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What It Is and What It Isn't Some kids start puberty too early. The fancy name for this is Precocious Puberty. Medically, it is defined as puberty occurring under the age of 9 for boys and 8 for girls. This occurs to about 1 in 5,000 to 1 in 10,000 children. I'm not talking about starting the ugly attitude early (although that may be part of it). The physical body changes can begin in elementary school (or earlier) which interferes with the child attaining their full adult height. This is a huge issue for Turner Syndrome girls, but also is significant for children with Russell-Silver Syndrome, Septo Optic Dysplasia, or several other syndromes. In addition to interfering with adult height, Precocious puberty can also lead to social difficulties as well. It is important for parents to watch for the signs of Precocious Puberty. Some of the signs are:
Causes and Work-Up The majority of the time, physicians do not know what causes Precocious Puberty. Your physician may order several tests to rule out a tumor or other remote causes for Precocious Puberty. If no reason is determined, it is called CPP or Central Precocious Puberty. A bone age x-ray will be done at the evaluation. If the child's bone age is one year older than their chronological age, this helps to confirm the diagnosis. Often a pelvic sonogram will be done to rule out a steroid secreting tumor. Height and weight of the child will be recorded. Additional confirmation of the diagnosis is done thru a GnRH stimulation test. (GnRH stands for Gonadotropin releasing hormone). A subcutaneous injection is given and then 45 minutes later blood is drawn to measure LH and FSH (Leutinizing hormone and follicle stimulating hormone). Treatments Injection of Lupron Depot every 28 days is the treatment. Lupron, a synthetic hormone, is a very thick liquid and has to be given deep into the muscle. It is imperative that the child not miss a dose because the hormones will begin again and growth will not be suppressed. Lupron is not a drug that you can find at your local retail pharmacy. It has to be ordered thru the pediatric endocrinologist office. Depending on your insurance company, they will have contracted with a home health pharmacy that will mail you the Lupron. Then you take the drug to your pediatric endocrinologist for the injection. The most common side effect from Lupron is a small rash or redness at the injection site. Other side effects reported are hot flashes, bone pain, loss of appetite, slowed weight gain, painful urination, and increased hair growth. Be sure to report any of these symptoms to your physician. We suggest you mark on a calendar when the 28 days occurs for at least 6 months at a time. If the 28th day falls on a week-end or holiday, then you must bring in your child early for the Lupron. It is much better to give Lupron earlier than later. The GnRH test is ordered by the endocrinologist, and used periodically during Lupron treatment, to verify that the Lupron dosage is correct. As the child grows, they may require more Lupron to keep puberty suppressed. Lupron is a very expensive drug. Approximately $1125.00 for 11.25 mg. This is a bio-engineered drug. Obviously, you will want to verify coverage with your insurance carrier. Many patients need to take Lupron for several years so the expense can be exorbitant. Once the child has reached their appropriate adult height, Lupron administration is stopped and the normal puberty changes begin again. Practical Tips Lupron injections can be painful because the medication is so thick and requires a fairly large, long needle for administration into the muscle. Using the gluteus maximum or (Thigh) muscle are the most often used sites. Depending on the age of the child, distraction or reward system can be used every month when it is time for the Lupron. For example, have your child bring their favorite toy to squeeze during the injection, or toy to play with while they are waiting. Tell them you will take them for their favorite soda or candy after the appointment. If you can work out a fun ritual to use each month, then a negative situation can be turned into a more positive one. “Yes, it is time for the shot again. Where do you want to go for your treat afterwards?” Another “game” we have played each month is bringing a bag of small used books or toys to give away at the endocrinology clinic. We have discussed how many less fortunate kids go to the clinic, many with nothing to play with while they wait. This makes us feel good to share what we have with others. Also, this is another way to turn a negative situation into a positive. One can always find another person who has a rougher, tougher road. We have discussed that many of these kids are facing more serious medical problems than Precocious Puberty. This has helped get the focus off the painful shot and onto the tough things others have to endure. For the young child, this discussion would not be understood. However, with an older elementary aged child, this might help them gain a new perspective and compassion for others. Resources TAP Pharmaceuticals, maker of Lupron Depot, has a Patient/ Parent Support Kit that is excellent. It contains a book for the parent, a storybook for the child, a brochure for your local doctor, and a Terry Too-Soon Doll. The booklets are easy to read and understand. (www.toosoon.com) The MAGIC Foundation (Major Aspects of Growth in Children) is another good resource. They can provide you with free brochures, growth charts, newsletters, and information on endocrine disorders affecting children's growth and development. (www.magicfoundation.org) For More Information MMFK is available for fee-based private consultation, lectures, and speaking engagements. For more information and fee schedule, please contact us. |
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