changes at some point in their life. The cause is unknown.
Adolescent breast lumps can occasionally be a fibroadenoma [a benign growth that is encapsulated, rubbery, and non-tender with no nipple discharge]. These are sometimes removed for evaluation or, if very large, to prevent breast distortion. Other conditions can cause lumps but are even less likely.
Trust your "motherís intuition". Arrange an appointment with her doctor if you have any concern about the lump. If she has menstrual cycles, report breast lumps that persist beyond two or three menstrual cycles to the child's physician (or sooner if you or your daughter are feeling any anxiety). Along with an evaluation of the breasts, there should be a complete history, including any previous breast disease or malignancy, chest radiation, menstrual history, symptoms associated with the breast mass and family history. Breast examination should also be a part of each regular physical examination.
Many physicians feel that teaching adolescents to do breast self-examination can start them on the road to understanding and taking charge of their bodies and their health. There is some concern that too much attention to self-examination could make young girls feel frightened. Reassure your daughter that serious breast problems are rare in the young. Adolescents, though usually able to perform a correct self-exam, tend to do so sporadically. Don't be concerned. The goal at this age should be getting comfortable with what should be a life long habit.
You can find out more about Puberty by contacting the following organizations:
Administration on Children, Youth and Families, (202) 205-8347
American Academy of Pediatrics, (800) 336-5475
Contributions to this FAQ on Adolescent Health: Magee Women's Research Institute/University of Pittsburgh, a National Center of Excellence in Womenís Health sponsored by the Office on Women's Health in the Department of Health and Human Services.
All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the source is appreciated.
Publication date: 1998
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