Understanding puberty

Puberty is a difficult and confusing time. Children may feel awkward and anxious as they try to cope through their mental and physical changes. This milestone can be even more challenging for children with developmental disabilities. If you are the parent of a child with a disability, it is essential that you learn how puberty will affect him/her so that you can guide them through the process more effectively.

Puberty stages in girls

The phase of development that begins with development of secondary sexual characteristics (growth, breasts, hair and menstruation) and ends with ovulation is considered puberty.

The phase referred to as adrenarche or pubarche relates to the growth of pubic and axillary hair. This is due to an increase in production of adrenal androgens and this occurs from as early as six years. Development of pubic and axillary hair without sexual characteristics is called premature adrenarche. Gonadotropin release come about as a result of hypothalamic secretion of GnRH (gonadotropin releasing hormone) and in turn stimulate the ovary to produce oestrogen (gonadarche) resulting in breast development, female fat distribution, vaginal and uterine growth and skeletal growth rapidly increases. With sufficient oestrogen stimulation the lining of the uterus proliferates and results in first menses (menarche). These cycles are usually anovulatory (without the release of eggs). Abnormal bleeding is a very common problem for young women.

Factors effecting puberty

It is unclear what triggers the onset of puberty, but it is believed that genetic factors play a major role. Other factors seem to influence the time of initiation and the rate of progression such as geographic location, exposure to light, general health and nutrition, and psychological factors. Mildly obese children and those living closer to the equator, at lower altitudes, and in urban areas start puberty earlier. There is also a correlation between mother and daughter, as well as sisters. The critical weight is believed to be 47.8kg and body fat percentage need to be between 16-23%. Higher levels of Leptin, a peptide produced by fat cells, seem to cause earlier onset of menarche.

Precocious puberty:

A girl may be considered as precocious if she shows signs of secondary sexual development before the age of eight years, or menstruates before the age of nine.

The cause of 74% of the cases with precocious puberty is idiopathic (has no cause). Eleven percent is due to ovarian cysts, 7% due to cerebral tumours and 5% due to McCune-Albright syndrome. Children under the age of four have a higher risk of nervous system lesions. The treatment revolves around making sure there is no life-threatening condition causing precocious puberty.

The prognosis is dependent on the cause and even so early detection and treatment can make the outcome good.

Delayed puberty:

It is abnormal for a girl not to have secondary sexual development by her 14th birthday, and warrants investigation. On the other hand a girl with secondary sexual development and no menses at age 16 also requires tests to find a cause.

The cause may be genetically (constitutional) normal, otherwise the balance between hormones produced by the brain and hormones from the ovary may be the cause and up to a fifth may be reversible and treatable. 26% of causes are as a result of congenital abnormalities of the genital tract, where the female genital tract may be abnormal or even absent.

Due to the fact that there are stigma attached to either early or late development, the condition gets pushed aside and only worried about when problems with regards to sexuality and or fertility arise. The psycho-social impact is huge and the need for support cannot be stressed enough. Early detection and treatment can improve the long term outcome for these young ladies.

Remember, as tough as this time is for you, it is ten times worse for her. Puberty doesn’t last forever and many girls come out on the other side of it, perfectly well adjusted within their abilities. Be patient, be educated, and be prepared.