In Review
Precocious Puberty: A Comprehensive Review of Literature

https://doi.org/10.1111/j.1552-6909.2007.00145.xGet rights and content

Context

Precocious puberty currently affects 1 in 5,000 children and is 10 times more common in girls. Statistics indicate that girls in the United States are maturing at an earlier age than they did 30 years ago and the number of girls with diagnosed precocious puberty (the appearance of secondary sex characteristics before 8 years of age or the onset of menarche before age 9) is on the rise. A summary of the growing body of literature on this topic is necessary to inform nurses and other health care providers of the current trends and incidence of precocious puberty to better meet the physical and psychosocial needs of these girls and their families.

Methods

EBSCOhost Research Databases that included CINAHL Plus, Health Source: Nursing Edition, MEDLINE, PsycINFO, and Women’s Studies International were searched for journal articles published in the past 10 years (1997‐2006) that explicitly examined precocious puberty in females and proposed theories to describe the phenomenon. Search terms included precocious puberty, sexual maturation, menarche, and secondary sex characteristics. These terms were searched individually and in combination with proximate determinants such as endocrine disruptors, environmental toxins, phthalates, stress, skin care, genetics, age, ethnicity, obesity, and assisted reproduction. The search yielded 947 articles addressing this issue.

Results

Eighty‐two studies or case reports met the criteria for inclusion in this literature review that captured six attributable causes of early sexual maturation in female children. These included genetic, ethnic, and pediatric obesity, as well as environmental toxins that disrupt endocrine function (chemicals, toxins, plasticizers, infant feeding methods, skin and hair products, assisted reproductive technologies), psychosocial stress, and early exposure to a sexualized society. The robustness of the reports varied and few of the studies were widely generalizable but did offer suggestions for assessment and nursing care.

Conclusions

Precocious puberty has health and social implications that are complex and influenced by multiple factors. Further research is needed to expand and elucidate theoretical relationships between the early development of secondary sex characteristics in young girls and the proposed causative factors.JOGNN, 36, 263‐274; 2007. DOI: 10.1111/J.1552‐6909.2007.00145.x

Section snippets

Precocious puberty and early sexual maturation

Puberty is a complex developmental process that begins in late childhood and is characterized by maturation of the hypothalamic‐pituitary‐gonadal axis, the appearance of secondary sexual characteristics, acceleration of growth, and ultimately the capacity for fertility (Kakarla & Bradshaw, 2003). There is evidence that girls are maturing at an earlier age and that precocious puberty is on the rise (Egli, 2003, Gillis and Schenker , 2002). Precocious puberty, seen more frequently in girls,

Endocrine disrupting chemicals

Synthetic and naturally occurring substances in the environment that affect the normal function of the endocrine system are referred to as endocrine disrupting chemicals (EDCs). An EDC is a chemical that either mimics or blocks hormones, thereby altering the normal hormone levels and endocrine function of the body (National Resources Defense Council, 1998, Wu et al., 2003). They can either accelerate or delay puberty due to their interruption in normal hormonal activity. Exposure to EDCs in

Assessment of the prepubertal and pubertal child

A comprehensive biopsychosocial assessment of the preteen girl experiencing early onset of puberty or pregnancy is of utmost importance. In addition to the usual components of a comprehensive examination, the assessment should include anatomic and physical markers as well as molecular and cellular biomarkers (Ritzen, 2003, Rockett et al., 2004, Traggiai and Stanhope, 2003). The evaluation of a girl demonstrating signs of precocious puberty requires a complete clinical history with an emphasis

Nursing care and interventions

The ACOG (ACOG, Committee on Adolescent Health Care, 2006) recommends that the initial visit to the gynecologist for health guidance, screening, and provision of preventive services should take place by age 13. Girls who demonstrate precocious development should be referred at an earlier age whenever secondary sex characteristics begin to appear. At these visits, nurses can furnish information about menstrual hygiene, menstrual protection, sexual activity, contraception, and sexually

Conclusions

Precocious puberty has physical, psychological, and social implications that are complex and influenced by many factors. A young girl exhibiting extremely early sexual development faces tremendous social stigma with probable negative effects on her health and well‐being (Mul, Oostdiijk, & Drop, 2002a). Health care providers play an integral role in coordinating services to these young patients and have the potential to influence society’s view of the developmental needs of this portion of the

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      This phenomenon, whose molecular basis remains partially unfolded, is the reflection of the strong influence of nutritional and metabolic cues on the hypothalamic centers governing puberty onset. Notably, perturbed timing of puberty has been linked also to higher disease burden later in life (Day et al., 2015; Elks et al., 2013; Velie et al., 2005), with an increased risk of cardiovascular and metabolic pathologies, as well as higher susceptibility to various oncologic, cognitive, and behavioral disorders (Cesario and Hughes, 2007; Day et al., 2015; Golub et al., 2008), and even reduced life expectancy (Lakshman et al., 2009). Much has been learned in recent years about the neurohormonal pathways responsible for the tight coupling between body energy status and puberty onset.

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