Early or delayed puberty

Also called Precocious puberty, Pubertal delay

Puberty arriving much earlier or later than expected. Usually a normal variant, and sometimes the first sign of something that needs finding.

What it is

Puberty starting before eight in girls or nine in boys is considered early; not starting by 13 in girls or 14 in boys is considered delayed.

**Early puberty** is far more common in girls, and in most of them no cause is found. In boys it is much less common and much more likely to have an underlying cause, including a brain tumour, so a boy with early puberty warrants more thorough investigation than a girl. Other causes include problems of the adrenal gland or ovaries and testes, and previous brain injury or radiotherapy.

Beyond the medical causes, early puberty has real consequences: a growth spurt that finishes early, so final adult height is reduced; and a child dealing with an adult body, periods, and adult attention, while still a child emotionally. That combination has safeguarding implications and needs thinking about explicitly.

**Delayed puberty** is most often constitutional delay of growth and puberty, a normal variant that often runs in families and resolves without treatment, though the wait can be miserable. Other causes include chronic illness, coeliac disease, inflammatory bowel disease, low body weight, intensive exercise, eating disorders, Turner syndrome in girls and Klinefelter syndrome in boys.

Treatment exists for both, and the psychological impact is a legitimate reason to treat, not merely a soft consideration.

Signs you might notice

Early puberty: breast development before eight in a girl; testicular enlargement before nine in a boy; pubic or underarm hair; a growth spurt; body odour and acne; periods before around ten.

Delayed puberty: no breast development by 13 or no periods by 15 in a girl; no testicular enlargement by 14 in a boy; being much shorter than peers; and distress about it.

Needing prompt assessment: early puberty in a boy at any age, because of the higher chance of an underlying cause; very rapid progression; headaches, visual problems or vomiting alongside; or signs of virilisation in a girl.

Also assess: delayed puberty with poor growth, bowel symptoms, weight loss, or a chronic illness.

Safeguarding: a child who looks physically mature but is chronologically and emotionally young is at increased risk, and that deserves active thought.

How it can affect day-to-day life

The social experience is the part clinicians most often overlook. A nine-year-old with periods, or a fifteen-year-old boy who looks eleven, faces daily difficulty at school, in changing rooms and among peers, and that is a legitimate reason to treat rather than watch.

For early puberty, practical support means explaining periods to a young child in an age-appropriate way, arranging school toilet and changing facilities, and briefing staff.

Treatment for early central puberty pauses it with regular injections or an implant until an appropriate age, preserving height and giving the child time.

For delayed puberty, a short course of low-dose testosterone or oestrogen can start things off and is often transformative for confidence, and it is under-offered because clinicians know it will resolve eventually.

For boys, height and development anxiety is rarely voiced and frequently profound.

Bone age X-rays are used to estimate remaining growth and are part of standard assessment.

Chronic illness that delays puberty needs treating in its own right; catch-up often follows.

Supporting someone well

Get early puberty in a boy assessed promptly; the chance of an underlying cause is higher.

Get early puberty with headaches, visual change or vomiting assessed urgently.

Ask for paediatric endocrinology referral rather than watching indefinitely.

Ask about treatment to pause early puberty, and about final height.

Support the child socially: explain in age-appropriate terms, brief the school, and arrange practical facilities.

Think about safeguarding where a child looks older than they are.

For delayed puberty, ask about coeliac disease, bowel disease, thyroid function and chromosomes.

Ask about a short course of hormone treatment for delayed puberty; the psychological benefit is real.

Take the distress seriously; it is a reason for treatment, not a side issue.

Where to get help

A GP practice for referral to paediatrics or paediatric endocrinology.

Urgent referral for early puberty in a boy, or with neurological symptoms.

Pituitary Foundation for hormone conditions.

Coeliac UK and Crohn's and Colitis UK where a bowel cause is found.