Precocious Puberty

My nine-year-old daughter has just started her period. She has consistently been tall for her age, and began developing breasts at age seven. I know that it is unusual to begin menstruating at this age, but is it abnormal? Will it alter her growth pattern? Are my friends accurate when they say it could be caused by too much bovine growth hormone in the fast foods she eats? And how do I help her cope with this? She is mentally and emotionally still very much a nine year old.
Groton, New York

Precocious Puberty

Dr. Greene’s Answer:

There is crucial information your daughter needs to know.

First, some background: The age of onset of puberty varies widely. In girls, the breast bud is usually the first sign, and is seen on average at 10-11 years. Pubic hair usually begins to appear 6-12 months later. Next comes the pubertal growth spurt. Lastly, menstruation begins (called menarche), on average, 2-2.5 years after the onset of puberty. The mean age for a girl’s first period is 12.75 years. Wide variations are seen in the sequence and timing of these events, but peak growth velocity (fastest growth rate) always precedes menarche.

For boys, the testes and scrotum begin to enlarge first, usually at about 10 to 13 years. A few months later, pubic hair develops (facial hair comes about 2 years later). The pubertal growth spurt usually follows about 6 months after pubic hair. Lastly, the penis grows longer about 1 year after the testes grow, and is accompanied by changes in the voice.

Precocious puberty is defined as the onset of true puberty before 7 to 8 years of age in girls or 9 years of age in boys. (Isolated breast development which doesn’t progress to the rest of puberty is called premature thelarche, and is a different, benign condition). Precocious puberty is 10 times more common in girls than in boys. Sexual development may begin at any age. Pregnancy has been reported as early as 5 1/2 years old.

Most precocious puberty is simply early maturation. Nevertheless, the Lawson Wilkins Pediatric Endocrine Society recommends evaluating for an underlying medical condition in Caucasian-American girls who have development of breast and/or pubic hair before age seven and in African-American girls before age six (Kaplowitz and Oberfield, Pediatrics 1999 Oct;104(4 Pt 1):936-41). These medical conditions include ovarian cysts, thyroid problems, McCune-Albright syndrome, central nervous system disorders, or external sources of estrogen. In girls over age 6, these other causes are quite rare, but should at least be considered by your pediatrician.

Your friends have suggested that bovine growth hormone is the cause of your daughter’s precocious puberty. I strongly doubt that. The only external compounds clearly implicated in girls’ early puberty are estrogens. Moreover, when human growth hormone is intentionally given to children to increase their heights, in doses far higher than your daughter could accidentally consume, precocious puberty has not been a problem. Your friends are right to be concerned about the chemicals used by agribusiness, but from bovine growth hormone I would be more concerned about cancer.

Early maturation in girls is categorized in two main types: rapidly progressive and slowly progressive. Most girls who begin puberty early (especially those who begin before age 6) have the rapidly progressive variety. They go through each of the stages (including closure of the growth plates of the bones) at a very rapid pace, and thus lose much of their adult height potential. About 1/3 of these girls will end up shorter than the 5th percentile of adult height. Many girls, however (particularly those beginning puberty after their 7th birthdays), will start puberty early, but still go through each of the stages at a more typical pace. While their “adolescent” growth spurts are over early, they will continue to grow until their bones reach final maturity at about age 16.

Now for the crucial information: The earlier before age 12 a girl starts her period, the higher her lifetime risk for breast cancer (probably from the prolonged estrogen exposure). The highest average risk for breast cancer is in non-Hispanic white women, where it is 1 in 8, or 12.5%. In all girls who start their periods before the age of 12, taken together, the risk is 16.25%. As she reaches maturity, she needs to be made aware of controllable risk factors for breast cancer, such as use of estrogen-containing birth control pills (10 years of use would raise her risk to about 22%), first pregnancy after age 30 (if she did this also, it would raise the risk to about 35%), high-fat diet, alcohol use, fertility drugs, pesticides, and radiation exposure. Each of these factors multiplies her accumulated risk. If she is aware of these, she can make informed decisions for herself.

She can also learn what can reduce her risks. During adolescence, it is vital to teach her the habit of regular breast self-exam. If she has a child, breastfeeding will lower her risk. Strenuous exercise (particularly before the first baby), such as running, gymnastics, and ballet have all been shown to reduce estrogen exposure and thus reduce risk. Diet seems to be more important in the development of breast cancer than any other single risk factor. A low-fat diet, high in natural sources of vitamins A, C, E and zinc, is protective. Vegetables seem to be protective for other reasons as well, which is why the National Cancer Institute has come out with their “five a day” plan (which sounds hard, but is not so bad when you see what they call a “serving” — one carrot is a serving). A healthy diet is also one low in pesticides (wash fruits and vegetables thoroughly and/or use organically grown foods). It should also be low in artificial hormones, like those found in beef in the U.S. (your friends are friends indeed).

Although your daughter is still emotionally and mentally a nine-year-old, she now has the hormones of an adolescent. She undoubtedly feels a range of emotions that are difficult for her to cope with. As a parent, it is very important for you to carefully watch and listen to her. Help her put her feelings into words, and be careful not to make judgmental comments. She will probably express many diametrically opposed emotions in the same sentence and then feel confused about what she just said. This is normal.

One of the most difficult things she is facing is finding a peer group. She no longer entirely fits in with her nine-year-old friends, but it would be a big mistake for her to develop a peer group that is much older than she is (even if they would accept her). She needs people to help her bridge the gap between being a little girl and a woman. As a parent, this is an important time for you to be involved in the daily activities of her life. It may seem like a challenge to get excited about the things that she is interested in, but there is no one better equipped to help her through this difficult time than you.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. kg

    I’m 10 and I started my period at 10 my first sign was breast I was 9 then I saw so hair below called pubic hair then I had armpits hair and discharge and this summer July 15 2016 I saw so dark brown stuff on my panties it was discharge so I went to the bathroom and whipped I saw blood I did not wanted to tell my mom until it got worse so I told her July 16 2016 and she understood so we went shopping for pads and we had a talk I’m still 10 until Oct 16

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    • Dear kg,

      You are very brave to share your story. I was 10 when my periods started and I didn’t want to tell anyone either. Once I did, I felt much better.

      I know you are very young to be going through these changes. I’m glad your mom is there for you.

      Thanks again for sharing,
      @MsGreene

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  2. Sima

    I started puberty at 8-ish? Around that age, I was bigger than beyond. Already over 5ft and bigger than the other 8 or 9yrs. I was the same height as my sister and nearly as tall as my dad (but under 5’5). I started breast development around 9 (that’s when I got my period). I wore a bra between the age s of (9?)10-12. I remember borrowing one of my mom’s bras (similar to a training bra) every time I get ready for elementary school. I know this girl who 9 and she is the same as I was. She wore a bra like I did. I know this doesn’t happen to every girl, but I guess I was lucky to hit puberty earlier than the average. My sister hit puberty at a fair time, but never got her period. She’s blind and suffered from octave nerve coloboma . Not sure if that had anything to do with her not getting a period….

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  3. Rose

    Hello. I’m 13 and recently got my period. It’s only been around a year after breast development began; I don’t even fit a bra yet. I also never had a growth spurt and am still 4’11. Discharge has been coming for only around two months. I used to be over the fiftieth percentile in height, but now I’m in the tenth. Will I ever get a growth spurt?

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  4. Grace

    I’m 9 and i’ve got more hair, I sweat more and i’ve got bigger breasts than most of my friends and i’m a bit worried. I’m also sometimes quite moody.

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    • Sima

      You are not alone. This happen to me before. I started early just like that, but I think it’s pretty normal.

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  5. Emma

    Hi,

    I am so worried about my daughter who is now 4 and 5 months,having her left breast a bit big as if it is developing.

    I am afraid she is having a precocious puberty,and we are in a developing country where I think it cannot even be possible for her to get the required treatment.

    Please doctor tell me,will that breast continue growing big or it can go back.If it continues,that means that my daughter is going to have her period like in two or three years,and her stop growing?

    Please advice me !I am so worried and I don’t know what to do.

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  6. Katana

    Hi, I looked for this question and found no answer. I started to bud at the age of six, and had my puberty at the age of nine. I’m highly confused cause I wasent a chubby child and had nothing Wong with me besides having been very strong. My mother was confused also, just one day your child has no bump, and after three days later she already needs a training bra. I was confused also, I was only in second or first grade. By the time i was in third grade i had already wore D bras and quickly when to DD in fith grade. Is their any reason I would have bud before puberty?

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  7. Sofia Racha

    I’m a worried mother. My 8yrs old is spotting everyday since last month. She has no sign of puberty. I asked my doctor and she said it’s normal. But everyday can’t be normal. Pls help me.

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  8. El

    Hi,
    I started my menstral cycle when I was about 10 and a half. I’m 13 now (turned 13 in September) and only 163 cm tall. I weigh about 56 kg.
    My Father is around 181-183 cm.
    My Mother is about 159 cm.
    My mothers mum is about 155cm and her Father is about 170cm.
    My fathers mum is 165 cm and his father is 180cm.
    Anyways, to the real question here:
    Will I grow any taller?
    I just really want to be about 167-170 cm. Just 4 more cm to grow!
    Do you think I’ll make it before I completely stop growing and what height do you think I’ll grow to?
    I’m not quite sure I will grow that much anymore. I had one big growth spurt about 6 months before my mental cycle started and I grew about 10-15 cm (grew to about 157cm).
    So, I’ve grown about 6 cm in a period of 2 and a half years (since my mental cycle started.).
    I have pretty big feet and hands for my height and my family is known to have small feet and hands, especially my parents.

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    • Rose

      It doesn’t seem like it, but there’s no way to tell for sure. If you don’t reach that height, remember that height doesn’t define a person :)

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  9. Sunita

    My daughter will turn 11 on 16th January 2016 . On 12th jan she got her First Period . She Is 145 cm Tall . I am also 150 cm Tall . I am concerned about her growth. Please let me Know if she Would grow further?

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  10. Shayla

    Hi,

    I want to start off by telling the reader that I am 14 years old, and I am 5 feet. My mom is 5’5 and my father is 5’7. I had started by period when I was only in the 3rd grade, making me 8-9 years old, and during that same year had began to grow armpit hair. I had developed a small amount of breast when I was 7 years old a little bit. When I had gotten my first week of period, I began to notice, as well as my mother had noticed that I was not growing like I was before. During my junior high year (6th grade) , I was only 4’8 and my 7th grade year I was 4’9, I was growing only inches. I had doctors, that even said that I might grow anymore. So now, that I am 5 feet and 14, I need a little bit advice, has to know, will I end up having one of that growth spurt moment, where I am suddenly starting to grow normally again? Or will my growing now take time some time still? I had also join my school tennis team, and have been trying to stay healthy and active as possible, now that I fully understand, that I need to start taking care of body, and bones.

    Thank you for reading, and I would be more thankful for some advice. x

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    • Jenni

      Hi,
      I’m Jenni and I am 10. I have had puberty since I was 8, started off with breast development then pubic hair now discharge. This is all totally normal so nobody should be worried about their bodies. I’m certainly not! My period signs are there so it’s not long until that happens. My breasts are painf so nobody worry, that’s normal. If you want to find out more about your bodies just search up Puberty. You should ask your parents for anything more private. Thank you for reading and hope this helped.

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      • Princess Faye

        Hi I’m the same age as you. I also have the same symptoms but recently I had my period and I’m still waiting for it to stop… It’s kind of embarrassing to say but it’s true. I wonder if puberty can stop though.

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  11. Alexcia

    I comment was posted below, please read

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  12. Alexcia

    Hi
    I’m 11 and I’ve been having my period for a year.
    I started puberty at 6, am I normal ?
    I’ve got breasts of an adult and some boys are fighting over me ( not exactly but they say they want me real bad)
    What do I do ?
    I’m also a depressed girl .

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    • Princess Faye

      Hi,
      I’m only 10 but I’m going through the same thing as you, except the puberty at 6 part. Normally at 11 you can get those kinds of breasts but just remember to wear something like a sports bra to keep it in. (I’m a girl so it’s ok) If you don’t I highly suggest it. About the boy part, your probably pretty in real life and those boys may see that, it’s what they call ‘criss cross love’ so prepare for the battle. Try to lighten up or daydream, play some sports with your friends too.

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  13. Sara Walker

    My daughter is a10 year old. She is “mentally” mature for her age. She developed some pubic hairs at about 5 years. She’s developing breast buds that became noticeable, just a few months, ago? She seems to be paying very close attention to them. She seems to, also be very, excited. I, on the other hand have had talks with her on preparation. But, what is or could be, our next step? For example;
    I thought about sending her to school with a pad or a liner, just in case, she does start her cycle at school. But, do you think, I should do that?

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    • Corza

      Definitely send a liner or thin pad. My nine year old daughter got her period yesterday. She has breasts and pubic hair so I knew it was coming. I explained about cramps and about listening to her body to understand when it might happen. Yesterday she wore a liner to school because she thought she might get her period and she did. I went out and bought four kinds of pads for her to try so she would have something comfortable. If she hadn’t had something with her it would have been an extremely negative experience. Preparation is always a good thing.

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  14. taylor locklear

    i am 12 years old i have a lump on my right breast i have showed my mother the lump but the lump doesnt hurt or anything im just scared that it is something serious like breast cancer my great anut had breast cancer also the lump is close to were my nipple is it feels like a golf ball and its kindly big & i started my period about a year ago i havent had my period in 2 months im so scared should i be worried

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    • Gloria fletcher

      Get to a doctor and get tested!!

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    • Princess Faye

      Please don’t be worried but there is a possibility that you may get breast cancer so I really I MEAN REALLY get a doctor as quick as you can.

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      • Princess Faye

        Sorry I made a mistake
        Real one: so I really I MEAN REALLY think that you should get a doctor ASAP

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  15. Jasmine

    My daughter turned 8 yrs old, August 10, 2015. The school just called me today, 10/6/2015 to inform me she came to them and told them she was bleeding. The nurse thought maybe she cut herself. My daughter said no, my mom said I will need one of those pad things when it happens. Thank God, I talked to her a few months ago about pads, just in case. She went to her well check up a couple of weeks ago, and I informed her doctor her mood changes/emotions are all over the place lately and she is changing. The doctor recommended American Girl book (the care and keeping of you)

    She started wearing a training bra when she was 4 yrs old, the doctor said it was normal for some children to show some signs of chest growth early. This year they got progressively larger and over the summer she started to grow pubic hair. Her doctor projected she will start her cycle next year around school time or shortly after but between 4th or 5th grade. She was wrong. :-(.

    I’m so not ready for this to happen to her at such a young age. But it is! I know there is Lupron injections, or Histrelin implant and other medicines that can stop her body from producing hormones, and stop the cycle until she is older. But are there any serious side effects to this with her being 8 yrs of age. Also, I’ve read her growth can stop 2 yrs after her cycle stops (that’s age 10) when 16 yrs of age is the norm. I don’t want this to happen to her if I don’t do anything. But if I do, do something, I don’t want her to have serious side effects.

    I’ve just started doing a lot of research, and have reached out to her doctor to discuss other options, but any good sound advice is helpful if anyone has done the shots. My friends say to be excited for her and treat her extra special, but I’m so sad that this is happening to her at such a young age, and she is handling it so well when I talked to her on the phone in the nurses office. It’s hard to be excited right now. I didn’t prepare myself for age 8. Oh by the way: my mom was 14 and I was 9 when I started my cycle. My mom chose not to give me the shot because the doctors told her it messes with the child’s mind. However medicine is more advance now. Has anyone tried the shots? Did it cause any serious side effects? My daughter has also had severe allergies/asthma since she turned 3 months. Seasonal allergies year around and they continue to get worse even with the medicines as she gets older. I will have to find out if there are any drug interactions with her allergy medicine to any of the hormone treatments as well, if I decide to go that route. Thanks for your help.

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    • Princess Faye

      Try to keep watch maybe write it down and wait to see what happens… Keep watch and make sure she doesn’t have her period at that age. In the ages between 10 and 15 she should have her period.

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    • Sima

      I remember when I was 9, I was sitting on the toilet and then discovered some blood inside of my panties. I said “Uh Mommy?” and probably said “There is something wrong…”. I wasn’t freaked out or nothing just slightly scared. That’s when my mom told me I was on my period.

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  16. kit

    I have a 8 and a half year old boy and he is getting pubic hair on his testicles. So did my husband at the same age. Should I be concerned and start intervention or leave it be

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    • Shayla

      Hi Kit,

      I just wanted to let you know, that if your husband is saying, that he had also began to get pubic hair around the same time, your son has. The it is normal, because it’s in your son’s genes, from the dad’s side. It’s very common for kids to start puberty around the same age that a parent had began as well (there are a few other articles online talking about this topic). Hope this helps :).

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  17. Sophie

    Hi, I just started my period and needed help and I don’t want to tell my mum because it was very heavy and never had cramps. It’s just that I had a really bad cold for two days and it felt very sticky down there. I have grown breasts, public hair, but don’t have hair growing out of my arm pits. Btw — I am a 12 year old girl (turning 13 tomorrow) that is very scared. Do I get pregnant when I have my period.

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    • Hi!

      I am not Dr. Greene, but perhaps I can help with advice from a woman.

      I started having my periods at age 10. I didn’t want to tell my mother, either. Of course, when I did, she understood perfectly. I very much encourage you to tell your mum.

      Starting your periods is a signal that your body is becoming fertile. If you have unprotected sex when you are fertile, you can become pregnant. Additionally, birth control is not 100% effective, so if you are fertile, you might become pregnant even if you are using birth control.

      I hope that’s helpful, but it’s only a very small answer to the many questions you’re likely having. If your mum can’t help, you need to find a kind adult that you trust to help guide you through this process.

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      • Sophie

        Thanks I thought I was gonna get pregnant. And I heard that giving birth hurts!

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      • Princess Faye

        Yeah THANK GOODNESS… For the next 10 years I won’t go boy hunting. (I actually never went boy hunting but you know what I mean) I hope that a peck on the cheek won’t cause pregnancy though

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    • Kendra

      It is important to tell your mom that you have started. At your age, it is normal to start your period. Starting your period does give you the ability to get pregnant, but unless you are sexually active, you will not get pregnant.

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  18. Alexis Pollard

    My daughter is 8 years has hair, complains for tummy ache, perspiration smell, has pimples. Does that means she will soon have menstrual?

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    • Alicia mom of 5...

      Hi. Absolutely she is near starting. I just dealt with all of those things with my 9 year old and she had this going on for about a year and just the other day she started her period I really figured it would take even longer but she got 1 year from the time she started the hormone bumps,pubic hair,and boobs.. Good luck!

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      • tiana

        Hi I’m 10 and my mom says I might start my period this year do you think I will?

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        • Lm

          Well you probably don’t know when it will happen. I’m 11 and I started it a month after my bday.

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        • Princess Faye

          Yes, I’m the same age as you and I’m still on my period. The truth is it doesn’t actually doesn’t hurt at all and you don’t actually have to stay on the toilet for days

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  19. Leslie

    My daughter, who is 9, came to me yesterday afternoon and told me that she is bleeding below. I looked seriously at her and said to not joke with me and if she is we need to get cleaned up. She then denied it. We went to the bathroom and sure enough my daughter has now become a young lady. I told her its normal, she wasnt scared. I went and go the right size pads for her (I was not expecting a 9 yr old to start) I should have seen more of the signs as she started to wear training bras half way of school last year and had hair already growing prior to that. A few months ago she got her first pimple, and her face clearned up nicely! Earlier this week she complained of a sore tummy but nothing else. I will be switching her to a female ped soon so she will be more comfortable talking about girly things. I know its part of life but it feel as if my little girl is leaving me. :( I plan on letting her keep being a 9 yr old !!! Shes so young and still a child. So for those reading this: My daughter started to develop a chest about 7 months ago. Hair I would say a year ago. In the past month her chest has gotten a little bit bigger and has started her monthly.

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    • Tina

      My 8 year old just started this weekend. We knew it was coming but thought there waa at least a year before menses. I’m So worried she will be short like me. I’m only 5’1. I too started towards the end of 9 years old. Dr. Thought she would not fully start until 9-10

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  20. Sonia

    Hi my daughter is 7 year old and her breast starting develop. She is very Young in her age. I feel so worried can u suggest me what shall I do to stop her early puberty.

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  21. Melinda Valdez

    My 8 yr old has just started discharging a clear thin white mucous. While I’ve been reading that that is normal…what I am alarmed about is that I’ve read that this is indication that she will start her period within a yr. My concern is that she hasn’t even began developing the symptoms of puberty such the development of breasts…nothing other than this..is this a sign she is going to go into puberty and not necessarily get her period?

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  22. Jenny

    Hi Dr Greene,

    I have a wonderful 9 year old and she is also developing quickly. We have been back and forward to our doctor over the past year with pain in her tummy, she has been complaining of sore breasts with a small lump behind nipple and has started developing pubic hair. Last week she had a sore throat and then developed a pain in center of her chest, which has continued since Friday, we have seen our doctor and he feels that it is all growing and developing pains. I’m very worried. She showed me a lump on right side of pubic bone the size of golf ball this evening, which has since gone down after an hour or so. Is all of this connected?

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  23. Helen Choi

    Thank you Dr. Greene. Your message has helped me to understand my child’s emotional state and how I can help to bridge the gap for her from being a child to a woman by listening and to be a friend to talk to.

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  24. Anish

    I have a 9 year old daughter. She’s got all of the above signs and more.

    Her breast are quite developed. She has pubic hair, a bunch of them, even on her armpits. She already has been through menarche, now she has regular period, once every 28-30 days. She has pimples on her face, more pronounced on her forhead.

    These are only physical changes and bodily changes. However, the other issue that I am facing is that she has started hanging around more with boys than girls. And, moreover she likes a boy a year older to her. In fact, have come to know that they hug each other in the store room at school. She likes other boys in the school too.

    Being a single father, this has left me very tensed & worried. Her mother left her when she was 4 years old. She doesn’t even remember her mother. I have been taking care of her myself for the last 5 years. We are from India, Asian in origin.

    Kindly give me guidance as to how to deal with this. Should I take her to a Child Counselor or Psychologist. Or should I go myself initially.

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    • sara

      Yes take her to a female pediatrician, so she can talk to your daughter and explain about being a girl and growing up. Your daughter will be more comfortable that it is a female doctor, also it would be good for a woman counselor at the school to talk to your daughter and you as well so you can understand what your daughter is going through.

      Don’t forget to ask the doctor for some pamphlets on girls and puberty when you take your daughter to the doctor. There is no such thing as too much information. It will help you both understand it more. Also it’s good idea to urge your daughter to visit a counselor to talk about how she feels with her mom being gone. Your daughter needs to open up about what she is feeling. Leaving feelings inside and not expressing them will cause her to be angry. I know you don’t want that. Keep being a great and understanding Dad.

      Your friend and mother of 3 daughters ages 15, 11, and 10. SARA.

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      • Annette

        The same thing is happening to my daughter she got her period today this morning and she is very uncomfortable her breast have been a little too big for her age. And she has 2 friends that are girls and the rest are boys

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