Though there are few types of precocious puberty, CPP is the most common. It occurs when the brain releases certain hormones too early. These hormones are the ones that are responsible for puberty. The condition is called "central" precocious puberty because the brain is part of the central nervous system.4

Keep in mind that children grow at different rates. As you may have noticed at school or playground, it's normal for children who are the same age to develop at different times. Even large differences may be normal. And since girls usually go through puberty at slightly younger age than boys, they are often taller than boys their own age during the early phases of puberty.6-7

So how do you know if your child has signs of CPP? Let’s start with the basics.

The signs of CPP are not really different from the signs of normal puberty - it's the timing that's different.1,2,7

Puberty usually begins around age 10 for girls

For girls, "normal" puberty generally begins around age 10, but it can range from 8 to 13 years old.

Puberty usually begins around age 11 for boys

For boys, "normal" puberty generally begins around age 11, but it can range from 9 to 14 years old.

Overall, CPP only occurs in 1 out of every 5,000 to 10,000 children and is more common in girls.5

It's only when puberty starts before the age of 8 for a girl or 9 for a boy that CPP is a possible diagnosis.3

Trust your instincts. Don't wait. If you suspect your child is showing signs of puberty at an age you think is too young, see his or her pediatrician for a referral to a pediatric endocrinologist for a confirmed diagnosis.8

Without treatment, CPP can have potential complications beyond childhood.5

Here are the signs you should look for:

Breast development normally occurs in girls from age 7-13. This is when nipples and breasts rise slightly and the areolas may also start getting bigger and darker. Your doctor may refer to a specific "Tanner Stage" when discussing your child's breast development. Doctors use the Tanner Stages to help determine if your child is developing early.1,9-11

Girls usually get their first period anywhere from age 8-15. You may see an increased amount of clear vaginal discharge before you see any blood. The amount of blood can vary widely from girl to girl.7,9,12-14

Has your child gone through a sudden gain in height? Girls usually have their first pubertal growth spurt between 9-14 years old. You can compare your child with other kids in her age range on the growth chart.6,9

Some girls may develop pubic hair before breast buds. Pubic hair changes over time. It starts out fine and straight. Then it grows thicker and becomes curly. So your physician might refer to a specific "Tanner Stage" when discussing the development of pubic hair in your child. Underarm hair usually appears about 2 years after the first appearance of pubic hair.9-11

Testes and scrotum growth are the first signs of male puberty. A boy may have adult-sized genitals as early as 13 years old.9,15

One of the most noticeable changes is a sudden gain in height. Often, boys will have their first pubertal growth spurt after other signs of puberty have begun. Look at the growth chart to see how your child compares with other kids in his age range.6,9

Normally, boys start growing pubic hair after the penis and scrotum start to enlarge. Pubic hair changes over time. It starts out light and straight. Then it grows darker, coarser and becomes curly. Your physician might refer to a specific Tanner Stage when discussing the development of pubic hair in your child. Underarm hair usually appears about 2 years after the first appearance of pubic hair.9,11,15

Tanner stages for girls11

The Chart below shows the Tanner Stages for Girls. It tracks what are known as "secondary sexual characteristics," such as breast development and pubic hair growth, that take place in a girl’s body as she develops. Your doctor may use Tanner Staging to see if your daughter is maturing early.

Stage 1 (Prepubescent)

Breast Development No breast development. Only the nipple is raised.

Pubic Hair Growth There is fine, very light hair in the pubic area like that on the abdomen—this is not pubic hair.

Stage 2

Breast Development In the breast bud stage, the breast is a small mound and the areola diameter enlarges.

Pubic Hair Growth There is sparse growth of longer, slightly pigmented but downy hair, straight or slightly curled, appearing mostly along the labia.

Stage 3

Breast Development The breast and areola continue to enlarge, with no separation in the contour of the breast and the nipple/areola.

Pubic Hair Growth Considerably darker, coarser, and more curled hair. It is just beginning to spread across the pubic area, but there is still no hair on nearby thigh areas.

Stage 4

Breast Development The nipple and areola project to form a second mound above the level of the breast.

Pubic Hair Growth The hair is now more like adult pubic hair, but the area it covers is still smaller than that in adults. There is still no hair on nearby thigh areas.

Stage 5

Breast Development Mature stage. Projection of the nipple only—the areola now shares the general contour of the breast and is no longer a second mound as in stage 4.

Pubic Hair Growth The hair is now like adult pubic hair in both type and quantity. It is distributed in the classic triangle pattern and has spread to nearby thigh areas.

Tanner stages for boys16

Below is the chart for Tanner Stages for Boys. It tracks what are known as "secondary sexual characteristics" such as pubic hair growth and genital development that takes place in a boy's body as he develops. Your doctor may use Tanner Staging to see if your son is maturing early.

Stage 1 (Prepubescent)

Genital Development Testes, scrotum, and penis are all about the same size and proportion as in early childhood.

Pubic Hair Growth There is fine, very light hair in the pubic area like that on the abdomen--this is not pubic hair.

Stage 2

Genital Development The scrotum and testes have enlarged. The texture of the scrotal skin is changing, and there is some reddening of the scrotal skin.

Pubic Hair Growth There is sparse growth of longer, slightly pigmented but downy hair, straight or slightly curled, appearing mostly at the base of the penis.

Stage 3

Genital Development The penis has grown—at first mainly in length but with some increase in width.

Pubic Hair Growth The testes and scrotum have also grown. Considerably darker, coarser, and more curled hair. It is just beginning to spread across the pubic area.

Stage 4

Genital Development Penis is further enlarged in length and width, with development of the glans (the wider area just behind the tip).

Pubic Hair Growth The testes and scrotum have continued to enlarge, and there is further darkening of the scrotal skin. The hair is now more like adult pubic hair, but the area it covers is still smaller than that in adults. There is still no hair on nearby thigh areas.

Stage 5

Genital Development Penis and scrotum are adult in size and shape. No further enlargement takes place after stage 5 is reached.

Pubic Hair Growth The hair is now like adult pubic hair in both type and quantity. It is distributed in the classic triangle pattern and has spread to nearby thigh areas.

Growth chart for girls

This growth chart lets you and your daughter's doctor compare her height with that of other girls her age. Where her measurement falls on this chart can help your doctor see if she is having an early growth spurt.

Growth chart for boys

This growth chart lets you and your son's doctor compare his height with that of other boys his age. Where his measurment falls on this chart can help your doctor see if he is having an early growth spurt.

Why Treatment is Important

Without treatment, CPP can have lasting complications.2,3 If CPP is left untreated, your child can continue to experience puberty as a result, and that can have lasting complications beyond childhood.5 That's why it's important to see your child's pediatrician if you think your child is showing signs of puberty too soon.

Potential complications of CPP include3,18:

Shorter adult height

At first, early puberty may cause a child to grow much taller than other kids his or her age. This happens because in kids with CPP, bones mature earlier than they should due to the hormones that cause puberty. But as the bones mature, the growth plates start to close. And once that happens, bones can’t get any longer. This can lead to short adult height if their CPP is not treated.

How children feel

Since children with CPP are often too young to understand what’s happening with their bodies, it can affect how they feel and cope.

Don't blame yourself. CPP can just happen.3 It's natural for parents to blame themselves when something happens to a child, but know that you did not cause your child's CPP, nor is it passed from parent to child. In most cases, there is no known cause for CPP. Puberty just happens to be starting early for your child. Fortunately, it's treatable if caught early.

 

How Puberty Begins1-3,19

As we've said, puberty normally begins in girls between the ages of 8 and 13 and in boys between the ages of 9 and 14. Here’s what happens:

When a child’s body is ready to begin puberty, a part of the brain called the hypothalamus releases a hormone called gonadotropin-releasing hormone (GnRH).

This hormone causes the pituitary gland (a small gland at the base of the brain) to release two other hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

These hormones, LH and FSH, lead to the changes you see during puberty by stimulating the ovaries to produce estrogen in girls and the testicles to produce testosterone in boys.

Image of brain showing how puberty begins

In children with CPP, the hypothalamus releases GnRH earlier than normal, triggering the release of the puberty-causing hormones, LH and FSH. LUPRON DEPOT-PED works to suppress the natural GnRH hormone. This interrupts the release of the hormones that cause puberty until a more appropriate time for it to occur.

How is CPP Diagnosed?

If you think your child may have CPP, don’t wait to find out. Start by scheduling a visit with your child’s pediatrician.

Seeing the pediatrician3

While your regular pediatrician knows your child’s medical history, it’s your observations of early puberty signs that will help direct your child’s exam. The Doctor Discussion Guide below can help you keep track of any signs and symptoms you see so you can easily provide them at the appointment. During your visit, the doctor will do a physical exam and may ask the following questions:

  • What signs of puberty have you noticed?

  • When did you first start noticing them?

  • How fast have they been progressing?

  • Does your family have a history of early puberty?

Doctor diagnosing a child with CPP

To rule out other medical problems that could be causing signs of early puberty, the doctor will also ask whether your child has had any other pains or problems. If he or she suspects CPP, you may be referred to a pediatric endocrinologist for an official diagnosis.

Why seeing a pediatric endocrinologist is important3,8

Pediatric endocrinologists are specialists who focus on the treatment of hormone-related conditions in children. Remember, CPP is a hormone-based condition. At this exam, the pediatric endocrinologist may do some or all of the tests below to help him or her determine if your child has CPP.

What tests to expect during your first visit:

This can help determine your child’s “bone age.” By comparing the results to standard growth charts, your doctor can see if the bones are growing too quickly.8,9

This measures the level of hormones in your child's bloodstream.9

Because there are other possible causes of early puberty, this can help show if your child has CPP.2

This shows the development of your child's ovaries and testicles, as well as the adrenal glands.8,20

These scans are used to rule out other possible causes of early puberty.21

After the doctor looks at the results of these tests, he or she will make a proper diagnosis. If your child is diagnosed with CPP, the doctor may prescribe a treatment like LUPRON DEPOT-PED.14,17,18

Need a Pediatric Endocrinologist?

While AbbVie does not recommend any specific health care providers, we can help you find a pediatric endocrinologist in your  area.

Find one now

Talking to Your Doctor

You are your child’s best advocate, so whether you suspect CPP or your child has already been diagnosed and you are considering treatment with LUPRON DEPOT-PED, having an open and honest discussion with your doctor is important. This Doctor Discussion Guide can help make the conversation easier.

LUPRON DEPOT-PED is the GnRH agonist most often prescribed in the US.22 It’s given in the form of an injection on a routine basis, allowing your pediatric endocrinologist to monitor your child at regular intervals and adjust the dose to make sure your child has just the right amount of medicine in his or her body.19

Which CPP treatment is best for your child?

Understandably, choosing the right treatment for your child is a big decision. Your pediatric endocrinologist is the best authority on how and when to treat CPP3,8, but the more you know, the more of an educated decision you can make along with your child’s doctor. So here are some important facts to keep in mind:

The most common treatment for CPP is called a gonadotropin-releasing hormone (GnRH) agonist.5,23,24 It works by making sure the pituitary gland ignores signals from the hypothalamus and stops the release of sex hormones from the ovaries and testicles to delay the puberty process.1,8,25

When considering treatments, ask your pediatric endocrinologist to explain any possible side effects that can happen with CPP therapy.

Once your pediatric endocrinologist decides that your child has reached a more appropriate age, he or she will stop GnRH agonist therapy, and the puberty process will start back up again.2,8

During the first weeks of treatment with a GnRH agonist like LUPRON DEPOT-PED, an increase in the signs of puberty (like vaginal bleeding) may occur. This is a common initial effect of the drug—your child will experience an increase in puberty-causing hormones before they start decreasing. Notify your pediatric endocrinologist if these symptoms continue beyond the second month of treatment.1,19
 

References:

  1. Muir A. Precocious puberty. Pediatr Rev. 2006;27:373-381.  2. Carel JC, Léger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377.  3. Mayo Clinic Website. Precocious Puberty. Available at: http://www.mayoclinic.com/health/precocious-puberty/. Accessed October 17, 2016.  4. WebMD. Children's Health. Early Puberty: Causes and Consequences. Available at: http://www.webmd.com/children/guide/causes-symptoms. Accessed October 17, 2016.  5. Saenger, P. Novel treatments seem promising for central precocious puberty. Endocrine Today. 2008. Available at: http://www.healio.com/endocrinology/pediatric-endocrinology/news/print/endocrine-today/%7Bbe447e73-0aab-417e-8ce4-4cb91d8f095d%7D/novel-treatments-seem-promising-for-central-precocious-puberty. Accessed October 17, 2016.  6. WebMD  Physical Development, Ages 11 to 14 Years - Topic Overview. http://www.webmd.com/children/tc/physical-development-ages-11-to-14-years-topic-overview  Accessed October 17, 2016.  7. HealthyChildren.gov, Physical Changes During Puberty. Available at:  https://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Physical-Development-of-School-Age-Children.aspx. Accessed October 17, 2016.  8. Nebesio TD, Eugster EA. Current concepts in normal and abnormal puberty. Curr Probl Pediatr Adolesc Health Care. 2007;37(2):50-72.  9. Blondell RD, Foster MB, Dave KC. Disorders of puberty. Am Fam Physician. 1999;60(1):209-218.  10. HealthyChildren.org. Physical Development in Girls: What to Expect. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Physical-Development-Girls-What-to-Expect.aspx. Accessed October 17, 2016.  11. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child. 1969;44:291-303.  12. GirlsHealth.Gov website, An honorable discharge: Where? Your underwear! Available at: http://girlshealth.gov/newmoon/body/discharge.html. Accessed October 17, 2016.  13. Mayo Clinic Website. Healthy Lifestyle Tween and teen health. Menstruation: Preparing your preteen for her period. Available at: http://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/menstruation/art-20046004. Accessed October 17, 2016.  14. American Congress of Obstetricians and Gynecologists (ACOG). 2015. Available at:  http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Menstruation-in-Girls-and-Adolescents-Using-the-Menstrual-Cycle-as-a-Vital-Sign. Accessed October 17,2016.  15. HealthyChildren.org. Physical development in boys: what to expect. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Physical-Development-Boys-What-to-Expect.aspx. Accessed October 17, 2016.  16. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45:13-23.  17. Tanner JM, Davies PSW. Clinical longitudinal standards for height and velocity for North American children. J Pediatr. 1985;107:317-329.  18. Kaplowitz PB. Precocious puberty. Available at: http://emedicine.medscape.com/article/924002-overview. Accessed October 17, 2016.  19. LUPRON DEPOT-PED® [package insert]. North Chicago, IL: AbbVie Inc.  20. Imel EA, Bethin KE, Etiology of gonadotropin-dependent precocious puberty. In: Pescovitz O, Walvoord EC, eds. When Puberty Is Precocious. Totowa, NJ. Humana Press; 2007.  21. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004;10(2):135-147.  22. IMS Health, IMS National Prescription Audit, June 2016.  23. Nabhan ZM and Walvoord EC. Treatment of gonadotropin-dependent precocious puberty. In: Pescovitz OH, Walvoord EC, eds. When Puberty Is Precocious. Totowa, NJ. Humana Press; 2007: chap 16.  24. Carel JC, Eugster EA, Rogel A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-762.  25. Neely EK, Lee PA, Bloch CA, et al. Leuprolide acetate 1-month depot for central precocious puberty: hormonal suppression and recover. Int J Pediatr Endocrinol. 2010;2010:398639. Doi: 10.1155/2010/398639 Epub 2011.