Can a nine-year-old girl become pregnant and give birth, as recent media reports have claimed?
If it happened, she is by no means the youngest girl to have a child. That record goes to Lina Medina, a Peruvian who gave birth to a baby boy in 1939 when she was just five years old.
These incidents put the spotlight on precocious puberty, when the change to adulthood occurs abnormally early.
Normal puberty takes place in girls between the ages of nine and 131/2 years, and in boys between 91/2 and 14. It is the transition from child to adult, with rapid growth of bones and muscles, changes in body shape and size, and development of the body's ability to reproduce.
'Traditionally, precocious puberty is considered to be present when the physical changes of puberty begin before age eight for girls and before age nine for boys. It is an uncommon condition, and at the clinics, it tends to be seen more often in girls than in boys,' said Associate Professor Loke Kah Yin, with the National University Hospital (NUH).
Prof Loke is a paediatric endocrinologist, or a doctor specialising in hormone disorders in children. He sees about one new patient a month at his clinic at the Children's Medical Institute in NUH.
'With the girls, in 90 per cent of the cases of precocious puberty, there is no known cause except that the 'switch' came on early. But in 10 per cent of the cases, the cause may be traced to a tumour in the brain or ovary,' Prof Loke said.
'As for the boys, the control switch is early in 50 per cent of the cases without any other cause. The remaining 50 per cent is often due to a tumour of the brain or testes or other diseases.'
Sometimes, suspected cases of precocious puberty are picked up during health screenings in school. They are then referred to a doctor specialising in hormone disorders in children.
Before starting on any treatment, the children have to undergo a thorough investigation to confirm precocious puberty. Prompt medical evaluation is also important to rule out any underlying cause.
The doctor will review the medical history and perform a physical examination. A blood test is done to check on the level of pubertal hormones. The child will also have an X-ray taken of his hand so the doctor can see if the bones are growing too quickly, beyond the child's chronological age.
Treatment Prof Loke says that precocious puberty can be treated effectively with drugs if there is no underlying medical condition causing it.
This involves injections of a drug to inhibit the production of gonadotropin-releasing hormones.
'The child stays on this medication until he reaches the normal age of puberty. Once he stops receiving the medication, the process of puberty begins again,' says Prof Loke. An injection, costing between $300 and $350 each, has to be given once a month.
If an underlying medical condition such as a brain tumour is the cause, then that must be dealt with to stop the progress of puberty.
Children who reach puberty early may feel different from their peers, which can cause them to have low self-esteem or suffer from depression, as well as other problems which usually affect pubescent teenagers.
Counselling may be needed for the child, the parent and other family members so that they can better understand and handle the emotions, issues and challenges that accompany precocious puberty.
