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EDUCATION CORNER
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    Puberty

    Puberty is the initial stage of adolescence, in which along with physical development, the body becomes capable of reproduction.

    The Pubertal changes include:

    • Appearance of secondary sexual characteristics
    • Physical growth to adult size
    • Attainment of reproductive capacity.


    Role of Hormones in Puberty

    The body undergoes various hormonal changes by which children flourish into mature adults. The onset of puberty occurs by the pulsatile release by the hormones present in the brain at two separate axis:

    • Brain hormones stimulate the reproductive organs (testes and ovary) to release sex hormone (i.e. estrogen in females and testosterone in males). These hormones are responsible for the growth of primary sexual characters viz. testes and penile growth in males and breast and uterine growth in females.
    • Brain hormones also stimulate the adrenal gland (located at the top of each kidney) to release androgens responsible for secondary sexual characteristics viz. pubic and axillary hair, acne, axillary odor. 

    The pattern of pubertal development in girls:



    Pubertal development varies in boys and girls. Puberty starts at around the age range of 8-12yrs in girls and in boys it starts in the age range of 9-14 years.


    Pubertal changes in girls: The 1st visible sign of puberty in girls is the appearance of the breast bud (thelarche). Breast development is asymmetrical in the initial phase. This is followed by the appearance of pubic hair (pubarche) and the onset of menstrual cycles (menarche). Menses typically occurs 2-2.5 years after breast development.

    Enlargement and development of the female gonads, widening of the hips, accumulation of fat are the other less obvious changes that occur.This is also the period of the peak growth in height of adolescents.


    Pubertal changes in boys: Enlargement of the testicles and gonad is the first visible sign of puberty in boys which is followed by penile growth with thickening and pigmentation of the scrotum.

    • This is followed by the appearance of pubic hair, underarm and facial hair. Development of larynx (Adam's Apple) results in a hoarse voice.
    • There is a rapid increase in height and an associated increase in muscle mass. Sperm production starts at the age of 14 years.


    Puberty concerns and issues

    During puberty, most of the changes are normal physiological and can be tackled by knowing about them. Some changes require early attention and treatment.


    First menstruation or Menarche: Menarche is the onset of menstruation, which occurs on average age of 12-13 yrs. As the female body is getting prepared to have a child in future years, there is an onset of the cyclical vaginal bleeding that occurs as a part of a woman's monthly cycle.

    Menstruation may be irregular initially for the first few years before the attainment of regular ovulatory cycles. If the problem of irregular menstruation continuous or develops later an expert consultation is advisable.


    Vaginal discharge: With the development of the female gonads during puberty, the cervix elongates, vagina thickens and lubrication increases leading to the appearance of clear vaginal discharge.


    Unilateral breast development: It is a quite common breast abnormality often seen in children who are younger than 12 years. It is distinguished by the evolvement of a unilateral breast mass correlating with asymmetrical breast development. It is true that one breast grows earlier than the other in some cases. However, in most of the cases, the breasts take symmetrical shape ultimately.


    Early puberty (precocious): Onset of puberty before the age of 8 years in girls and 9 years in boys is considered precocious puberty.

    Precocious Puberty occurs either due to the abnormal stimulation of brain hormones at various levels or due to autonomous sex hormone production.This early development of pubertal changes may be restricted to one component of puberty like premature breast development, premature pubic hair, premature menses or it can involve all the aspects.

    Early puberty is common in girls and may represent normal variation if it progresses slowly. But it is advisable to seek expert consultation as apart from psychological impact, precocious puberty may lead to early bone maturation and shorter final height.


    Expert consultation and full endocrine workup are recommended in girls with a rapidly progressive form of precocious puberty.

    Precocious puberty is less common in boys and is usually associated with significant pathology, so a quick expert consultation and endocrine workup are mandatory.


    Delayed Puberty: Delayed puberty is more common in boys than girls. Delayed Puberty in girls is defined as lack of breast development by the age of 13 or absence of menses by the age of 16 years or 5 years after pubertal onset.

    While in boys, a lack of testicular enlargement by the age of 14 years is suggestive of delayed puberty. In most of the cases, it is simply a case of late bloomer which does not need any medical treatment. But rarely can it be due to some illness, low fat, hormonal imbalance, hereditary, etc.

    For a complete evaluation, expert consultation and full endocrine workup are recommended.

    Frequently Asked Questions

    It can be due to Delayed Puberty in which breasts don't develop by the age of 13 or more. You should consult your doctor for proper diagnosis and treatment so that timely action can be taken. 

    Only a few women have utterly symmetrical breasts and it is quite common for one breast to be a little larger than the other. Different breast size can be due to asymmetrical breast development. Often, one breast develops earlier than the other. If you are in your puberty stage, there are chances that your breasts ultimately become symmetrical. 


    Although most of the girls have their first period by the time they are 14 or 15, lack of menses does not necessarily mean there is a problem. But it is wise to visit your doctor for proper diagnosis and treatment so that timely action can be taken. 


    Yes, this can be due to early puberty, referred to as precocious puberty. The type of Puberty that starts before the age of 8 in girls and before the age of 9 in boys is known as precocious puberty. In most of the cases, there's no medical problem at fault and it is simply an early start of puberty for no reason. But it is always wise to refer a doctor if your child experiences such changes. This condition can be cured by balancing hormones through medicine and is nothing to fear about.


    The crucial landmark of puberty in girls is menarche, usually, menstruation starts on an average between the ages of 12-13. Menstruation is a big change for every girl child and it can definitely make her anxious. So your role as a mother should be very assertive and calming. Talk with your child and explain to her that this is totally normal and she is not alone who is getting this change. But if you find it difficult to manage, see a health professional and take her help. 

    -    Set limits

    -    Be clear

    -    Give reasonable choices

    -    Grant independence in stages

    -    Health and safety come first

    -    Say no to choices that cut off future options

    -    Guide, but resist the temptation to control

    -    Let kids make mistakes

    -    Allow them to make actions and have consequences

    Adolescents undergo various physical changes and become more and more conscious about their looks and personality. That is why your daughter is conscious about her self-image. Apart from this, social media and peer group interaction also contributes to stress and confuse them about their decisions and choices. But you need to be assertive and talk to her frequently that more than looks it is the inner personality that matters, and she is beautiful from inside and out. So, encourage her to be positive and to be beautiful. 


    It is completely normal for a growing girl to experience pain as their breasts grow and this is nothing to worry about. Breasts develop due to the release of hormones estrogen and progesterone at puberty. These hormones make the breast tissue grow and this results in stretching of the surrounding skin, which is one reason breasts can hurt when they grow. This pain often passes quickly but if required, there are treatments that can help. These include over-the-counter painkillers, such as ibuprofen, and pain-relieving gels.


    Both girls and boys face skin problems like acne, pimples and cleanliness is not the only reason behind it. However, it's often triggered by hormones. During puberty, a lot of hormones are produced which often lead to sexual development, mood swings, excessive oil secretion, etc. It is an outcome of this surplus oil getting locked in skin pores that generate pimples on the surface of the skin. These normally disappear in a few days or weeks, so there is no need to worry about it. But if you feel a little conscious about it, then there are various counter medications available for its treatment in the market. Apart from medications, a healthy routine, and a diet with a lot of water intake and reduced stress help in reducing pimples. 


    This is because of the flush of hormones and the changes caused by them in the body of your daughter. So it is absolutely normal for your girl to be cranky and aggressive. Follow the tips mentioned in the section “Role of Parents during child puberty phase”. 

    Punishment is not a solution to any issue. In fact, it can make your child more defiant or rebellious. You can refer to the “Role of Parents during child puberty phase” section and take appropriate steps. 


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