Patient education: Late puberty (The Basics)

What is late puberty? — Puberty is a term for the changes in the body that happen as a child becomes an adult. Late puberty is when a child starts puberty much later than normal. The body changes in late puberty are the same as those in normal puberty. They just happen when a child is older.

Puberty usually starts between ages 9 to 12 in girls and 10 to 13 in boys. Doctors use the term "late" or "delayed" puberty if:

●A girl hasn't shown any signs of puberty by age 12. Usually, the first sign of puberty in girls is that the breasts grow bigger.

●A boy hasn't shown any signs of puberty by age 14. Usually, the first sign of puberty in boys is that the testicles get bigger (figure 1).

What causes late puberty? — Puberty is caused by hormones in the body:

●The brain makes hormones that start puberty. These hormones travel to the testicles (in boys) and to the ovaries (in girls) (figure 1 and figure 2).

●The brain hormones signal the testicles to make a hormone called "testosterone." They signal the ovaries to make a hormone called "estrogen." Testosterone and estrogen cause the changes in the body.

Late puberty can happen if this process doesn't happen on time. But it doesn't mean that your child has a medical problem. Some children start puberty late because:

●They are growing more slowly than other children. This can be normal.

●Late puberty runs in their family. If a parent went through puberty late, chances are good that their child will, too. This is especially true for boys.

Other children start puberty late because of a medical problem or condition. These can include:

●A long-term illness or condition

●An abnormal growth or other problem in the brain, ovaries, or testicles

●Genetic problems that babies can be born with

Children (especially girls) can also start puberty late if they are too thin, don't eat enough, or exercise very heavily.

Will my child need tests? — Yes. If your child isn't showing any signs of puberty, the doctor or nurse will want to know why. They will talk with you and your child, and do an exam. They will also probably do:

●Blood tests

●X-rays of 1 of your child's hands and wrists – These X-rays can show how fast your child is growing.

Depending on these results, the doctor might do other tests. These can include more blood tests or a CT scan, ultrasound, or other imaging test of your child's brain or belly. Imaging tests create pictures of the inside of the body.

The doctor or nurse will also do repeat exams over time. This lets them follow your child's growth and development as they get older.

How is late puberty treated? — Treatment depends on your child's age and the cause of the late puberty.

●If puberty is late because of a medical problem, the doctor will treat the problem if possible. Different treatments might include medicines (such as hormones) or surgery. After treatment, your child will most likely start puberty.

●If your child is healthy but growing slowly, or if late puberty runs in their family, treatment might not be needed right away. The doctor might suggest "watching and waiting" for puberty to start on its own.

Some children (mostly boys) who are healthy but growing slowly are treated with a hormone to help start puberty. Doctors usually recommend this only if late puberty is having a big impact on the child's life.

●If your child is underweight or exercises too much, the doctor can give you advice about how to help your child get to a healthy weight and have a healthy lifestyle. If there are concerns that the child might have an eating disorder, the doctor can refer you to a specialist who can help.

What else can I do to help my child? — You can help your child feel good about themselves. Point out your child's strengths instead of focusing on their body. Some children who start puberty late can have a hard time fitting in, because they look younger than other children their age.

If your child is teased or treated badly, talk to the doctor or nurse about ways to get help.

More on this topic

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