This past week was National Child Health Day (October 4, 2021). This isn’t just one of those new & fancy “National Dog Day” type of observances— Child Health Day was first recognized in 1928 by proclamation by President Coolidge.
The health issues children in this country face today are much different than back in 1928. We, thankfully, aren’t still battling basic child labor laws and many harmful diseases with lifelong implications from that era have been largely eradicated. However, new concerning problems due to our diets and environment have arisen. One that a lot of my patients ask me about regarding their children is early puberty due to hormonal dysregulation.
According to the Mayo Clinic, precocious puberty – the medical term for early puberty – is when “a child’s body begins changing into that of an adult (puberty) too soon. When puberty begins before age 8 in girls and before age 9 in boys, it is considered precocious puberty.”
Early puberty can have lifelong effects on a person and is found to be particularly hard on girls. For boys, early puberty can be linked to an increased frequency of anxiety disorders and tobacco use. For girls, early puberty is associated with a higher incidence of depressive disorders, substance abuse disorders, eating disorders, and disruptive behavior disorders. Additionally, for both sexes, it can affect bone growth and slow down potential growth spurts. According to a study published by NIH’s National Library of Medicine, 18% of Asians and Caucasians, 43% of African-Americans, and 31% of Latina girls begin puberty before turning 8.
Signs of early puberty for children below the defined age include early breast development in girls, enlarged testicles and penis in boys, public or underarm hair growth in both sexes, rapid growth spurts, acne, adult body odor, deepening voice, and facial hair in boys.
A lot of my patients are parents who are (rightly) concerned when their child’s puberty starts early. Many of these children are between 7 and 9 years old. They have consulted their pediatrician and are being told that this is much more common now than it used to be 15-30 years ago. Parents are being referred to endocrinologists who confirm their child’s early puberty and offer hormonal blockers like Lupron.
While interventions like Lupron can be necessary, I recommend families also consider a functional medicine approach to precocious puberty as they weigh their options. In some cases, a functional medicine approach may delay or limit the need for hormonal blockers thus minimizing or avoiding the potential side effects of these medications.
While we don’t yet have enough large-scale epidemiologic studies to define the many ways in which environmental factors drive precocious puberty, a growing body of research indicates that there is a relationship between early puberty and exposure to certain endocrine-disrupting chemicals. Through a functional medicine approach, we aim to reduce inflammation, identify past exposures to potential toxins. We look specifically for potential hormonal dysregulation that may be mimicking estrogen, and work on eliminating these, so we can try to potentially slow the development of early puberty and set the child and family up for better habits and lifestyle changes for life.
I would recommend starting with an evaluation from an experienced integrative or functional medicine provider and pursuing a functional medicine approach for up to 6 months either before or while starting on hormonal blocking medications. It is important to keep your pediatrician and endocrinologist in the loop so if this approach is not effective enough you can quickly shift to a more conventional approach.
In our practice, our integrative and functional medicine providers take an approach that includes the following steps:
- Review all relevant measurements and labs from the pediatrician and endocrinologist that confirm early puberty
- Conduct a thorough functional medicine history, including a review of dietary history, past trauma, and exposures to environmental toxins
- Stool testing to evaluate gut health and additional blood work for any inflammatory markers, food sensitivities and nutritional deficiencies
- Urine and blood testing for environmental endocrine disruptors such as
Herbicides, pesticides, heavy metals and mycotoxins. This includes testing for exposure to potential endocrine-disrupting chemicals in household cleaning supplies, dyes, plastics and ingredients in commonly-used cosmetic supplies and lotions (believe it or not, many lotions have hormone-mimicking ingredients)
- For some patients, childhood obesity can play a part in early puberty and efforts to improve diet quality with more nutritionally rich and less calorie dense foods should be prioritized and a referral to a nutritionist may be part of this approach. Adequate sleep and movement is also an important part of the assessment.
- Findings from this thorough evaluation may sometimes reveal relatively obvious contributors or likely causes for early puberty. If it is found that there are environmental factors that could be causing these issues, lifestyle changes such as avoiding plastics and toxins and trying plant based oral supplements to detoxify may be recommended.
If you’ve noticed early puberty in your child, talk with your pediatrician and consider getting an integrative medicine evaluation early before the need for medication becomes imperative. In our practice, we have a naturopathic doctor that sees our pediatric patients. Find one local to you that is experienced and works alongside your primary pediatrician.
About Dr. Shilpa Sayana: I am a board-certified MD in Internal Medicine, Obesity Medicine, and Functional Medicine. I became interested in a holistic approach to medicine that attempts to figure out the root cause of illness after I was diagnosed with a tumor that thankfully turned out to be harmless.
Being trained in a western medicine framework, I underwent additional training in Functional Medicine looking at ways diet and lifestyle medicine can prevent disease and improve our quality of life. I love spending time with patients and figuring out what is the true root cause that may have triggered their symptoms.