is it puberty?

[anxiousmom007]

My daughter is 9 years 2 months old. She is very slim built- approximately 48lbs, 4ft.6inches tall. She used to be extremely low-weight until last year (generally at the 3rd percentile), but otherwise healthy and fit, and around the 20th percentile for height. Over the past year, she gained both height and weight, although is still by no means "overweight" Still is pretty skinny. This summer I noticed pubic hair, and am not sure I see any breast changes. She had some pubic hair at 8, but her ped. assured me that it was just fine normal hair, not the typical pubic hair. We are of Indian(Asian) origin, hence she has darker hair and it shows more. However, I notice this year that the pubic hair has definitely increased. She is an active, healthy young girl but has a sister, now 16, who was diagnosed with hypothyroidism at a very young age, and is on thyroxine ever since. She is short, at just over 5 ft.
I do not want to cause anxiety to my daughter, but although she shows none of the symptoms her sister had, should I consult an endocrinologist? If these are pubertal changes, should anything be done to slow them down if all thyroid functions are normal, in order to ensure she grows to her height potential?
Please advise.
Thanks

[Deanna L Aftab Guy, MD]

this sounds like premature adrenarche-normal normal early production of part of the adrenal gland that matures just at this age (anywhere from age 6-8 in most kids).
I would first ask your pediatrician to talk with a ped endo to see if any tests are needed, honestly I would get a bone age-xray of her left hand, if it is not advanced beyond normal range for her age this is very very reassuring and I would simply follow her.
Also Indian decent and middle eastern and african american and hispanic families tend to have this a little earlier-also those children born very small for gestation tend to have robust adrenal glands that helped them out during stress like times and they can be seen with slightly earlier adrenarche as compared to their classmates. The adrenal glands are on top of our kidneys they have stress hormones, adrenaline and corticosteroids and mineral retaining hormones as well as sex steroids(male and female hormones) that usually give us most of the annoying symptoms like body odor,  oily hair, skin and pubic hair and even axillary hair.
The female hormones are true puberty that us moms worry about-breast development, ovulation and menstruation, this is from the brain signalling to the ovaries that lead to increased estrogen and true puberty.

[delilah001]

A related discussion, my 3yrd old daughter was started.

[anxiousmom007]

A related discussion, puberty advancing too rapidly? was started.

[anxiousmom007]

Thank you. I am glad I contacted you. I am relieved that things are normal with my daughter.

[Deanna L Aftab Guy, MD]

ok, tanner 2 is fine for a 9 yo, also tanner 1-2 is fine for her age as well and the bone age is not advanced, there is normal variation and she is right where she needs to be! Glad she is not overweight. So it is hard to say how long she will take to change stages as this is yet to be known and determined by her body alone along with genetics but from all that you have told me I totally agree with your pediatrician. In my girls I see them every 4-6 months when their bone age is advanced, so seeing your doc in another 4-6 months for a check up is fine-this will settle your mind as well!
Glad to hear the good news.

[anxiousmom007]

Thank you, Doctor. I did as you said. The pediatrician told me that my daughter is in stage 2 for breasts, and between stage 1-2 for pubic hair, but according to her, this finding at age 9 years 3 mo. is not abnormal. We also had a bone age xray done, which showed a bone age of 9 years 5 mo. which is just a couple of months advanced of her chronological age, again acc. to pediatrician very normal and nothing to worry about. My child is 55 lbs. and 52 inches in height, therefore by no means overweight and with no evidence of fat on her body. I would like to know if you agree with the pediatrician. Should we follow her up more than once a year? Bearing in mind that the bone age is consistent with chronological age, would she continue to grow normally over the course of puberty? Could she reach menarche early? How long does it take for a child in stage 2 to reach stage 4 typically?
Thanks so much.