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Puberty is a period of sexual maturation during which both the female and male body undergo changes inducted by increased levels of sex hormones. 

Individual variations regarding these changes are great. Therefore, many misconceptions evolve from comparisons of a child’s development with other children of the same age. Determining whether an individual is dealing with either early or delayed puberty is nowhere as straightforward as most people think, and even physicians make mistakes in diagnosing delayed and early puberty.

The Significance Of Pubic Hair Growth

Pubic hair growth is often falsely interpreted as a sign of puberty. Although it usually happens during puberty, along with other physical changes, this should not be taken as a strict indicator, given that pubic hair growth has been spotted in six-year old girls and in boys younger than nine years. These changes are induced by low-potency sex hormones (androgens) produced by the adrenal glands. The actual changes in puberty are induced by potent sex hormones produced by the testicles in males, and ovaries in females.

Pubic hair growth in absence of other body changes is not a viable indicator of premature puberty.

Other important indicators that early puberty isn't the correct diagnosis include a lack of acne, a low growth rate, the absence of voice lowering in boys, no increase breast size or testicles, and no increase in clitoris size in girls.

Early Normal Puberty

Puberty can occur at an early age and still be a variation of normal. Studies suggest that normal early puberty can start in girls aged seven and boys aged nine. If signs of puberty (penile or clitoris enlargement, testicles or labia enlargement, breast enlargement, pubic hair growth) appear earlier than that, examinations are needed in order to discover possible reasons for such early changes. Some of the causes include exposure to synthetic estrogens from food or different materials and obesity in children. Obesity has been shown to speed up maturation of bones and also the onset of puberty.

Delayed Puberty

In most cases, children who fail to develop pubertal signs at the same time as their peers will eventually enter puberty, but with some delay. These children usually have a lower height and weight before adolescence, so they constitutionally need more time. The critical time for boys is 12 to 14 years, while the critical time for girls is 10 to 12 years. If, after that age, puberty signs are still not showing up, a detailed examination is recommended. The most useful test is an X-ray of the bones, which shows the residual potential for growth. There are determined values of testicular size and breast size for a particular stage of bone maturation. 

Laboratory findings include thyroid hormone levels, red blood cell count, electrolytes, creatinine, and growth hormone levels.

In summary, most cases of parental concern are exaggerated and most of those children with signs of early or delayed puberty turn out to be normal variations. Physicians should follow the development of these children and suggest a detailed examination and interventions in cases of genuine concern.

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