What should you know about true precocious puberty?

A child may develop breast tissue, pubic or underarm hair, body odour, acne, a growth spurt, or menstrual bleeding earlier than expected. True central precocious puberty involves activation of the brain–pituitary–gonad pathway. Other changes can come from hormone exposure or hormone production outside that pathway, so early signs do not identify the cause by themselves.

Assessment may include a growth review, physical examination, bone-age imaging, and hormone testing. A female hormone blood panel may be one part of that evaluation, interpreted alongside the child's development and other findings.

Arrange a paediatric review if changes are progressing or appearing earlier than expected. Record when each sign began, how quickly it is changing, and any medicines, supplements, or hormone creams the child could have encountered. Avoid blame or teasing; calm, age-appropriate explanations can help a child feel secure while assessment is underway.

Seek prompt medical advice for rapidly advancing changes, vaginal bleeding, severe headaches, vision changes, seizures, or marked changes in behaviour. These symptoms may need timely assessment because puberty-related signs can occasionally occur alongside another medical issue.

Which signs suggest central puberty? What tests are needed, and what will each one clarify? Could a medicine or external hormone explain the changes? How might treatment affect growth and emotional wellbeing?