Early puberty?

[neuroticmum]

My daughter started breast development when she was six years old.  She is now eight years old, and although her breasts are not significantly larger, tests have shown that her bone age is about a year advanced of her actual age.  I don't know how significant this is - is that a small or a large difference?  She has recently had blood taken and an abdominal ultrasound, which we should get the results from in a few weeks.  What questions should I be asking her paediatrician?  She has not yet started her period, although she has said that her pants sometimes feel a bit damp, and she is now suffering stomach pains - could this be onset of menstrual cramps?  Sorry to ask so many questions, but I am concerned what the effects on her long-term might be, and worried about the reason for it happening at all!

[Deanna L Aftab Guy, MD]

Breast development prior to age 8 or so needs sooner evaluation than others. She may indeed have early signalling of the pituitary hormones. I would ask her pediatrician to refer you to a pediatric endocrinologist. They could get levels while waiting to include LH, FSH, estradiol, TSH, free T4, these are the puberty hormones and thyroid hormones that are helpful in looking at other causes.
A pelvic ultrasound from the abdomen will look at her ovary to see if there is a cyst causing the estrogen effect.
Yes, since she had breasts at age 6 she needs an evaluation.
In regards to the almost 9 year old I also evaluate those girls to be sure that it is just a normal tempo of puberty. So workup might include just a bone age and a good history and physical to determine if labs or other workup is needed.

[grace5]

Another neurotic mum here...

My daughter is the same age (will be 9 in two months) and I've got the same concerns.  I will do more research on the topic.  Do you have an appt with a paediatric endocrinologist?  Great Ormond Street would be the place for that.  I am guessing you are in the UK by the language you use.  I used to live in the UK.  

With my best,

Grace