AAP Publishes Guidance on Treating Early Puberty

The American Academy of Pediatrics (AAP) has issued new guidance to help pediatricians and primary care physicians manage patients with early signs of puberty. The new clinical report has become necessary, as studies have show breast and pubic hair development occurring at younger ages.

Pediatricians and primary care practitioners have been working from a standard of 8 years of age in girls and 9 years of age in boys when diagnosing central precocious puberty (CPP). The new report highlight recent research that calls this standard into question, and recommends that physicians look for a number of indicators before referring patients to a specialist for testing:

  • For girls: Early breast development showing a clear progression over an observed 4- to 6-month period, especially when the patient crosses growth percentiles upward; Tanner 3 breast development before the age of 8 years.
  • For boys: enlargement of the penis and/or testes before the age of 9 years showing a clear progression over an observed 4- to 6-month period, especially when the patient crosses growth percentiles upward.

“Reassurance without testing usually is the best strategy, with referral in selected cases that are atypical or to reassure anxious parents,” advised Paul Kaplowitz, the report's lead author. “Even when genital hair appears before age 1, it generally does not indicate a more serious hormonal disorder.”

The goal of the report is to review the development process, and help practitioners identify early-onset features of puberty that are “benign normal variants of puberty,” the authors explain. This is in contrast with children who may be experiencing CPP and evaluated for further treatment by specialists, such as an endocrinologist.

The report “aims to help primary care providers deal with these situations more knowledgably and efficiently, and to co-manage the more benign scenarios with specialists,” Kaplowitz wrote in an accompanying editorial. “The majority of such cases are normal variations that require neither testing nor treatment,” he added. “Yet knowing when to worry and when to reassure may be challenging to sort out during the visit.”

The full report will be published in the January issue of Pediatrics.

—Drew Amorosi

Reference:

  1. Kaplowitz P, Bloch C, the Section on Endocrinology. Evaluation and referral of children with signs of early puberty. Pediatrics. December 14, 2015. doi:10.1542/peds.2015-3732.