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From One Easter to the Next

I invited my sweet friend, Leslie, to write a guest post that I think you will find very interesting and informative. I’m posting Part 1 today, and Part 2 tomorrow.

“Wow, she is so tall!”  Tell me about it! She grew 10 inches in 2 years, from the 12th percentile to the 90th percentile for height! Being tall for one’s age is considered a great thing, while being short often goes unmentioned.  Growth is part of life, and children who have had early childhood (even prenatal and infant) malnutrition are frequently shorter than their American peers. It is nothing short of amazing to see how quickly children who have been adopted grown once they are in loving families with good nutrition, which even the best orphanage can not replace. We all cheer when children who have been under their growth curve or in single digit percentiles cross the growth curve lines and start growing.

There is another aspect of growth that we often aren’t as comfortable with, when children start to go through puberty.
Even that word is something that makes many adults uneasy enough to lower their voices and avoid the subject altogether. Many people would prefer to ignore the subject for as long as possible; after all, eventually kids will realize their bodies are changing without us saying anything about it, right? Puberty makes us adults think about sex, which is something we are uncomfortable thinking about and talking about, especially in the context of our growing children. Although we know covering our eyes doesn’t make it go away, we still act that way at times.There is an intersection here with adopted children. That is, when children who have been nutritionally and growth challenged come into our loving, nutritionally rich families, they miraculously begin to grow. Sometimes when that happens, their endocrine system begins to work faster than normal, which can continue and can lead to a greater risk for precocious puberty for our internationally adopted children. The timing of puberty can vary depending on race and gender, but generally speaking, when signs of puberty begin before age 8, you should talk with your pediatrician. If you have a daughter of African descent, you may have to push to get her evaluated for precocious puberty because the “normal range” for puberty for African American girls is now considered to start at age 8! All I have to say about that is, it may be more common now (in a way that shifts the average/ range), but it can still cause many challenges.
Children who look older than their peer group may be treated older than other children and may be seen as more mature, even though inside they are still young children. They may also be subject to teasing and harassment. Few elementary schools are prepared to help 2nd and 3rd graders who are having periods. Beyond the social issues regarding young children starting into puberty, there are physical issues as well. One is that children with precocious puberty may initially be taller than their peers, because they are going through the puberty “growth spurt”, they may stop growing once they complete puberty and end up shorter than their peers who go through puberty later. There are also possible increased risks for fertility issues and breast cancer later in life.  It can be distressing to see your child go through puberty, but when children are at least 9 or 10, it is easier to expect and help them process.
Because internationally adopted children in particular can be at risk for developing precocious puberty, parents should be aware of this and proactive in monitoring children’s development with the pediatrician. A referral to an endocrinologist can be helpful, and once again, this sometimes takes advocacy on the part of the parent to do this in a timely way since many endocrinology clinics are very busy with children with other urgent issues such as diabetes. In addition to a history and physical, an endocrinologist will recommend different kinds of tests, which may include  a bone age, blood tests of hormone levels, an MRI (looking at the pituitary gland), and pelvic ultrasound. Once this testing is completed and the overall condition is assessed, treatments to delay further progression of puberty may be recommended. These may include monthly injections or an annual implant delivering similar types of medications to stop puberty. This is a difficult decision to make, but not more difficult than watching a 7 year old (or younger child) go through puberty. Parenting is full of uncertainties and other people’s opinions, but parents should feel comfortable in whatever decision they make with their child’s doctors.

Read part 2 tomorrow.

Have a great day, friends.

Lisa

 



  1. Fiona (Reply) on Thursday 13, 2013

    Thanks for covering this subject. Precocious Puberty doesn't just affect adopted children of African American descent. My daughter from China started her period at 7, 6 months after being in our family. Most likely because her body started to lay down fat deposits for the first time ever and "thought" she was ready to make babies. It was very hard, even more so because of her special needs (she has CP with one arm that doesn't have any strength), which makes dealing with the practical aspects very difficult. Also she was in 1st grade – teachers and peers are NOT ready for this. We did see an endochrinologist, and after much pushing with our insurance company had a hormone impant put in her arm, which has reverted the symptoms of puberty and stopped the progression. She is happier, I am happier, and the implant in her upper arm lasts about 18 months, so will only need to be replaced once or at most twice before we can allow nature to take its course. I wasn't aware of the possibility and was not prepared for this to happen, so I am happy to see this subject being covered.

  2. Sara (Reply) on Thursday 13, 2013

    My daughter is adopted from Africa. There are several others from her same orphanage in our area. They all seem to be growing up "quicker." I did have my daughter tested and we have been watching her growth. She's head and shoulders about others her age too. We watch her diet to keep as many estrogens out of her diet and all. And I pray. There are lots of issues that can come about from developing too early. I try to make sure she is friends with others her age and not with a lot of older girls. I'll tune in for part 2.

  3. Jennifer Litz Seivert (Reply) on Thursday 13, 2013

    Early puberty for me was so difficult. Other children did a ton of teasing and purposely bumped or poked tender parts of my body. Even though I understood what was happening because I had an older sister, it was embarrassing to be different than the other girls. I was a head or more taller and needed to wear a bra and deal with monthly periods. It was hard to describe the menstrual pains to friends who just had no concept of what it was like. Now I am shorter than most as I was done growing in the fourth grade. I wish my parents had investigated finding a way to delay puberty.

  4. Melissa (Reply) on Thursday 13, 2013

    This is very well-written and informative. Thank you for taking the time to share this.

  5. Laurel (Reply) on Thursday 13, 2013

    This is a great post and describes exactly what we have gone through with our daughter from Haiti. We do the monthly injections. I wasn't having any part of my 7 year old going through puberty when she had no clue of what was happening, having some emotional issues, and really at times functioning psychologically at a 3 year old level. For us it was not a difficult decision. We didn't want to see her go through more on top of everything else. However, for others I can see how it might be. It takes much consideration. Thanks for the post :0)

  6. Carol Bittner (Reply) on Thursday 13, 2013

    Great post behave you already run part 2?

  7. Christine Lester Forbes (Reply) on Thursday 13, 2013

    I’ve heard of this but had no idea there was medical help for it. Thank you.

  8. Renee (Reply) on Thursday 13, 2013

    YES… you will likely have to advocate very strongly in favor of intervention. My daughter begain puberty at 7 and our pediatrician just said it is at the low range of normal for girls of African descent… so we did not push. The problem with this is, even though she was 7, due to trauma and early history her mental and emotional age was probably HALF that! Sexual interest and urges starting in third grade with a child who is emotionally 4 or 5 is NOT a good thing. I wish I had pushed harder to stop this. :-/

  9. Michelle Byrne (Reply) on Thursday 13, 2013

    Especially difficult issue when you can’t be sure exactly how old your daughter is!

  10. Cathy (Reply) on Thursday 13, 2013

    Children adopted from other parts of the world can have this too. Our daughter, from western Russia, saw an endocrinologist at the age of 7 due more to onset of hair growth more than need for a bra. We learned this was a medical condition with Eastern Euroupean Women. That had its own issues when needing to shave so early and be aware of dressing room challenges. Our daughter did not have a period until age 12.
    We have journeyed with other friends through adoption with children from India whom faced the decision of having to medicate their daughters to slow puberty's onset.

  11. Kimber (Reply) on Thursday 13, 2013

    Hi Lisa, Melissa, Leslie and all- long time no . . . I am so glad you posted on precocious puberty, my just-turned-10-year-old has been on Lupron shots once a month for most of the past year. I wondered if it was caused by ARVs, do you really think it's a by product of early malnutrition?
    What got our attention was the extra defiant teen-like bahavior accompanying the hormone flood. I really notice the challenges a 7-8-9-10 year old mind has trying to deal with the teen-like emotional/sexual/mental manifestations of precoc. puberty.
    So glad you brought up this issue!

  12. Catherine (Reply) on Thursday 13, 2013

    I adopted a boy from China who had just turned 11 and was clearly in puberty. He looked 13 or 14 at least. We were shocked when we met him. We would have thought that we were lied to about his age had we not seen him four years earlier when he first arrived at the orphanage. At that time he looked about 4 years old although he was really 7. In his case it was the improved diet that he received at the orphanage that sent him into early puberty.