Precocious puberty, what should parents do?

Recently, 3-year-old Hu Hu and 2-year-old little cousin Niuniu were taken to the hospital together. The doctor asked about the basic situation and physical examination, and found that the physical condition of the two children was significantly different from the children of the same age. Huhu has a beard faintly on his mouth, his voice becomes thick, and Niu Ni’s bilateral breasts are enlarged. This obvious precocious puberty symptoms make people sigh.

What is precocious puberty? How to find it early? When do I need to deal with it? How to treat … These problems have been haunting everyone. Today, we address issues related to precocious puberty in young children.

Precocious puberty cannot be generalized
Precocious puberty is a sexual developmental abnormality that is characterized by the early onset of sexual maturity in children. Generally, girls with a second sexual characteristic before the age of 8 years old and boys are defined as precocious puberty. Regarding precocious puberty, we generally pay attention to precocious puberty in children (greater than 6 years old), but we do not know much about precocious puberty in young children (less than 3 years old).

It is not uncommon for young children to have secondary sexual characteristics in clinical practice, mainly manifested by unilateral or bilateral breast enlargement and premature pubic hair. Breast development in young children can be seen in premature breast development, pseudoprecocious puberty, and McCune-Albright syndrome (a clinical syndrome coexisting with the characteristics of multiple osteoporosis, multiple skin and coffee pigment spots, and various endocrine abnormalities). Young children with premature pubic hair are accompanied by excessive androgen, which usually manifests as clitoral hypertrophy.

So, what causes precocious puberty? From the clinical point of view, the common causes can be roughly divided into 3 types according to the classification of precocious puberty: ① true precocious puberty. It refers to the neuroendocrine dysfunction of the hypothalamus, which triggers the hypothalamus-pituitary-gonadal axis (HPGA) in advance, which leads to the early appearance of reproductive capacity. Generally speaking, the saddle occupancy, hypothyroidism, and intracranial disease will cause this disease. ② Pseudoprecocious puberty. This means that under the action of endogenous or exogenous hormones, the reproductive organs develop early and secondary sexual characteristics appear early, but HPGA has not been activated, so it does not have reproductive capacity. This may be caused by diseases such as congenital adrenal hyperplasia and ovarian cysts, or it may be caused by exogenous factors such as regular exposure to adult books or television, supplements or off-season fruits. ③ Partial precocious puberty. This type of precocious puberty may be related to the fact that the negative feedback mechanism of hypothalamic stability has not been established. It is manifested by simple early breast development, early menarche, or simple pubic hair and armpit hair. It may be caused by light pollution, exogenous factors or unknown reasons.

“Miniature adolescence” within 3 years
In the clinic, breast enlargement and sclerosis often occur in two- and three-year-old children, and most parents will feel worried and anxious.

First of all, it must be clear that the majority of breast development in young children under the age of 3 is only a special manifestation of secondary sexual characteristics, that is, a developmental mutation and a self-limiting disease, which we generally call For pure breast development, it is also called “minor puberty.” This is because the HPA in this age group is in a temporary “activated state”, the shaft system is unstable, and it can cause intermittent estrogen secretion. Of course, children’s intake of exogenous hormones and other pathological factors may also cause this phenomenon.

Second, the symptoms of precocious puberty in children of different genders are different. The symptoms of precocious puberty in girls are mostly unilateral or bilateral breast enlargement, or alternately enlarged and subsided breasts on both sides, without deepening of the nipples and areola pigmentation, and are generally not accompanied by other signs of sexual development. Symptoms of precocious puberty in boys: long beard, thicker voice, emotional excitement, penis growth, testicle enlargement, pubic hair appearing, and height growth accelerates. If parents find that the baby’s breasts are enlarged or the penis is enlarged, they should pay close attention to the change in size and do not touch it often. At the same time, go to the hospital for follow-up inspections regularly to monitor indicators such as sex hormones and bone age.

Finally, the premature epiphyseal fusion of children with precocious puberty may cause their adult height to be lower than their expected genetic height and may affect their adult health. In addition, premature sexual development may lead to psychological problems such as anxiety and depression in immature children, self-cognitive disorders, etc. In severe cases, it may even affect academics, so parents need to pay attention and seek medical treatment in a timely manner.

Precocious puberty diagnosis and treatment
If children are found to have symptoms of precocious puberty, parents should promptly take them to a child endocrinology clinic in a regular hospital. In general, the causes of precocious puberty in children of different ages are different, and their treatment methods are different. Therefore, it is necessary to identify whether the cause is physiological or pathological.

Young children can observe when they find that their breasts are simply enlarged. During the observation period, if it is found that the breast enlargement persists, progressive enlargement, recurrence after regression, or other sexual characteristics and accelerated growth, you need to go to the hospital for treatment. At this time, the growth rate, bone age, gonad color ultrasound, sex hormone levels, and development of secondary sexual characteristics should be checked. If there are no obvious factors leading to precocious puberty in young children, the head imaging examination needs to be improved, and the possibility of xenophobic central disease may be.

If the clinical manifestations and auxiliary examinations are used to confirm the diagnosis of true precocious puberty, 4 indicators need to be evaluated before treatment: linear growth, skeletal maturity, secondary sexual development, and prediction of adult height. Treatment was started when the indicators reached the indications for medication.

There is a clear cause of precocious puberty, and of course the doctor will treat the cause. If there is no clear cause, the doctor will choose the medicine according to the priority of the disease. Acute or severe patients are preferred for gonadotropin-releasing hormone analog (GnRHa) treatment. When the age has caught up with the bone age, and the bone age reaches the normal puberty starting age (≥8 years), the drug can be discontinued when the height is predicted to reach the genetic target height. Its gonad axis function restarts and should be tracked regularly. It should be noted that although GnRHa is effective in treating precocious puberty, long-term use may have a negative effect on bone mineral content.

If the symptoms of precocious puberty are mild and the disease progresses slowly, it is recommended to use TCM syndrome-based intervention. After all, TCM treatment is safe and reliable, and there are no special adverse reactions. Xiehuo granules and Zishenqinggan granules can slow down or even reverse the process of children turning into rapid progressive precocious puberty, thereby delaying the trend of advanced bone age and impaired growth potential.

Factors that can cause precocious puberty and how to avoid it
What are the external causes of precocious puberty? How should we pay attention?

Food factor

① If you consume too much fried foods, sweets, sugary drinks, animal foods, etc., excessive heat will build up in your body. These calories will turn into excess fat in children, which will cause fat accumulation, cause obesity, and induce precocious puberty. Therefore, it is recommended that children pay attention to the matching of meat and vegetables in their daily diet, avoid frying braised as much as possible, and use steaming more.

② Many out-of-season fruits are marketed or matured early with the help of “ripe-promoting agents”, and “ripe-promoting agents” can induce precocious puberty. Therefore, parents are advised to choose more fresh fruits and vegetables of the season.

③ Cordyceps sinensis, ginseng, astragalus, chicken embryo, royal jelly, snow clam, bovine colostrum and other nutritional supplements often contain higher sex hormone analogs, which is one of the causes of premature puberty. Therefore, it is necessary to avoid eating supplements containing sex hormone analogs. .

family environment

Frequent exposure to adult books or television, the use of skin-care products containing sex hormones, and misuse of contraceptives are also prone to precocious puberty. Parents are advised to keep hormonal cosmetics and contraceptives out of reach of young children. Poor information will give young children sexual cues. If they are not guided in a timely and correct manner, they may also trigger the stimulation of the gonadal axis in advance.

At the same time, faced with mobile phones and computer screens for a long time, turned on the lights at night to sleep, excessive light will reduce the human body’s pineal gland secretion of melatonin, so that melatonin inhibited pituitary gonadotropin secretion in advance, resulting in precocious puberty. It is recommended to turn off the lights at night to control the time that children watch electronic products every day and go out for more activities.

Natural environment

Emission of harmful substances in nature, estrogen-like pollutants produced by degradation, can cause precocity after direct contact with the skin or direct consumption. It is recommended to go out and wash hands in logistics to develop good hygiene habits.