five-year-old as a teenager. >> mcfarland: if a child is going through early puberty, there are ways to slow down the condition, and in some cases, even reverse the symptoms. [upbeat instrumental music] ♪ >> male announcer: major funding for healthy body, healthy mind is provided by: endo pharmaceuticals-- an integrated healthcare solutions company focused on providing patients with branded products, specialty generics, and a suite of complimentary devices and services. and by amgen, a biotechnology company committed to providing novel therapeutics to address unmet medical needs in the treatment of cancer patients. additional funding provided by: and by: >> mcfarland: going through puberty is awkward enough for most teenagers, but imagine a five-or-six-year-old girl with obvious breast development, body hair growth, or who's getting taller than other children her age. early puberty, also known as precocious puberty, is not generally life-threatening, but it can be life-changing for the children and their families who go through it together. puberty as we know it today has changed throughout the course of human history. >> what? >> maybe i'll start shaving soon. >> 200 years ago or so, the average age of puberty as indicated by the onset of per w and that's gradually become earlier and earlier, probably largely because of better socio-economic conditions, better nutrition, and less chronic disease. the trend toward early puberty continued until at least the 1950s, with the average age declining progressively over time from 19 to around 12 1/2. >> we can think of puberty as kind of a bridge between childhood and adulthood. it refers to the specific developmental period, during which a lot of changes occur. [playing ambling piano music] >> mcfarland: six-year-old iris has been a performer nearly all all of her young life. ♪ >> iris loved music from a very early age. she would sing to me before she could speak. in fact, she was slow to speak, but she was quick to sing, if that makes any sense. some people i guess are like that. she's very creative. she considers herself an artist. >> mcfarland: indiana resident and mother of two colleen can remember when her baby girl started blooming prematurely. >> i remember, you know, looking twice at, you know, she doesn't look like my son did at that age. she had little breast buds before she could walk. >> normal puberty is defined really by the normal population. and in girls the onset of puberty typically begins between 7 1/2 to 8 years, all the way up to 13 years of age. and in boys the normal onset of puberty is defined as being between age nine and age 14. so there's a very wide spread of normal. >> precocious puberty is defined as early maturation. it is the process of normal puberty, but occurring at a younger age than it should. >> mcfarland: precocious puberty is kind of a broad term, and under that umbrella are several categories. >> one of those is typically called central precocious puberty, which refers to the normal reproductive system within the body being turned on early. >> mcfarland: most children who exhibit early puberty have central precocious puberty, or cpp. and cpp is much more common in girls than in boys. >> central precocious puberty usually occurs without a known cause. there are instances, however, where there is disruption of something in the brain that allows puberty to proceed earlier. >> there is a signal in the brain that starts the puberty, and then that signal come from the brain to the pituitary in form of gonadotropin releasing hormone also called gnrh, or lhrh. when that hormone begin to be stimulated, the pituitary will start to produce the sex hormones-- lh stands for latinizing hormone, and fsh, which stands for follicle stimulating hormone. these hormones in turn turn on the gonads to make the sex steroids, which cause the secondary sex characteristics typical of puberty. >> it's important to realize that the controls develop during fetal life. and so by the time of birth, there is the potential of the apparatus, the base of the brain, the hypothalamus, and the pituitary, to secrete hormones of puberty and stimulate precocious puberty. >> mcfarland: unfortunately, as of right now, doctors can't predict who will be at risk for developing precocious puberty. when iris started exhibiting more signs of puberty, colleen, who was living in italy with her family at the time, started seeking medical attention for her daughter. >> when we were spending the year in italy, i sent an email to the pediatrician here in indiana, asking her, you know, i said, "i know you told me not to worry about this, but come on. things are blooming." i noticed her breasts had fullness-- not little buds, but round fullness that just seemed too mature. actually she was growing very quickly. she looked like a tall toddler. >> mcfarland: having a child who is going through puberty years before or she is expected to can be a scary thing. trying to understand why it's occurring in the first place can often be even more concerning. this is 12-year-old joshua. by looking at him, you'd think he was a teenager. when joshua was 10, his parents got the news that not only does he have precocious puberty, but his 10-year-old body was that of a 15-year-old. >> i waited till we had his annual physical. and his doctor examined him. one thing a mother does not want to hear, he looks up at me and says, "yeah, he's pretty well developed." [chuckles] and i was just shocked 'cause this is my baby boy. he's only 10. >> mcfarland: joshua may be younger than he looks, but he seems to understand the problem. >> precocious puberty is, like, when you are maturing way too quickly. >> mcfarland: signs of puberty include adult body odor, hair under the arms and face, pubic hair, sudden growth spurt, acne or oily skin, voice changes in boys, changes in mood-- what people think of as teen moodiness-- and menstruation in girls. [girl shouts indistinctly] talia is four years old. she's a happy kid who loves to spend as much time in the pool as she can. >> talia i think would be described as an old soul. she doesn't like anything that a typical four-year-old. so her favorite thing in the world is justin bieber. she loves the color blue and anything to do with law enforcement, police officers, dogs... >> cops. >> cops, cars. >> mcfarland: when talia was only nine months old, new parents desiree and eric started noticing something unusual. >> i started to notice a smell like a teenager that's going into puberty. so she kind of had that sweaty, stinky gym smell to her. but we weren't sure 'cause we were new parents and we were older, and maybe kids go through that. >> [chuckles] >> mcfarland: talia started growing rapidly, and by the time she was 18 month sold, she not only had adult body odor, she started to develop breasts and pubic hair. it was at that time that the trujillos were referred to dr. kletter, a pediatric endocrinologist at swedish medical center in seattle, washington. >> hi. how are you doing? i'm dr. kletter. nice to meet you again. >> mcfarland: a pediatric endocrinologist specializes in diagnosing and treating precocious puberty. >> can you give me a high five? and the parents should bring the kid to the physician to have an assessment. if he or she suspect there is precocious puberty, they will either order the appropriate test or make the necessary referral to a specialist. >> mcfarland: dr. erica eugster is a professor of pediatrics and the director of pediatric endocrinology at riley hospital for children at indiana university health. >> before the child's put into a room, the height and weight are obtained and they're plotted on the growth chart, and the child's obviously blood pressure and pulse are measured. >> we're going to go around here to see how tall you are, okay? >> and then we have a way of staging pubertal development in children, which is called the tanner stages. and so we tanner stage the breast development. we tanner stage pubic hair. if it's a boy, we actually measure testicular volume. at the end of the visit, we can decide what if any tests are needed. >> so this is part of the camera, and i'm gonna bring the camera over, and this is what's going to take your picture. >> the first test that i find most useful is the skeletal maturation, which is a film of the wrist to the tip of the fingers called a bone age x-ray. skeletal maturation will show an advancement over the chronological age in a kid who has a true rise of the hormones. >> and then the second thing typically involves blood tests, and here we're measuring hormone levels. and the most important one in terms of evaluating puberty is called lh, or latinizing hormone. this is a hormone produced by the pituitary gland that stimulates the ovaries. then the last thing that the child undergoes would be a brain mri scan. and here we are looking specifically at the hypothalamus and the pituitary to make sure that there's no structural abnormality. >> mcfarland: joshua kellogg underwent a bone age x-ray that revealed his bones were in puberty. >> now, we're taking he's age 10 at this point. his bone growth was already showing that he was 15 years old. and that, you know, was the concern, was that his body was already five years head of his mind side. >> ready? >> i shuffled them. >> mcfarland: for talia, her bone age revealed that she was growing way too fast. >> and what we learned was, as children go, they get bones in their hands or they get certain... >> we have seven bones, right, and they all grow together as you get older. and her bones had shown that she was 4.2 years-- this was, like, between 4.2 and, you know, 4.6. so there was, you know, a variance between there. but as we looked at the pictures of her hands, you could actually see the bones coming together. and as soon as dr. kletter saw that, he knew exactly what it was. >> you down. >> mcfarland: dr. peter lee is a pediatric endocrinologist and a professor of pediatrics at penn state university hershey school of medicine. >> i think it's fairly clear that precocious puberty has been happening throughout the history of mankind, although it has not been well documented until relatively recent. precocious puberty back then was diagnosed as a consequence of the physical development that we're seeing. hormones couldn't be measured, causes couldn't be delineated, and there was no treatment for it at that point. >> mcfarland: while going through puberty is not necessarily dangerous or life-threatening, children who develop precocious puberty, and are not treated, may be left with some consequences later on in life. >> their main issue is maturing at a younger age. this will affect their height because they'll have less years to grow, and then will rapidly end up short. there is a effect on their psychosocial well-being. if you're maturing when no one else does, you look bigger than your size, people treat you accordingly because people who do not know who you are think and expect from you more by your size, which creates frustration when your brain has not reached that maturation. there's also peer-to-peer interactions. >> 'cause when your body develops, your emotions all automatically come to it, and he didn't understand that-- you know, mood swings, crying very easily, but then getting angry real fast. he didn't really understand, you know, all that. >> mcfarland: and there are emotional consequences that the families have to face as well. >> and in talia's case, she was so big and looked so much older than her actual age, there were a few circumstances where there was a reaction from somebody in the public. one very specifically was on the ferry. i was changing her diaper, and she was not quite two. she was in a diaper because there was concern she could start her period early, and so we kept her into diapers. and because she was so incredibly big-- she really looked like she was three or four years old-- a woman in the bathroom made a comment about, i should potty train my child. [laughing] i was pretty angry. it was concerning only not that i was embarrassed, but i actually... sorry. yeah. i was concerned that we were gonna see that she would see more of that, that it... it would not have bothered me if the woman would have asked. but she made a judgment. >> mcfarland: while the emotional impact on patients and family members can be difficult, there are treatments available for children with precocious puberty. when children are diagnosed early, treatments stabilize the hormones, slow the advancement of puberty, and in some cases can reverse some of the physical changes that have occurred. when we come back, we'll take a look at those treatments and find out how they work. did you know that the term precocious puberty was coined in the 1940s by alvin hayles, a physician who dealt with childhood development. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: >> if you didn't know the dates on these two, it would almost be difficult to tell them apart. >> well, the earlier a child is evaluated and diagnosed, the earlier that treatment can be initiated. and the outcome of the treatment is definitely going to be influenced by, you know, the time at which the treatment was begun. so and then the predictability of that outcome becomes less and less as a child gets older. so it's absolutely essential to make the diagnosis early and begin therapy as soon as possible. >> there's really only one treatment for precocious puberty that's effective, and that treatment turns off puberty temporarily, and that is the use of the gnrh analogues. if you use the gnrh analogue in adequate doses, it blocks the effect of gnrh and blocks the pituitary from secreting hormones, so one creates a prepubertal environment, or if you will, a hypogonadal state, and everything that has been stimulated by those increased hormones will stop or regress. >> mcfarland: there are different ways to administer gnrh analogues, or gnrh agonists. >> the most common historically has been to give a monthly intramuscular injection. however, there also are daily preparations that can be given either intranasally. >> mcfarland: both talia and iris started on injections of gnrh, but switched to an alternate therapy, which is a small, flexible implant placed beneath the skin that provides therapy for a year. the fda approve the implant with a recommended dose of one implant every year. this means every 12 months, the implant must be removed and replaced with a new one in order to continue therapy. essentially, the implant is a small medication-filled tube that is surgically implanted into the child's arm. >> the tube is designed to have tiny pores in the walls to allow a steady diffusion of the medicine for up to one year. and this implant is placed in the subcutaneous tissue right under the skin, usually in the inner aspect of the upper arm. >> that implantation should be considered a minor surgical procedure. >> mcfarland: it minor surgical procedure, there are always risks. the most common side effects with the implant therapy are at the sight of the implant. they include temporary bruising, pain, soreness, redness of the skin, and swelling. the age of the child when beginning therapy will determine how long he or she will continue to receive the medication. >> if a child is diagnosed at age three, then we certainly are going to treat them for, you know, quite a while, probably five or even six years. but there's no absolute criteria for when you discontinue therapy. >> how's your arm been since we did the implant. >> good. >> mcfarland: the idea is to get the child as close to the age of actual puberty before removing them from the medication. joshua received his implant soon after he was diagnosed. >> i wasn't looking forward to him growing up so fast. i think that's the hardest for me. you know, it doesn't matter that i have a younger child. josh will always be my baby too. his growing up too fast has been very hard for me. >> cannonball! >> mcfarland: talia and iris received their implants and have been doing great. >> feels like this, but it looks like that. sometimes i forget it's even there. >> mcfarland: as far as pain goes, iris says... >> no way. but except when i'm getting it in. it hurts. >> i think it's very important for parents of children that have precocious puberty, if there isn't an underlying identifiable driving abnormality that this is a variation of normal. >> mcfarland: and normal is what the pants spoke with want for their children. >> that she grows to be normal and happy and she doesn't let any of this keep her down. always be positive. >> and she's a kid with a great deal of self-esteem. it's given her some experience that she wouldn't have gotten otherwise. >> i expect her to continue to do--well, she does gymnastics, and she's showing interest in soccer. and i expect her to continue to show interest in all kinds of differenthings. and i expect her to wel in school d sty ha, learhow to pick up after herself. and make healthy choices. and... [chuckles] continue in her music. i just expect her to grow up to be a happy, hlthy child who goes to bed tired at night and proud of her day. >> mcfarland: a child with precocious puberty can live a happy and healthy life without any long term consequences. the key is catching any developmental changes early on, because the earlier this condition is diagnosed and treated, the better it will be for the child. th's it for this edition of healthy body, healthy mind. i'm dr. scott mcfarland. see you next time. if you'd like to see this program again or watch any of our other healthy body, healthy mind programs, please visit our website at: to answer any specific questions you may have, be sure to contact your health care provider. to comment on today's program, please call: or email: or visit our website at: >> announcer: major funding for healthy body, healthy mind is provided by: endo pharmaceuticals-- an integrated healthcare solutions company focused on providing patients with branded products, specialty generics, and a suite of complimentary devices and services. and by amgen, a biotechnology company committed to providing novel therapeutics to address unmet medical needs in the treatment of cancer patients. additional funding provided by: and by: captioning by captionmax www.captionmax.com gcgcww >> "sit and be fit" is a free, convenient way to stay functionally fit. so let's get ready to have some fun. sit and be fit made possible in part by vq actioncare.com, when you imagine your future, you wanted to be healthy and active. stay strong. 1-800-570-6220. 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