'Meanwhile, socially and emotionally, they’re still children': Is COVID causing precocious puberty?

Does it seem like more of your young patients these days are hitting puberty earlier than usual? The pandemic may be to blame. A number of medical centres and research groups in India, Italy and the United States have been reporting spikes in cases of idiopathic central precocious puberty—with some girls as young as five years old developing breasts, and some starting menstruation before they turn eight—and linking this phenomenon to COVID-19. In Italy, a study that looked at children across five Italian centres of pediatric endocrinology found that, between March and September 2020, 328 girls were referred for suspected precocious puberty. By comparison, only 140 cases were referred over the same period the previous year. Read: Handle with care: Current management of depression in children and adolescents The authors noted the increase in cases was more evident during the latter half of the observed period, with a 72% increase from the previous year between June and September compared to 28% between March and May. In Turkey, a 2021 study found the number of girls diagnosed with precocious puberty during the pandemic was more than double than any of the previous three years: 58 patients from April 2020 to March 2021, compared to 66 patients over a three-year period from April 2017 to March 2020. “Various factors are thought to play a role in the emergence of early and accelerated pubertal progression: high-calorie food consumption, sedentary lifestyle, the use of electronic devices, and psychological factors such as fear and anxiety,” the study’s authors wrote. “The pandemic period increased the instance of such factors that adversely affect puberty: people were forced to stay at home, which decreased the frequency of indoor and outdoor physical activities and increased the frequency of fast-food consumption and electronic device usage. This lifestyle may potentially impact the timing and/or tempo of pubertal development by increasing the BMI and fat ratio in the body.” Similarly, the authors of the Italian study pointed to lifestyle changes during the pandemic as potential factors for the observed increase in precocious puberty cases. They did note, however, that the girls who presented with precocious puberty in 2020 were more sedentary before and during the pandemic than those diagnosed in 2019. Increased stress levels may have been the most influential factor, the authors suggested. Read: Study: concussions associated with higher risk of mental health concerns in kids “In our study more than half of the 2020 population reported behavioral changes and a relevant increase in stress-related symptoms,” they wrote. “We could assume that a dysregulation of stress-induced brain neurotransmitters underlies the increase of new cases of precocious puberty in girls, related to the COVID-19 pandemic. Stress may act as a more powerful trigger on GnRH-secreting neurons in girls with additional risk factors as a sedentary lifestyle already evident before the pandemic.” Dr. Vaishakhi Rustagi, a Delhi-based pediatric endocrinologist in India, has seen more than 300 girls since June 2020 with precocious puberty, according to a report co-published by the Washington Post and the Fuller Project–a non-profit news organization that reports on social justice issues that affect women. Before the pandemic, she would see about 20 such patients in a typical year. “I think it’s directly related to the amount of stress that the children have gone through,” said Dr. Rustagi. “These children have lost family members.” Read: Adolescents can benefit from etonogestrel-releasing contraceptive implant: experts Adiaha I.A. Spinks-Franklin, a pediatrician at Texas Children’s Hospital, observed that “quite a few” of his young female patients got their period after a lockdown. “Breast buds come at about 10 or 11 years, and then your period comes two years later. That’s the normal process,” he said. “From 9 to like 15, you’re going through this process, but the stress of the pandemic sped up that physiological process. Meanwhile, socially and emotionally, they’re still children.” The consequences of precocious puberty go beyond physical changes. A 2018 study by researchers in Columbia and Spain found that girls who hit puberty much earlier than their peers had higher anxiety levels, lower self-esteem and a more negative body image. Read: BMI, insulin levels in children may be linked to adult depression, psychosis

'Meanwhile, socially and emotionally, they’re still children': Is COVID causing precocious puberty?

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