Dr. Rajeev M R
Senior Consultant – General Pediatrics, Aster Whitefield Hospital
Delayed puberty can impact children both physically and emotionally; it is important seek medical help early in order to ensure an accurate diagnosis and timely treatment
Delayed puberty is more than just a normal variation; it can have serious repercussions if it is not identified in time or treated properly. Puberty is an important part of growing up, a stage that witnesses growth spurts, sexual maturation, bone growth, and psychological hardening or mental toughness, because of hormonal changes. If this stage gets delayed, the repercussions can be felt even beyond the age of adolescence.
What Is delayed puberty?
Delayed puberty can be defined as the lack of appearance of pubertal changes in girls by age 13 and in boys by age 14. Studies indicate that delayed puberty, affects 2-3% of children in their adolescence, and more cases are reported among boys than girls. This can sometimes be the result of a constitutional growth and development delay, but in some instances, it may present certain physiological problems or diseases in children.
Impact on physical growth
Puberty is responsible for nearly 20–25% of adult height gain and up to 50% of bone mass accrual. A delay in puberty thus delays this growth spurt, usually leading to shorter heights at an adolescent stage. While many children catch up over time, significantly delayed puberty could compromise peak height attainment, especially when the condition relates to chronic illness, malnutrition, or untreated hormonal deficiencies.
The age of exposure to sex hormones, such as oestrogen and testosterone, also contributes to the level to which bones become mineralised. Delayed puberty has been known to result in low bone mineral density among many people, thus predisposing them to higher risks of fractures or even osteoporosis during their youth or later in life.
Impacts on sexual development
Sex hormones play a crucial role in the development of secondary and primary sex characteristics and organs. Delayed puberty can delay the maturation of the ovaries, testes, and external sex organs. Delayed puberty that occurs due to conditions such as hypogonadism and pituitary disorders could have implications for fertility in the future if not treated on time.
When puberty is delayed in girls, it delays the start of menstruation, and in boys, a deficiency of testosterone decreases muscle mass and delays changes to the voice and sex organ development.. Early detection is important to be able to get timely treatment.
Psychological impacts
The emotional consequences of late puberty are sometimes overlooked. When puberty occurs late in relation to their age, young adolescents may suffer from low self-esteem, body image issues, isolation, and sadness. Some research suggests a higher vulnerability to bullying and exclusion by age mates for boys with late puberty, and greater emotional problems on the part of girls due to feelings of being “left behind.”
Adolescence is an age during which acceptance from society or building an identity among peers assumes critical importance; physical differences, therefore, may cause severe psychological impacts.
Impacts on social development
Delayed puberty could also potentially affect social interactions among adolescents and their perception of themselves within a social setting. If a child looks younger than their counterparts, they can also attract differential treatment at their learning centres and social circles in terms of leadership and socialisation roles.
Studies suggest that young people with untreated and delayed pubertal development, score lower in health-related quality-of-life compared to their peers because of problems in emotional/social functioning.
Causes and early evaluation
Although constitutional delay is very common, delayed puberty may also be caused by illnesses such as inflammatory bowel disease, kidney disease, deficiencies in nutrients, overexercise, genetic disorders, or problems in the endocrine system that involve the thyroid, pituitary glands, or gonads. Sometimes, delayed puberty is the initial manifestation of a health problem that needs to be addressed.
Early evaluation by a clinician helps in differentiating between normal variations of development and pathological causes. The simplest diagnostic tests for the conditions include growth analyses, bone age evaluation, as well as hormonal assessments aimed at informing intervention. Where the need arises, short-term hormonal replacement has been effective in stimulating growth rate, pubertal development, as well as mental well-being without adversely altering final height.
Take action
Delayed puberty cannot simply be allowed to “sort itself out.” The effects could be numerous as far as growth and bone structure are concerned, and could be critical as far as emotional and social development are concerned. Parents, teachers, and healthcare professionals must be aware of, and informed on this matter so that it can be addressed early, as this could enable the children to start their teens with confidence as far as their health is concerned.