[FONT=Lucida Sans Unicode]I recently read an article on another forum regarding precocious puberty in adopted children and a recent post reminded me of it. Did you all know this? Again another interesting result of our kiddos early beginnings impacting them biologically. The human body is amazing.[/FONT]
[FONT=Lucida Sans Unicode]And just out of curiosity...anyone's agency or SW ever mention this? I never heard of it until just recently...but there is quite a bit of info out there on it. [/FONT]
early puberty
Development of signs of sexual maturity that occur well before age eight in girls and age nine in boys. Some children have shown pubertal changes as young as age three or four years. In otherwise normal U.S.-born children, there is generally no identifiable cause in girls, but in about 50% of boys there is an underlying medical problem, such as a hormone-secreting tumor. In adopted children, early puberty is recognized and reported most often in girls, although careful studies indicate that boys are also at risk.
Precocious puberty is seen in some U.S.-adopted children, especially those with central nervous system abnormalities such as cerebral palsy or [URL=""]FETAL ALCOHOL SYNDROME[/URL]. However, early puberty is reported most often in children adopted from other countries and who have shown dramatic catch-up growth after adoption.
In one study reported in Archives of Disease in Childhood in 1998, Italian researchers studied 19 girls adopted to Sweden from developing countries, (15 children were from India) and who were referred to a specialist for the onset of early puberty. The researchers reported that the children showed signs of "chronic undernutrition" at the point of adoption. They divided the girls into children adopted before the age of four and children adopted after age four. The age at adoption had little association with the age at the onset of puberty (six and one-half to seven years), but the girls adopted younger were somewhat taller. Hormonal treatment to suppress the precocious puberty was not very successful, in part because many girls were referred when the puberty was too advanced.
The theory suggested by some researchers for an early puberty in some children adopted from other countries is that the abrupt change from deprivation and malnutrition to relative affluence and psychological security may have triggered the body into launching into an early puberty. Thus, the altered diet of the girls in the study could have exacerbated puberty.
Said the researchers, "Before adoption these girls were mostly on a low protein, low energy, vegetarian diet, which changed to a balanced enriched diet after adoption . . . Improved nutritional conditions increase insulin-lie growth factor 1, which would stimulate both the maturation of ovarian follicles and their oestrogen production, and also the hypothalamic secretion of gonadatrophin releasing hormone, favouring sexual maturation."
Girls who are adopted from other countries before age three are less likely to experience an early puberty than girls adopted after that age. In addition, girls who show a dramatic growth spurt within two years of adoption are more likely to experience an early puberty.
Sometimes a seeming early puberty is not "precocious" but is actually appropriate. For example, a child's age may have been underestimated because of deprivation or small size.
Early puberty can be difficult for a child and family to deal with. The child may be more sexually mature than her classmates or older siblings, causing teasing and resentment. Parents may have their own difficulties coping with puberty that occurs early. The child may be expected to behave more maturely than his or her chronological age. Many children adopted from a background of abuse or neglect may be emotionally very immature, exacerbating the problems of dealing with puberty.
Treatment. Medications to suppress menstruation in children with early puberty do not halt the pubertal maturation and do not change a too rapid maturation of bone growth. Very young children (under age five) with precocious puberty may gain some benefit from drugs to directly suppress the pituitary gland in the brain, thus giving the child more years to grow in height. An early puberty could otherwise put an early halt to increases in height.
Experts such as pediatrician Jerri Ann Jenista, M.D., say that children with even subtle signs of early puberty, such as acne, body odor, pubic or underarm hair, should be evaluated by an experienced pediatric endocrinologist to
[*]determine if this is an early puberty,
[*]make sure there is no other cause,
[*]decide whether treatment could benefit the child.[/LIST]Early recognition provides the probability of the best outcome, says Jenista.
Jerri Ann Jenista, M.D., "Understanding and Dealing with Early Puberty," Adoption/Medical News 2, no. 2 (February 1996): 1-4.
Increased Risk of Precocious Puberty in Internationally Adopted Children in Denmark
Grete Teilmann, MDa, Carsten B. Pedersen, MScb, Niels E. Skakkebk, MD, PhDa and Tina Kold Jensen, MD, PhDc
a Department of Growth and Reproduction GR, University Hospital of Copenhagen, Rigshospitalet, Denmark
b National Centre for Register-based Research, Taasingegade 1, University of Aarhus, Aarhus, Denmark
c Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark
BACKGROUND. Studies have indicated that internationally adopted children have an increased risk of developing precocious puberty, but no epidemiologic risk estimates have previously been calculated. We aimed to assess the risk of developing precocious puberty in intercountry adoptees, children immigrating with their family, and descendants of immigrants living in Denmark.
METHODS. Patients who were registered with the diagnosis of precocious puberty during the period 1993–2001 were identified through the national patient registry. The background population of children born from 1983 to 2001 were identified through the unique Danish Civil Registration System and subsequently categorized as being Danish (N = 1062333), adopted (N = 10997), immigrating with their family (N = 72181), or being descendants of immigrants (N = 128152). The incidence rate ratio of precocious puberty was estimated by log-linear Poisson regression. All rate ratios were adjusted for age and its interaction with gender and calendar year. P values were based on likelihood ratio tests, and 95% confidence intervals were calculated by Wald's test.
RESULTS. In the study period, 655 children developed precocious puberty during 5627763 person-years at risk. Adopted children were followed during 39978 person-years at risk, during which 45 girls and 6 boys developed precocious puberty. The risk of developing precocious puberty was significantly increased 10 to 20 times in adopted girls compared with girls with Danish background. The risk of developing precocious puberty depended on the country of origin. In children immigrating with their family, the risk of developing precocious puberty was only marginally increased. Older age at adoption significantly increased the risk of precocious puberty in adoptees independent of region of origin. The incidence rate ratio was significantly higher in children adopted after the age of 2. In children immigrating with their family, we found no effect of age at migration.
DISCUSSION. In this large, nationwide, register-based study including 655 cases of precocious puberty, we found that intercountry boys and girls were 10 to 20 times more likely to develop precocious puberty compared with the Danish reference group. Older age at adoption significantly increased the risk of precocious puberty. Uncertainty of the exact age is a well-known problem in adopted children, and systematic underestimation of age might bias the result. However, using the worst-case scenario that all children who according to the Danish Civil Registration System were adopted after 2 years of age were in fact 1 year older, we still observed a highly increased risk of precocious puberty associated with adoption and especially with adoption after 2 years of age. Surprisingly, the risk of precocious puberty was not increased in the large group of children adopted from Korea. One case of precocious puberty was identified among Korean children, whereas >20 cases of precocious puberty would have been expected if the risk for a Korean child was at the same level as observed among adopted children from India and South America. In the study population, 99% of Korean children were adopted before 2 years of age, which may contribute to explaining our finding. In Korea, children appointed for adoption are often living in foster care settings from birth to adoption, whereas most other countries are reported to take care of the children in orphanages before adoption. It can only be speculated whether a relation between preadoption living conditions and later risk of precocious puberty exists. Genetic factors play a key role in the timing of puberty, and large variations in age at menarche are observed worldwide. Age at menarche is reported to be in the same age range in South Korea as in well-off populations in other parts of the world, indicating that the different risk of precocious puberty observed between Korean and other adoptees probably cannot be explained by genetic factors alone. The finding that the risk of precocious puberty was significantly increased among adoptees in contrast to what was seen in children immigrating with their families contradicts a direct effect of migration. An increasing number of studies have shown long-term effects of certain prenatal and postnatal growth patterns, including advancement in pubertal maturation after poor intrauterine growth and catch-up growth during childhood. Different growth patterns and dietary habits between adoptees and children immigrating with their families might contribute to explain our findings. It has been hypothesized that stressful psychosocial factors in infancy and childhood may lead to earlier pubertal maturation. In general, adoptees have experienced several traumatic life events, and it may be speculated that these events alter the susceptibility for developing precocious puberty.
CONCLUSIONS. Foreign-adopted children originating from regions other than Korea had a 15- to 20-fold increased risk of precocious puberty compared with Danish-born children, whereas adoptees originating from Korea had no increased risk of precocious puberty. In addition, children immigrating with their families had no increased risk of precocious puberty. The effect of country of origin might be explained by genetic factors or by different environmental exposures and living conditions in the different countries. Older age at adoption increased the risk for premature onset of puberty, which may suggest that environmental factors influence the risk of precocious pubertal development in adopted children.
Yes, my IA pediatrician discussed this with me at Delaney's first appointment, but I was not aware of it before then. I think it's just something to be aware of and watch in child as they grow.
I have seen this discussed on various IA message boards and forums over the years. I am praying that Anastasia hits puberty at a normal age and we do not have to deal with this. But thanks for bringing it to the attention of the group. :)
Thanks for sharing this. I had seen it in my research before adopting Emily. I discussed it with my pediatrician. She was aware of it also (comforting-you want to know that they are reading the latest studies) but didn't think that Emily would be affected by it. I hope that proves to be true.
You are a wealth of knowledge!