About Central
Precocious Puberty

When a Natural Process Happens Too Soon

Puberty is a normal part of growing up. For some children, puberty may start at too early of an age. When this happens, it may be due to a condition called central precocious puberty (CPP). CPP occurs when a child shows signs of puberty sooner than normal—before the age of 8 in girls and before the age of 9 in boys.1,2 CPP is a rare condition that affects 1 in every 5,000 to 10,000 children.3

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If you suspect your child has CPP, it's probably because you've noticed changes in your child's physical development that seem to be happening sooner than they should. This might leave you feeling confused, concerned or stressed. It's important to know that there is power in information. Explore this section to better understand the causes of CPP, the potential symptoms and effects, and available treatments.

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CPP Causes and Diagnosis

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Although the exact cause is usually unknown, CPP results from the early release of a hormone from the brain called gonadotropin-releasing hormone (GnRH), which causes a child to begin puberty at an age earlier than normal.4,5

A pediatric endocrinologist is a type of physician who specializes in diagnosing, treating and managing disorders involving hormones, including CPP. If CPP is suspected, your pediatric endocrinologist will evaluate your child, and may order further testing. Some of those tests could include:6

  • Blood tests to measure hormone levels, including a test called a GnRH stimulation test. In children with CPP, GnRH will cause other hormone levels in the body to rise. In children without CPP, these hormone levels will stay the same.
  • An x-ray of the hand and wrist to measure how fast your child's bones are growing (often called a bone age test or study).
  • An ultrasound, for girls, which can check for an ovarian cyst or tumor.
  • An MRI (magnetic resonance imaging) or CT (computed tomography), which is a scan of the brain that looks to see whether any brain abnormalities are causing puberty to start too soon.

How Does CPP Affect Children?

The good news is that there is treatment for CPP. Below are some reasons why you and your child's
physician may choose to move forward with treatment.

Growth and Height

Your child may have experienced a growth spurt, related to CPP, and may even be tall for his or her age. Treatments for CPP are designed to delay puberty by stopping the signaling of certain hormones that are responsible for jump-starting the puberty process.2

Children with CPP can be taller than their peers, however children that go untreated may be shorter in height when they become adults. This is because their growth plates (growth plates are areas of cartilage at the ends of long bones) close too early.7 Typically, growth plates close toward the end stages of puberty.

Social and Emotional Impacts

Girls and boys who begin puberty before their peers may be extremely self-conscious about the changes occurring in their bodies. This may affect their self-esteem and may increase their risk of developing depression, eating disorders, or substance abuse, perhaps as a result of standing out before they're ready for the extra attention.4,8-10

There is no data demonstrating outcomes of Triptodur® on stature, social or emotional health.

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How to Talk to Your Child About CPP

Children with CPP may have a hard time understanding the changes taking place in their bodies, such as the growth of pubic or underarm hair, the appearance of acne, or the development of body odor. Girls may be upset to see their breasts growing or to get their first period while boys may be surprised by facial hair or a deepening voice.

It's not unusual for children with CPP to feel confused or embarrassed by these changes. Because they tend to look older physically, they are often expected to behave more maturely, which can increase the pressure and expectations placed upon them.13 As a parent, you play a key role in shaping your child's understanding of CPP and creating a nurturing environment where your child can feel loved and supported.

Get Help Talking to Your Child About CPP

Guiding Your Child Through Treatment

Keeping track of your child's growth
When you bring your child in for their regular doctor visits during treatment, it is helpful to report to the doctor any changes you see in your child's body such as: height, growth of underarm and pubic hair, breast development, voice change, and oily skin and acne.

Aside from the classic pencil markings on the doorway, there are other fun, interactive ways to track your child's body changes. Below are some ideas to make tracking your child's body changes less clinical, and more fun!

Art project

Create a giant ruler or use blank measuring tape with your child that you can use to track body changes, but there’s also plenty of room to create fun designs and drawings together!

Photoshoot

Let your child go to the store and pick out some of their favorite accessories. These accessories can be anything such as tiaras, scarves, a superhero costume, etc. Do regular "photoshoots" with your child using the same accessories and clothing items to track how fast they are outgrowing the items. You'll be able to track your child's growth and have some great photos for your memories!

Treatment Options for CPP11,12

Below are some different treatments for CPP. Your child's doctor can help you find the
treatment option that best fits your child.

Talking to Your Child About Central Precocious Puberty: A Helpful Guide

Going through puberty too early can be a confusing and unsettling time for a child and his or her family. There are changes taking place in your child’s body that he or she may not fully understand.1

As a parent, you play a key role in helping your child understand and cope with central precocious puberty (CPP). Creating a loving, comforting, and reassuring environment may help your child grow up to be strong and secure.2

This guide includes some helpful tips to keep in mind as you discuss CPP with your child.

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For Children Ages 3-6:

Tip #1: Communication. Reinforce that your child’s body is normal.

At such a young age, your child might not be fully aware of the changes happening in his or her body, and may even seem unaffected by it. However, children may ask questions about why they are going to the doctor, or why they have to get tests or treatment. If your child is tall or perhaps more developed for their age, he or she may also have other children or adults comment or ask questions.

How you talk about CPP can go a long way toward shaping your child’s understanding of it, so it is a good idea to think about how you will discuss CPP with your child. It may be helpful to start with something like “Everyone’s body goes through these changes. Your body just started a little early.”

It may also be helpful to use objects to open lines of communication between you and your child about the changes in his or her body. Comparing the size of objects such as toys gives children a chance to play with measurement and helps them learn how to compare and use words such as “taller,” “shorter,” etc.3 For example, directly compare the heights of two stuffed toys and describe one toy as taller/shorter. This not only helps children understand measurement, but can help guide the conversation between you and your child about which parts of his or her body are growing or changing.

Tip #2. Prepare yourself so you can best help your child.

A CPP diagnosis can raise a lot of questions such as: What’s happening to my child’s body? Who do I talk to if I need help? Do I tell my friends and family?

Children often mimic their parent’s behavior – your child is more likely to be anxious if you exhibit signs of stress.4 Understanding CPP, and how you plan to talk with your child, family members, and even your doctors, can empower you to be a reliable support system for your child.

A simple explanation of CPP that can be used with friends and family is “My child has started puberty sooner than normal.”

By talking to your child’s doctor about CPP and what to expect, you can help ease your own uncertainties and anxieties.

Tip #3. Treat them according to their age.

Although your child’s body is developing early, he or she is still a young child. Sometimes adults or other children may treat your child as if they are older because of their appearance.5 If you are worried about family members, teachers, or other adults in your child’s life treating him or her as if they are older, it may be helpful to explain the condition to them. Talk to your healthcare provider for suggestions on explaining CPP or share this helpful guide.

For Children Ages 7 and Up:

Tip #1: Stay positive. Reinforce that your child is going through a natural process that usually happens
at a later age.6

Right now, your child might not understand the changes happening in his or her body or they may have negative feelings about developing early. How you talk about CPP can go a long way toward shaping your child’s understanding of it. When discussing CPP, being honest and open about the changes happening to their bodies can be helpful.7 You can start out by saying something like: “Everybody goes through puberty. You just started a little early.”

Tip #2. Prepare your child for what to expect.

Being diagnosed with CPP can raise a lot of questions such as: What’s happening to my body? Why am I so moody? Why don’t I look like my friends?1 By talking to your child about what CPP is and what to expect from it, you can help ease his or her fears and anxieties. Enlist the help of your child’s healthcare provider to explain what is happening. Be sure to stay involved.

Tip #3. Be there.

Although your child’s body is developing early, he or she is still a child and they need your support and guidance. Reassure your child that you’re there when he or she has questions, concerns, or just wants to talk. It may be helpful to tell your child: “I’m here to help you” or “You can ask me anything.”5

Tip #4: Help your child feel comfortable responding to questions.

Because it’s natural for other people—especially kids—to be curious, it helps to arm your child with some simple responses to questions he or she might get from other kids. A confident, straightforward response to other people’s curiosity can help.7

For example, if one of your daughter’s classmates asks her why she has breasts, you may want to suggest that she smile and say, “Because I’m a girl.” Or your child might choose a more direct approach and simply answer: “I have a medical condition” and leave it at that. The important thing is for your child not to feel ashamed or embarrassed about CPP.5

Children look for guidance on how to think about and respond to CPP. Your love and support means everything and can go a long way to boosting your child’s self-acceptance.5

References

  1. Parenting. The precocious puberty phenomenon. (2017) Retrieved from: http://parenting.com/article/p...
  2. Department for Children, Schools, and Families. Child Development Overview. (2016). Retrieved from: http://www.keap.org.uk/documen...
  3. MacDonald, A., & Lowrie, T. (2011) Developing measurement concepts within context: Children’s representations of length. Mathematic Education Research Journal, 23(1), 27-42. https://doi.org/10.1007/s13339...
  4. Maccoby, E. E. (1992). The role of parents in the socialization of children: An historical overview. Developmental Psychology, 28(6), 1006.
  5. Helping your child cope with precocious puberty. WebMD website. Available at: https://www.nichd.nih.gov/health... . Accessed October 16, 2017.
  6. Carel JC, Lahlou N, Roger M & Chaussain JL. Precocious puberty and statural growth. Human Reproduction update. 2004; 10: 135-147. 7. Bordini, B. (2017). Precocious Puberty. The MAGIC Foundation. Retrieved from: https://www.magicfoundation.or...

References

  1. Muir A. Precocious Puberty. Pediatr Rev. 2006;27:373-381.
  2. Carel JCm Léger J. Clinical Practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377.
  3. Partsch CJ, Sippell WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab. 2002;16:165-189.
  4. Precocious Puberty. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/dxc-20266003. Accessed June 21, 2017.
  5. Precocious Puberty. Eunice Kennedy Shriver National Institute of Child Health and Human Development Web site. https://www.nichd.nih.gov/heal...spx. Accessed August 14, 2017.
  6. Precocious puberty. Mayo Clinic website. Available at: http://www.mayoclinic.org/dise.... Accessed October 16, 2017.
  7. Carel JC, Lahlou N, Roger M & Chaussain JL. Precocious puberty and statural growth. Human Reproduction Update. 2004;10:135-147.
  8. Mendle, J., et al. Detrimental Psychological Outcomes Associated with Early Pubertal Timing in Adolescent Girls. Dev Rev. 2007; 27(2): 151-171
  9. Johansson T & Ritzen EM. Very long-term follow-up of girls with early and late menarche. Endocrine Development. 2005;8:126-136.
  10. Helping your child cope with precocious puberty. WebMD website. Available at: https://www.webmd.com/parentin.... Accessed October 16, 2017.
  11. Triptodur [package insert]. Atlanta, GA: Arbor Pharmaceuticals, LLC.
  12. Carel J-C, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-e762.
  13. Barker, J. (2010). Helping your child cope with central precocious puberty. WebMD. Retrieved from: https://www.webmd.com/parentin...

IMPORTANT SAFETY INFORMATION FOR TRIPTODUR

INDICATION

TRIPTODUR is indicated for the treatment of pediatric patients 2 years of age and older with central precocious puberty (CPP).

IMPORTANT SAFETY INFORMATION

Contraindications

TRIPTODUR is contraindicated in:

Warnings and Precautions

Initial Rise of Gonadotropins and Sex Steroid Levels - During the early phase of therapy, gonadotropins and sex steroids rise above baseline because of the initial stimulatory effect of the drug. Therefore, a transient increase in clinical signs and symptoms of puberty, including vaginal bleeding, may be observed during the first weeks of therapy or after subsequent doses.

Psychiatric Events - Psychiatric events have been reported in patients taking GnRH agonists. Postmarketing reports with this class of drugs include symptoms of emotional lability, such as crying, irritability, impatience, anger, and aggression. Monitor for development or worsening of psychiatric symptoms during treatment with TRIPTODUR.

Convulsions - Postmarketing reports of convulsions have been observed in patients receiving GnRH agonists, including triptorelin. These included patients with a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs. Convulsions have also been reported in patients in the absence of any of the conditions mentioned above.

Adverse Reactions

In clinical trials for TRIPTODUR, the most common adverse reactions (≥4.5%) are injection site reactions, menstrual (vaginal) bleeding, hot flush, headache, cough, and infections (bronchitis, gastroenteritis, influenza, nasopharyngitis, otitis externa, pharyngitis, sinusitis, and upper respiratory tract infection).

For additional safety information, please consult the Full Prescribing Information

IMPORTANT SAFETY INFORMATION FOR TRIPTODUR

INDICATION

TRIPTODUR is indicated for the treatment of pediatric patients 2 years of age and older with central precocious puberty (CPP).

IMPORTANT SAFETY INFORMATION

Contraindications

TRIPTODUR is contraindicated in:

  • Individuals with a known hypersensitivity to triptorelin or any other component of the product, or other GnRH agonists or GnRH.
  • Women who are or may become pregnant. Expected hormonal changes that occur with TRIPTODUR treatment increase the risk for pregnancy loss and fetal harm when administered to a pregnant woman. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be advised of the potential risk to the fetus.

Warnings and Precautions

Initial Rise of Gonadotropins and Sex Steroid Levels - During the early phase of therapy, gonadotropins and sex steroids rise above baseline because of the initial stimulatory effect of the drug. Therefore, a transient increase in clinical signs and symptoms of puberty, including vaginal bleeding, may be observed during the first weeks of therapy or after subsequent doses.

Psychiatric Events - Psychiatric events have been reported in patients taking GnRH agonists. Postmarketing reports with this class of drugs include symptoms of emotional lability, such as crying, irritability, impatience, anger, and aggression. Monitor for development or worsening of psychiatric symptoms during treatment with TRIPTODUR.

Convulsions - Postmarketing reports of convulsions have been observed in patients receiving GnRH agonists, including triptorelin. These included patients with a history of seizures, epilepsy, cerebrovascular disorders, central nervous system anomalies or tumors, and patients on concomitant medications that have been associated with convulsions such as bupropion and SSRIs. Convulsions have also been reported in patients in the absence of any of the conditions mentioned above.

Adverse Reactions

In clinical trials for TRIPTODUR, the most common adverse reactions (≥4.5%) are injection site reactions, menstrual (vaginal) bleeding, hot flush, headache, cough, and infections (bronchitis, gastroenteritis, influenza, nasopharyngitis, otitis externa, pharyngitis, sinusitis, and upper respiratory tract infection).

For additional safety information, please consult the Full Prescribing Information