The stress of being different from peers is a problem shared in both delayed and precocious puberty. The lack of visible changes of puberty such as deeper voice for boys or breast development for girls can lead to loss of self-esteem or teasing from peers. Short stature often accompanies delayed puberty and further worsens the visible difference between peers.
Knowledge of the expected timing of puberty combats some of the stress of delayed puberty. The points for delay in puberty include the following:
- Boy – no change in testes size by age 13
- Girls – no breasts by age 13 or no period by age 16.
It is important to realize that it is testes size and not pubic hair development that is the main sign of puberty in boys.
Understanding what average timing of puberty is and when a teen and family should anticipate certain milestones of development.
The physician’s challenge in delayed puberty is determining normal vs. abnormal. Fortunately, the majority of otherwise healthy children have a normal variant in growth and puberty known as constitutional delay. Constitutional delay – “being a late bloomer” tends to run in families. Most of us can recall a classmate who probably had constitutional delay who appeared to be a totally different person a year or two after high school.
There are numerous medical conditions that negatively impact timing of puberty. Delayed puberty is a prominent feature in children affected by chronic medical conditions such as cystic fibrosis, inflammatory bowel disease or cancer survivors. A careful medical history and examination are essential in gathering clues for the cause of delayed puberty. A bone-age X-ray is an essential tool at the beginning of a medical evaluation of delayed puberty.
The bone-age X-ray looks at the appearance of the growth plates in the hand. The appearance of the growth plates is strongly influenced by puberty. Certain physical findings of puberty are anticipated at certain bone ages. More importantly, the percentage of final adult height achieved is strongly linked to bone age.
What can a family do to insure progress in puberty and when should they become concerned?
No evidence of puberty at or near the extremes of the puberty spectrum or significant stalling in the progress of puberty should raise concern in the family.
What can be done for delayed puberty?
The primary priority in approaching delayed puberty is determining whether the cause is from a serious medical condition. If the delay is not from a serious condition, reassurance can be offered. However, some children and their families may still be more concerned and distressed by the delay. Carefully monitored treatment with low doses of testosterone or estrogen can be used to “jump start” puberty in cases where there is significant distress in otherwise normal, delayed puberty.