Anonymous: I think my 7yo daughter has started her period. I noticed some spots of blood on her underwear a few months back but this has started to become heavier and more regular. I also noticed that she is getting pubic hair and we recently bought her first bra. Should I be concerned given she is so young?
Most of us remember getting our first period and are able to recall the details with ease – when, where, what we were doing at the time. For me, it was during a school day and I was 14-years-old – so I was at the point where I felt like it was never going to happen.
Looking back, I do think I was pretty lucky to be a bit older when I started my period (a time known as menarche) as there is a small percentage of girls who are too young to remember this time clearly. Approximately 5 to10 per cent of females will undergo what is known as precocious puberty, which is where they develop breasts and pubic hair before 8 years of age, often associated with the onset of regular periods.
Interestingly, there is not a lot of data on how young this can occur. What we do know is that early onset puberty is far more common in females than males and that the vast majority of cases occur between the ages of 7 to 8 years old.
There are rare recorded cases across the world that demonstrate children of any age can develop breasts, pubic hair and commence periods – including young babies. Even though this is rare, it is important to note that the younger the child, the more likely it is that there is a serious cause for their symptoms.
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Your child should be investigated thoroughly by your GP with referral to a specialist paediatrician for review. In all cases, it is important to determine if the symptoms, particularly any vaginal bleeding, are due to puberty or other causes including infection, foreign bodies or trauma.
The first thing I do when a young female presents with early onset puberty, is to take a detailed history, including a family history, and conduct a physical examination with the patient’s and parent’s (or guardian’s) informed consent. If the young child isn’t comfortable with examination, this is OK, we can work around it.
I explore whether their mum, aunties or grandmothers also started their sexual development at a very young age. Genetics are an important factor to consider. If there is a family history of precocious puberty and the young patient is tracking well with other development and growth, this can be reassuring for the GP and the family that it may just be genetics with no other significant underlying issue.
However, before being able to say that it is purely a variation of normal sexual development, other causes need to be ruled out with some tests. This includes an X-ray of your child’s hand and wrist to determine what we call bone age. In those with precocious puberty this will show early maturing of bone as a result of increased oestrogen. Blood tests to assess hormone levels including thyroid function and reproductive hormones, should also be requested.
In girls, a rare cause of early sexual development can be a tumour of the pituitary gland in the brain or of the adrenal glands (near the kidneys) that both produce sex hormones. If the hormone levels are outside of expected levels, a referral through to a paediatrician should be provided and at this stage more investigations including ultrasounds or MRI scans may be ordered.
Your GP is a great source of ongoing support and care for your child with precocious puberty. This includes helping them manage any associated behavioural, social or mental health issues as well as monitoring them longer term for any related reproductive health concerns.
If this story has raised concerns for you, please consult a healthcare professional.
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