What is the most obvious signal to a girl that puberty has begun for her?

Editor’s Note: Former CNN correspondent Pat Etheridge is a journalist specializing in children’s health and family issues. She previously hosted CNN’s “Parenting Today.”

Physical changes don't mean puberty is imminent

There's no evidence that hormones or other chemicals are to blame

Experts think the obesity epidemic might be one trigger of early puberty

The trend toward early puberty is not as pronounced with boys

Should a mother be alarmed if her daughter begins to sprout breast buds and pubic hair at 7 or 8?

At the annual conference of the American Academy of Pediatrics this week in Orlando, Florida, pediatric endocrinologist Dr. Paul Kaplowitz explained that these early physical changes are quite common among American girls and represent a new norm.

“I spend a lot of time reassuring parents – usually, this does not signal a rapid progression into full puberty,” said Kaplowitz.

What’s normal?

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Obvious signs of development, such as budding breasts, pubic and underarm hair and body odor are appearing sooner in girls. But there has been only a slight shift in the age of menarche (the first period) over the past four decades. In the United States, the average age is 12.5 years, down from 12.75 in 1970.

“Once breasts begin to develop, it takes at least two to three years before menarche,” said Kaplowitz, also author of “Early Puberty in Girls: The Essential Guide to Coping with This Common Problem.”

“Time is the most accurate test of how puberty is going to progress.”

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When is it too soon?

There is debate about what constitutes the actual onset of puberty, but it is considered “precocious” when breast enlargement is accompanied by a growth spurt before age 8.

In most cases, the process will slow down or stall – something a pediatrician can monitor closely. A more rapid progression may warrant tests by an endocrinologist to rule out serious problems such as tumors or cysts.

Treatment options

There are treatments to delay early menses and ward off another consequence: premature aging of the bones that ultimately can lead to stunted growth and being short as an adult. Recommendations for drug or hormone therapy are based on the child’s age, rate of development, growth rate and emotional maturity.

Psychosocial aspects are important, too. Kaplowitz is cautious with medication but acknowledges, “suppressing puberty may alleviate behavioral issues and girls’ feelings of being different from peers.”

The other big issue is understandable: Parents simply don’t want their very young daughters having periods. “They worry about the risk of pregnancy or even how they will handle hygiene,” said Kaplowitz.

“It was a shock,” recalls one woman whose daughter started her period at 10. “Even though there were signs and we had talked about menstruation, she was not emotionally prepared. She came home from school scared and upset to be the first among her friends.”

Why is this happening?

There are lots of well-publicized theories about the causes of precocious puberty. Yet, there’s no consistent body of evidence that hormones in milk or other foods, chemicals in the environment or sexual messages in the media are to blame.

Boys – like girls – hitting puberty earlier

Kaplowitz contends the premise that holds the most weight is the epidemic of obesity.

He helped conduct a 2001 study of 6- to 9-year-old girls that links body fat to the timing of puberty. Other findings support this conclusion, but there are many other contributing factors.

In this country, African-American and Hispanic girls tend to reach puberty earlier than their white counterparts. There are varying explanations. Globally, patterns of early puberty appear to be influenced by everything from economic conditions to climate to genes.

Another conundrum: Although boys are getting facial and pubic hair at younger ages, the trend toward full-blown early puberty is not as pronounced as it is with girls.

Other doctors attending the AAP conference reinforced the complexities of the topic.

“The appearance of acne and pubic hair is common even in infants and toddlers. It goes away. We need to be careful about how we identify the true onset of puberty,” said Dr. Lawrence Silverman, a pediatric endocrinologist at Goryeb Children’s Hospital in Morristown, New Jersey.

Talking it through

Parents should not hesitate to get guidance from their pediatrician about how to talk with their child.

“It may mean having a sooner-than-expected conversation,” Kaplowitz advised. “If you remain calm, your child usually will respond well.”

Girls who blossom early need reassurance that, even when it happens ahead of schedule, the process is a normal part of life.

Video: Some girls hitting puberty earlier

How will my child change between the ages of 10 and 14?

Throughout our lives we grow and change, but during early adolescence the rate of change is especially evident. We consider 10-year-olds to be children; we think of 14-year-olds as "almost adults." We welcome the changes, but we also find them a little disturbing. When children are younger, it is easier to predict when a change might take place and how rapidly. But by early adolescence, the relationship between a child's real age and her* developmental milestones grows weaker. Just how young teens develop can be influenced by many things: for example, genes, families, friends, neighborhoods and values and other forces in society.

As they enter puberty, young teens undergo a great many physical changes, not only in size and shape, but in such things as the growth of pubic and underarm hair and increased body odor. For girls, changes include the development of breasts and the start of menstruation; for boys, the development of testes.

Adolescents do not all begin puberty at the same age. For girls, it may take place anywhere from the age of 8 to 13; in boys, on average, it happens about two years later. This is the time period when students' physical characteristics vary the most within their classes and among their friends—some may grow so much that, by the end of the school year, they may be too large for the desks they were assigned in September. Others may change more slowly.

Early adolescence often brings with it new concerns about body image and appearance. Both girls and boys who never before gave much thought to their looks may suddenly spend hours primping, worrying and complaining—about being too short, too tall, too fat, too skinny or too pimply. Body parts may grow at different times and rates. Hands and feet, for example, may grow faster than arms and legs. Because movement of their bodies requires coordination of body parts— and because these parts are of changing proportions-young adolescents may be clumsy and awkward in their physical activities

The rate at which physical growth and development takes place also can influence other parts of a young teen's life. An 11-year-old girl who has already reached puberty will have different interests than will a girl who does not do so until she's 14. Young teens who bloom very early or very late may have special concerns. Late bloomers (especially boys) may feel they can't compete in sports with more physically developed classmates. Early bloomers (especially girls) may be pressured into adult situations before they are emotionally or mentally able to handle them. The combined effect of the age on the beginning for physical changes in puberty and the ways in which friends, classmates, family and the world around them respond to those changes can have long-lasting effects on an adolescent. Some young teens, however, like the idea that they are developing differently from their friends. For example, they may enjoy some advantages, especially in sports, over classmates who mature later.

Whatever the rate of growth, many young teens have an unrealistic view of themselves and need to be reassured that differences in growth rates are normal.

Most experts believe that the idea of young teens being controlled by their "raging hormones" is exaggerated. Nonetheless, this age can be one of mood swings, sulking, a craving for privacy and short tempers. Young children are not able to think far ahead, but young teens can and do—which allows them to worry about the future. Some may worry excessively about:

• their school performance;
• their appearance, physical development and popularity;
• the possible death of a parent;
• being bullied at school;
• school violence;
• not having friends;
• drugs and drinking;
• hunger and poverty in the country;
• their inability to get a good job;
• nuclear bombs and terrorists attacks on the country;
• the divorce of their parents; and
• dying.

Many young teens are very self-conscious. And, because they are experiencing dramatic physical and emotional changes, they are often overly sensitive about themselves. They may worry about personal qualities or "defects" that are major to them, but are hardly noticeable to others. (Belief: "I can't go to the party tonight because everyone will laugh at this baseball-sized zit on my forehead." Facts: The pimple is tiny and hidden by hair.) A young teen also can be caught up in himself. He may believe that he is the only person who feels the way he feels or has the same experiences, that he is so special that no one else, particularly his family, can understand him. This belief can contribute to feelings of loneliness and isolation. In addition, a young teen's focus on herself has implications for how she mixes with family and friends. (" I can't be seen going to a movie with my mother !")

Teens' emotions often seem exaggerated. Their actions seem inconsistent. It is normal for young teens to swing regularly from being happy to being sad and from feeling smart to feeling dumb. In fact, some think of adolescence as a second toddlerhood. As Carol Bleifield, a middle school counselor in Wisconsin, explains, "One minute, they want to be treated and taken care of like a small child. Five minutes later they are pushing adults away, saying, 'Let me do it.' It may help if you can help them understand that they are in the midst of some major changes, changes that don't always move steadily ahead."

In addition to changes in the emotions that they feel, most young teens explore different ways to express their emotions. For example, a child who greeted friends and visitors with enthusiastic hugs may turn into a teen who gives these same people only a small wave or nod of the head. Similarly, hugs and kisses for a parent may be replaced with a pulling away and an, "Oh, Mom!" It's important to remember, though, that these are usually changes in ways of expressing feelings and not the actual feelings about friends, parents and family.

Be on the lookout for excessive emotional swings or long-lasting sadness in your child. These can suggest severe emotional problems. (For more information, see the Problems section.)

The cognitive or mental, changes that take place in early adolescence may be less easy to see, but they can be just as dramatic as physical and emotional changes. During adolescence, most teens make large leaps in the way they think, reason and learn. Younger children need to see and touch things to be convinced that they are real. But in early adolescence, children become able to think about ideas and about things that they can't see or touch. They become better able to think though problems and see the consequences of different points of view or actions. For the first time, they can think about what might be, instead of what is. A 6-year-old thinks a smiling person is happy and a crying person is sad. A 14-year-old may tell you that a sad person smiles to hide his true feelings.

The cognitive changes allow young teens to learn more advanced and complicated material in school. They become eager to gain and apply knowledge and to consider a range of ideas or options. These mental changes also carry over into their emotional lives. Within the family, for example, the ability to reason may change the way a young teen talks to and acts around her parents. She begins to anticipate how her parents will react to something she says or does and prepares an answer or an explanation.

In addition, these mental changes lead adolescents to consider who they are and who they may be. This is a process called identity formation and it is a major activity during adolescence. Most adolescents will explore a range of possible identities. They go through "phases" that to a parent can seem to be ever-changing. Indeed, adolescents who don't go through this period of exploration are at greater risk of developing psychological problems, especially depression, when they are adults.

Just as adults, who with more experience and cognitive maturity can struggle with their different roles, adolescents struggle in developing a sense of who they are. They begin to realize that they play different roles with different people: son or daughter, friend, teammate, student, worker and so forth.

Young teens may be able to think more like adults, but they still do not have the experience that is needed to act like adults. As a result, their behavior may be out of step with their ideas. For example, your child may participate eagerly in a walk to raise money to save the environment—but litter the route she walks with soda cans. Or she may spend an evening on the phone or exchanging e-mails with a friend talking about how they dislike a classmate because she gossips.

It takes time for young teens and their parents to adjust to all these changes. But the changes are also exciting. They allow a young teen to see what she can be like in the future and to develop plans for becoming that person.

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