Special report: Parents have key role during puberty, UAE doctors say

Doctors in the UAE have advised parents to educate their children about puberty and monitor them to avoid emotional and psychological damage.

Elena Andriotis, counsellor at Carbone Clinic at Dubai Healthcare City in Dubai. Pawan Singh / The National

Following the release of a study by the Children’s National Medical Centre in Washington DC, doctors in the UAE are speaking up about the emotional and psychological effects of early puberty on children.

Experts have seen an increase in early maturation in the UAE and have advised parents to educate their children on how to prepare for the transformations they will undergo. Understanding the differences between types of puberty is also key to detecting and avoiding the onset of serious diseases.

Contents:

- Early puberty can cause emotional harm, say UAE doctors

- The differences between early and precocious puberty

- Parents should explain puberty to children, UAE health experts say

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Early puberty can cause emotional harm, say UAE doctors

ABU DHABI // Effects of early puberty can leave children with emotional and psychological damage, experts say.

Early maturation can cause depression, eating disorders, and even suicidal thoughts, they said. Children could also have an inclination towards sexual activity at an unsuitable age.

A study by the Children's National Medical Centre in Washington DC found that one child in 5,000 in the United States hit puberty early.

Most girls in the study were either obese or overweight, it was found.

Elena Andriotis, clinical psychologist at the Carbone Clinic of Dubai, said she had noticed an increase in the number of children who had hit puberty early.

“Many research articles in the field are addressing this question to find what is triggering children to experience puberty at a younger age than expected – professionals are looking at children’s diets, and other environmental changes,” she said.

The effects puberty have on children, she said, depends on their age.

“Early maturation can have mixed effects for children. Seven-year olds and 12-year-old children have different reasoning strategies, which will greatly affect their perception and understanding of this sudden physical maturation,” she said.

“Consequently, this may lead children experiencing early puberty to feel confused about the physical changes that come with puberty – such as the development of breasts for girls or the appearance of pubic hair.”

She said children respond psychologically to those biological changes with feelings of embarrassment or shame.

“Especially when they will notice that not many of their peers and friends in their surroundings will be experiencing similar changes. This inability to relate to other children their own age will strengthen the feelings of confusion and humiliation,” Ms Andriotis said.

“These children will be more prone to experience forms of teasing and bullying by their classmates that can lead to symptoms of depression, loss of interest in daily activities, changes in school performance, behavioural modifications with parents and siblings and much more.”

Ms Andriotis said the limbic system – related to emotional growth – would also develop, causing the child to have “emotional storms”.

“Children will find themselves in a transitory period where a surge of hormones will build up mood fluctuations and trigger different bodily changes.

“Emotional storms can range from crying spells to slamming doors, or impulsive behaviours,” she said.

Early puberty can be caused by medical or non-medical factors. Medical factors include hormone disorders and diseases, while non-medical factors have to do with genetics and family history, as well as environmental and geographical reasons.

Obesity is also a factor in early puberty, especially for girls, said Dr Nabil Abu Tartour, a consultant in obstetrics and gynaecology at HealthPlus in Abu Dhabi.

Dr Ahmed Abdelhaq, consultant obstetrics and gynaecologist at Danat Al Emarat Hospital, said girls maturing prematurely were more prone to social difficulties and sexual harassment because they are viewed as mature women.

He said boys could be treated as mature adults based on their physical appearance while their mental and social development still lagged behind.

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The differences between early and precocious puberty

ABU DHABI // Doctors have emphasised the importance of differentiating between early puberty and precocious puberty.

Dr Ahmed Abdelhaq, consultant obstetrician and gynaecologist at Danat Al Emarat Women & Children’s Hospital, said while the terms early puberty and precocious puberty are used interchangeably, they are different.

“The former is usually a variance of normal sexual growth physiological process, while the latter is likely to indicate an underlying cause such as brain lesions due to infection, trauma, or ovarian cysts and tumours in girls,” he said.

“Precocious puberty can be a sign of a serious disease and must be investigated.

“Hormone-producing tumours are the most serious possibility, but are uncommon. They usually come very early, and could cause hypothalamic dysfunction.”

Many causes can trigger the onset of puberty, especially hormonal. Precocious puberty can lead to early closure of the growth lines of the long bones, resulting in reduced adult height potential, and may shift some lifelong health risks, said Dr Abdelhaq.

The condition is usually treated with hormones to limit puberty’s acceleration, he said.

“Most early puberty boys and girls are short, because the growth causes the bones to close early. They reach the phase where they should be closing at the age of 17 or 18, but because the process accelerated, they close early.”

Treatment can stop the effects of the hormones.

Dr Muhaj Al Shaikhli, obstetrics and gynaecology consultant at HealthPlus Fertility Centre, said central precocious puberty was a common type.

“In central precocious puberty, the puberty process starts too soon. The pattern and timing of the steps in the process are identical to normal. The pituitary gland is prompted to produce hormones, called gonadotropins,” she said.

“These hormones in turn stimulate the testicles or ovaries to make other hormones, testosterone [in boys] or oestrogen [in girls]. It’s these sex hormones that cause the changes of puberty, like breast development in girls.”

In rare cases, certain diseases or injuries to the brain or spinal cord might have caused it, she said.

“Rarely, certain conditions such as infections, hormone disorders, tumours, brain abnormalities or injuries, may cause precocious puberty.

“Precocious puberty needs to be investigated to rule out any underlying pathology.

“It is usually mild and has very few long-term effects, but it can have serious medical problems on top of the other effects associated with early puberty.”

It is not always necessary to treat the condition because most cases of early puberty and benign mild precocious puberty can be managed with counselling and behavioural adjustments. But if precocious puberty affects the growth and/or well-being of the patient, a prompt hormonal treatment may be needed to stop the accelerated process and delay the closure of the growth lines.

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Parents should explain puberty to children, UAE health experts say

ABU DHABI // The changes children will go through when they hit puberty should be explained to them by parents and teachers, say health experts.

Educating children on the transformations they will undergo is important to help them to prepare for it, said Elena Andriotis, clinical psychologist at the Carbone Clinic of Dubai.

“It is very important to give children the information so they can be equipped when they experience such a change or when they witness some of their classmates experiencing changes,” she said.

She said children should start having the facts about puberty explained to them by their parents and teachers when they are eight to 10 years old.

Ms Andriotis said it was important for parents to listen to their children’s questions and gauge how much they know about the topic. It is also important that they let the child know that puberty is a normal phase of growing up.

“This will make them feel safe and less alone, which is why it is important for schools to incorporate these discussions so all children realise that they are going through this together and are not alienated,” she said.

“Parents can always resort to getting their children some books concerning the topic or showing them a short video clip from reliable sources online if it makes them more comfortable.”

Dr Ahmed Abdelhaq, consultant obstetrician and gynaecologist at Danat Al Emarat Hospital for Women and Children, said the rise of the internet had made this issue even more important.

“With uncontrolled and unregulated information now readily available to youngsters through the internet and social media, the role of the parents and social workers is paramount,” he said.