Cases of precocious puberty increase in the pandemic – 08/16/2022

The anticipation of puberty, something that has been observed for a few decades, gained strength during the covid-19 pandemic with the increase in cases of early maturation.

The phenomenon, which has been seen in the offices of pediatricians and endocrinologists around the world, also intrigued doctors at the Bambino Gesù Children’s Hospital in Rome, who decided to clear up the doubt by comparing the data with the year before Covid.

Result: the cases more than doubled in a year, jumping from 118 in 2019 to 246 in 2020 in the Endocrinology Unit of that service. Although preliminary, the Italian study reinforces a general impression among professionals.

It is known that the beginning of sexual maturation has to do with genetic and environmental factors. The age at puberty of the parents, development in the fetal period and even factors such as obesity influence this moment. In girls, the first signs are the appearance of the breast bud —the ball under the areola— and a small increase in breast volume.

In about 15% of them, the initial manifestation is the appearance of pubic hair. In boys, the first sign is the enlargement of the testes, which is usually followed after about 6 months by the growth of the penis and the appearance of pubic hair.

It is considered precocious, that is, before the expected moment, if these changes happen before the age of eight in them and nine in the boys.

bad consequences

The arrival of this stage of maturation prematurely can have negative consequences for the child, both physical and psychological. This is because it accelerates the closing of the epiphyseal cartilages, the part of the bone responsible for growth, which restricts the final height of that teenager. In the long term, it can also increase your risk of breast cancer, for example.

“Not to mention emotional issues, because often the child is not yet ready to deal with these changes”, says pediatrician Debora Kalman, from Hospital Israelita Albert Einstein. In girls, for example, dealing with the onset of menstruation and all its discomfort is one of the problems of precocious puberty.

In recent years, it is speculated that the increase in obesity and exposure to certain products have accelerated this process. Substances present in plastics, such as BPA and phthalates, in addition to pesticides, can work as endocrine disruptors, capable of triggering hormonal changes.

Scientists still don’t know, however, exactly why the pandemic would have accelerated this process even further. But they have some clues. It is known that children gained more weight, became more sedentary and were more exposed to screens. The use of electronics, in addition to encouraging physical inactivity, also impacts the melatonin cycle, which is also associated with the anticipation of puberty.

“There is no single cause, what we have are associations, a combination of factors”, says Débora.

Parents and guardians must be aware of their children’s bodily changes. Presence of breast bud and increased testicular volume are the biggest alerts, and in these cases it is worth consulting a doctor. “Treatment must be individualized. Global assessment of the growth channel, bone age, hormones and emotional maturity is necessary to decide the cases in which we can observe or in which a hormonal block is necessary to interrupt this process”, explains the doctor.

When indicated, hormonal blockade is performed monthly, with intramuscular injections, and treatment should be followed up by a pediatric endocrinologist to assess the response and treatment time.

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