At the age of nine most girls across the UAE are learning times tables and practising for a pen licence. They've probably quickly progressed from fairies to Justin Bieber and love to experiment with mum's makeup and high heels. They grow up fast, but perhaps a little too fast. Young girls today increasingly have to deal with the emotional upheaval of menstruation at a time when they still struggle to remember their lunch boxes.
It was almost as though Chris* and Claire's* baby girl couldn't wait to grow up. Abby* began talking at eight months and was walking by nine months. "I remember feeling so proud. She was so much faster than her peers at all the milestones," recalls Claire. What Abby's parents didn't expect is that she would also be menstruating at the age of ten. "When Abby was around seven, I started to notice body odour on her clothes. By the time she was eight, she was developing breasts. Then, just after her tenth birthday she had her first period," says Claire. "It was quite a shock."
Doctors say Abby's story is becoming increasingly familiar. Today's pre-teens are maturing faster than any other generation in history. The average age of menarche, or first menstruation, in the developed world has dropped consistently from 17 years a century ago, to 12 years four months today. Boys are also entering puberty earlier but the rate increase is not as alarming as for girls. Research has shown that boys are generally two years behind girls in puberty development.
- Obesity epidemic
You only need to visit a playground in the UAE to observe the little eight- and nine-year-old Hannah Montanas strutting their stuff. As yet doctors are unable to pinpoint the exact cause of precocious development, but most agree it is most likely a combination of factors. Dr Denis Hardy, chief of Paediatrics at the Royal Hospital, Sharjah, says that the growing child obesity epidemic almost certainly plays a role. "Precocious puberty is defined as a girl starting puberty before the age of eight," he says. "Weight is not always the underlying cause but there's no denying that one of the many downsides of obesity is early puberty. Currently the incidence of obesity in children in the UAE is 32 per cent, making it a major public health concern."
"Obesity raises the body's levels of oestrogen and androgen, the key hormones principally responsible for the onset of puberty," explains Dr Hardy. In addition, fat cells manufacture leptin, another hormone believed to trigger puberty. Doctors say that if girls are getting bigger, faster, their bodies may be manufacturing leptin earlier, prompting puberty at a younger age.
Dubai naturopath Dr Lanalle Chapman-Dunn of the Wellbeing Medical Centre agrees. "The obesity rate has tripled in the past 20 years in children between the ages of six and 11. As the BMI (body mass index) increases, so does the incidence of precocious puberty."
For Abby, being overweight was not a contributing factor, but in her case genetics may be a factor; Claire herself was only 11 when she first got her period.
Another significant factor, according to Dr Lanalle, is today's food quality. "Fifty years ago there wasn't such thing as the ‘organic' label. Our grandparents ate wholegrains and locally grown fruit and vegetables that weren't sprayed with chemicals. They didn't give milk-producing cows hormones to increase or prolong lactation. They didn't give growth hormones to animals raised for meat consumption to increase productivity. Genetically modified foods weren't invented.
"Since then studies have recorded a decline in the nutritional content of today's food of between 6 and 38 per cent, with a 15 per cent average. To make up for the quality deficit we should ideally be eating at least 15 per cent more fruit and vegetables, but the opposite is happening. Over the past ten years, our consumption of convenience and fast foods has increased by over 70 per cent. Not only is this food lacking in nutrients, it's packed full of additives, preservatives and chemicals. It all affects a developing child."
- Environmental pollutants
Dr Lanalle claims that another guilty party is exposure to a variety of chemicals that interfere with our hormonal system. "One culprit is a particularly pervasive chemical family called phthalates that are widely used in most households," says Dr Lanalle.
"The chemicals are typically used in things like plastic toys, vinyl shower curtains, upholstery and packaging. Companies love them and they are widely used in many products. They make fragrances linger longer - in cleaning products, air fresheners, perfumes and cosmetics. They help lotions spread and women's makeup retain its colour. You'll find phthalates in lipstick, hairspray and nail polish. There are numerous studies documenting the effects of phthalates on the endocrine system, which is responsible for sexual development, among other things. One of the many side effects is the onset of early puberty."
Also of concern is another widely used chemical called BPA, or bisphenol A, found in hard plastics, such as babys' bottles, the linings of metal cans, body care products and many other consumer items. "BPA is another endocrine disruptor that can and should be avoided," says Dr Lanalle. "Stick to fresh foods, not canned, and organic where possible to avoid growth hormones. Use glass containers to cook and store food in and avoid microwaving food in plastic containers. Look for ‘safe' personal hygiene products and cosmetics and let your children play with toys made from natural products such as untreated wood. Plastics with the recycle codes 3 or 6 likely contain BPA, avoid the recycle code 7 as it almost certainly does."
- Absent dads
A study from the University of California, Berkeley, has unearthed a surprising offender for the speed of puberty - divorce, a trend that is also on the rise. "We discovered that girls who live with stepfathers are almost twice as likely to reach puberty earlier than those who live with both biological parents," says lead researcher Julianna Deardorff. "The same was true for adopted children. One suggested reason for this ‘strange male' phenomenon is that exposure to the male pheromones of an unrelated man may accelerate development. Backing this up is the research showing that the more older brothers a girl has, the later she tends to get her period."
- Screen time
There's no evidence that watching sexy TV images triggers puberty, but spending too much time in front of a screen can harm kids in other ways, says Dr Lanalle. "Tween fashion and MTV didn't exist in the 1970s. We live in an age where our children are exposed to sexuality from an early age. Steiner (the founder of Waldorf education) believes stimulation beyond the child's developmental age can promote early puberty." Limit screen time, suggests Dr Lanalle. "Get kids active and outdoors instead."
Whatever the reasons, should we be concerned that our seven year olds are beginning puberty? Medical experts say the risks are real. Early puberty puts girls at far greater risk of developing breast and uterine cancer later in life says biologist Sandra Steingraber from the California Breast Cancer Research Programme. "Our data concluded that if a girl gets her first period before the age of 12, her risk of breast cancer is 50 per cent higher than if she gets it at 15. Oestrogen and progesterone can feed certain tumours and early puberty means girls have more time to be exposed to these hormones. Over the past 30 years, we've shortened the childhood of girls by about a year and a half. That's not good."
One of the telltale signs of early puberty is often a growth spurt. "This can be a problem," explains Dr Hardy, "because essentially, when puberty ends, growth in height stops. Kids with precocious puberty usually don't achieve their full adult height potential because once oestrogen is introduced, bone growth stops. Their early growth spurt may make them initially tall when compared with their peers, but they may stop growing too soon and end up shorter than they would have otherwise been."
Early puberty also has many emotional consequences, says Devika Singh, licensed psychologist at the Dubai Herbal and Treatment Centre. "When girlfriends develop at around the same time they often support each other by sharing their experiences. It becomes natural and normal and can help the transition into womanhood. But when a girl reaches puberty earlier than her peers she will often feel isolated at a time when it's most important to ‘fit in'. She may withdraw, which can eventually lead to a host of psychological disorders such as depression, anxiety, substance abuse and disordered eating. Additionally, looking older than her chronological age can mean a girl runs the risk of being perceived as older, which changes the expectations placed on her. This can manifest in unwanted sexual advances, which can be very confusing and distressing."
Supporting girls as they go through puberty can help them weather the stress, at any age, continues Devika. "It can be a challenge to parent young girls experiencing early puberty when often emotional maturity lags behind physical maturity. Some girls may reject the idea of ‘growing up' by resisting useful advice to help them adapt to the changes. This may require extra support in the form of counselling and family therapy as it can indicate the presence of other psychological or familial stress.
"In general, talking to children about puberty can be difficult because many parents so desperately want to get it right," says Devika. "I always advise parents to take the pressure off themselves and see the ‘first talk' as a starting point rather than the only opportunity to impart information. Use books, videos, share your own experiences, both good and bad to help your child visualise a positive outcome."
"Abby is still our baby," says Claire. "It's a confusing time for her. While on the one hand she is still a little girl struggling to tie her shoelaces properly, at the same time she is a young woman learning to deal with PMT. We can only support her as best we can."
(*Names have been changed).
Puberty time line
(This is based on averages and may vary)
- Normal puberty for girls begins anywhere from nine to 15 years. Precocious puberty is defined as puberty that begins before the age of eight.
- Today's average age for menarche, or first menstruation, is 12.4 years.
- Breast development is usually the first physical sign of puberty and occurs on average at 10.5 years.
- Menarche typically occurs between two and 2.5 years after breast ‘buds' appear.
- A baby girl is born with all her eggs already. By the time she reaches puberty she will have between 300,000 and 500,000 eggs. Over her lifetime, only 400 to 500 will mature.
- Once a girl starts menstruation, growth slows down. She may only grow another 2cm to 5cm more before reaching her final adult height at approximately 15.
- There is no known correlation between early menopause and early puberty.