24th November 2023

Puberty

Puberty can be an exciting yet sometimes tumultuous phase for children and their parents alike! Puberty refers to the stage in life through which a child undergoes both physical and emotional changes to reach sexual maturity.

Puberty onset

The onset of puberty is denoted by the emergence of secondary sex characteristics such as testicular enlargement in males, breast development in females and increased body hair for both genders. The average age for males to begin puberty is around 12, while girls tend to begin earlier at around 11. However, it’s important to remember that it’s normal for puberty to begin at any point between the ages of 9-14 years in boys and 8-14 years in girls. On average, puberty lasts for a total of 3-4 years.

What happens if a child begins puberty before the age of 9 in boys or 8 in girls? Well, this is called precocious puberty (PP), which essentially means early puberty. PP is comparatively more common in girls. Most of the time, there is no obvious identifiable cause; therefore, the condition is termed idiopathic precocious puberty. Rarely, medical conditions, including hormone disturbances, tumours, brain abnormalities, infections, or trauma, may be responsible for PP. Treatment typically requires medications that impede puberty.

Conversely, delayed puberty can occur if children pass the age of 14 without evidence of any signs of puberty. This can be caused by genetic variations, chronic illness, malnutrition or a variety of hypothalamic, pituitary and gonadal disorders. Thus, the evaluation and management of delayed puberty relies on the primary pathologic cause.

The Tanner stages of puberty

James Tanner, a British paediatrician, conducted a twenty-year study and, in 1969, identified five distinct stages that makeup puberty. These stages of puberty refer to the physical changes that occur during adolescence as a result of hormonal changes in the body. These changes are commonly observed in both boys and girls. It is beneficial to have an overall grasp of the Tanner stages, as these questions may appear in the MRCPsych exam.

One of the earliest signs of puberty in girls is the onset of secondary breast development, known as thelarche. Thelarche typically occurs in Tanner stage 2 and is followed by the appearance of pubic hair in stage 3. In girls, a growth spurt (a quick period of growth) typically occurs between Tanner stages 2-3, with most girls having completed their spurt by the age of 15 years old.

Menarche, or the onset of the first period, usually occurs in Tanner stage 4, which is marked by further breast development and the growth of pubic hair. It is worth noting that the onset of menarche is typically preceded by the onset of thelarche by approximately two years.

Pubarche, or the onset of pubic hair growth, is typically preceded by the appearance of the breast bud and occurs in Tanner stage 3. In boys, pubarche is often followed by the pubertal growth spurt, which typically occurs during stages 3 to 4 and is completed by stage 5 in most boys.

References

• Berberoğlu M. (2009). Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. Journal of clinical research in pediatric endocrinology, 1(4), 164–174.
• Palmert, M.R. & Dunkel, L. (2012). Delayed Puberty. The New England Journal of Medicine, 366: 443-453.
• Tanner, J. M. (1992). Growth and development of children and adolescents: Normal patterns and abnormal results. In J. F. T. Bradley (Ed.), Pediatric endocrinology (pp. 3-18). Philadelphia: W. B. Saunders.