Early & Delayed Puberty in Children

What is puberty?

Puberty is the stage of development when a child's body begins to mature into adulthood. During this time, hormones trigger physical changes such as growth spurts, breast development, testicular enlargement, body hair and changes in body shape.

Every child develops at their own pace, and there is a wide range of what is considered normal. However, puberty that starts significantly earlier or later than expected may require assessment by a paediatric endocrinologist to determine whether there is an underlying hormonal or medical cause.

Our paediatric endocrinologists specialise in assessing children with concerns about pubertal development, providing reassurance where appropriate and investigating any underlying conditions when necessary.

What are the signs of early puberty?

Early puberty (also known as precocious puberty) occurs when puberty begins earlier than expected.

Signs may include:

In girls

  • Breast development before the age of 8 years
  • Rapid growth in height
  • Pubic or underarm hair
  • Body odour
  • Acne
  • Menstrual periods at an unusually young age

In boys

  • Enlargement of the testicles or penis before the age of 9 years
  • Pubic or underarm hair
  • Rapid growth
  • Deepening of the voice
  • Acne
  • Increased muscle development

Some children develop isolated features such as early breast development (premature thelarche) or early pubic hair (premature adrenarche). These conditions are often harmless but should be assessed to determine whether they represent normal variation or the start of true puberty.

What are the signs of delayed puberty?

Delayed puberty means that the expected signs of puberty have not begun by the usual age.

This may include:

In girls

  • No breast development by around 13 years
  • No menstrual periods by around 15 years or more than three years after breast development begins

In boys

  • No enlargement of the testicles by around 14 years
  • Slow growth during adolescence
  • Limited development of body hair
  • A voice that has not deepened

Many teenagers with delayed puberty are simply "late bloomers" (constitutional delay of growth and puberty), but some have an underlying hormonal or medical condition that requires treatment.

When should I seek medical advice?

You should consider arranging an assessment if:

  • Your daughter develops breasts before the age of 8 years
  • Your son shows signs of puberty before the age of 9 years
  • Puberty appears to be progressing very rapidly
  • Your child has not started puberty within the expected age range
  • Puberty appears to have stopped after it has started
  • Your child is distressed by delayed or early development
  • There are concerns about growth as well as puberty

Early assessment helps determine whether the changes are part of normal development or require further investigation.

What causes early or delayed puberty?

There are many possible causes, and in many children no serious underlying problem is found.

Possible causes include:

  • Normal variation in development
  • Constitutional delay of growth and puberty
  • Family history of early or late puberty
  • Hormonal disorders
  • Thyroid disease
  • Growth hormone disorders
  • Conditions affecting the brain or pituitary gland (uncommon)
  • Genetic conditions
  • Obesity, which may contribute to earlier puberty in some children

Your child's endocrinologist will carefully assess which, if any, investigations are needed.

How are puberty concerns investigated?

Your consultation will include a detailed discussion about your child's development, growth, medical history and family history.

Assessment may include:

  • Measurement of height and weight
  • Growth chart review
  • Physical examination
  • Blood tests to assess hormone levels
  • Bone age X-ray
  • Pelvic ultrasound (in girls, where appropriate)
  • MRI scan (only in selected cases)

Investigations are tailored to each child and not every child will require all of these tests.

What treatment is available?

Treatment depends on the underlying diagnosis.

Many children simply require monitoring over time, as their development falls within the normal range.

If treatment is needed, options may include:

  • Medication to pause early puberty until a more appropriate age
  • Hormone treatment to help start puberty in delayed cases
  • Treatment of thyroid or other endocrine disorders
  • Ongoing monitoring of growth and development

Your consultant will discuss the benefits and potential risks of any treatment before making a personalised management plan.

Long-term outlook

Most children with early or delayed puberty have excellent outcomes, particularly when assessed and treated promptly if necessary.

Early diagnosis can help optimise growth, support healthy emotional development and reduce the impact that puberty concerns may have on a child's confidence and wellbeing.

Regular follow-up appointments allow your child's development to be monitored and treatment adjusted if needed.