Q: Assalammualaikum doctors, I would like to ask about the development of breast tissue in toddler age 1 yr 7 months. It is normal? What is the side effect of the breast tissue development to a child? How is it happened? Beside the breast tissue development, there is no other sign of puberty development was discovered on her. How many of this case happened in Malaysia? Can you please explain further about this?What should I do? ( worry mommy )
A: Dear worry mommy, yes I do understand you are concerned just as any parent would be concerned as well. However I would want to assure you that most of these cases are not worrisome and harmless if a proper assessment of your daughter has been done by a paediatrician and the more worrisome causes are ruled out.
q1. What is premature breast development? Is it normal? What is the side effect?
The most commonest cause of breast enlargement in girls as of your daughter’s age is known as “premature thelarche”. Premature = means of early onset/ before time and the word thelarche is derived from the Greek word thele meaning nipple and arche which means beginning, onset. Premature thelarche is not a disease instead it is a normal finding in some girls or female infants and there is no identifiable group of girls as to who develops early breast enlargement.
Premature thelarche is diagnosed in infants upto 3 years of age – sometimes a girl from 3-6 years of age may show an enlargement of one or both breasts. However after the age of six the beginning of breast development is actually the the beginning of puberty. Therefore if a girl begins to show breast enlargement at an early age (anywhere from birth to six years) it is called “premature thelarche”- which maybe one side first or both sides simultaneously.
Premature breast enlargement is worrisome if it is associated with the development of other physical signs of puberty such as acne, pubic hair, periods, or rapid growth. If premature breast enlargement is associated with signs of puberty then it is called precocious puberty which is definitely needs to be investigated further. Breast enlargement in boys is not “premature thelarche” but is termed as “gynaecomastia”. In this article I will be talking about premature breast enlargement in girls.
q2: Why do this happen ?
Worry mommy to give you a better picture allow me to explain a little further about normal puberty (process where the childs body becomes an adult body) in a girl.
The onset of puberty is signalled by the secretion of increasing frequency and amplitude of pulses of a hormone (chemical messenger) ↓ Breast enlargement (ocassionaly starts of unilateral) is the first obvious sign of puberty and occurs between 10-11 years of age ↓ Pubic and axillary hair ↓ Menarche (1st mentrual period) – usually 2-3 years after the start of breast development.
These hormones are present and active at all stages of life even in the first few years after birth. Until puberty these hormones are actively suppressed by the brain and at the onset of puberty they are actively released. Sometimes there is incomplete inhibition of these hormones leading to the release of hormones earlier than expected leading to “premature thelarche”.
Or the breast tissue is simply sensitive to the hormones from mother – which usually is the case in a newborn.
q3: Are there are any investigations?
No investigations are required just reassurance unless there are features of precocious puberty (such as premature pubic hair). Laboratory studies are not helpful. There are no complications, no treatment and no preventive strategies for premature breast development however you should follow-up your child with your paediatrician to monitor the size.
q4: What is the incidence in Malaysia
There are no studies in Malaysia that I could find to determine the incidence of premature thelarche in Malaysia however the only study that I could find was a study in Puerto Rico on Natural history and incidence of premature thelarche in Puerto Rican girls aged 6 months to 8 years diagnosed between 1990 and 1995. Result of this study showed Incidences were 6.2 and 1.62 per 1,000 live births for girls aged < 2 years and 2 to 8 years, respectively.
q5: What should you do?
“Worry mommy”, I hope that I have answered your questions however you should bring your daughter for a thorough clinical assessment by your local paediatrician .
If the assessment concludes that your child has “ premature breast enlargement” no further investigation is required and if your paediatrician is worried your doctor would possibly make a referral to a paediatric endocrinologist depending on the situation. There is a very good website that you can refer to :-http://www.choc.org/specialists/endocrinology
There are also some challenging issues associated with premature thelarche such as negative body image (for a bigger child), anxiety, lowered self-esteem. These issues can be dealt after a formal assessment from your paediatrician who will refer your child to a child psychologist. There are also some beliefs that the breast should be squeezed to allow the milk to come out however this is just a belief and it is not recommended
( answered by Dr Charlotte Jane Joseph)
Comments
31 responses to “Why are my little daughter’s breasts developing?”
**Comment Notification**
Very nicely done and easily understood by layperson. I think some paediatrician may still prefer to do LH/FSH test for them just to be sure, and prolactin too if there is secretion of milk
Yes, thank you Dr Nga for your input.
Thank you Dr Nga, your comments are invaluable.
Well written and well explained, charlotte. as always the best person to explain things.
Thank you suraj, i am glad you liked it.
Excellent write up. Your article has wiped off the worried frown of many parents out there. Very educational for the rest of us.
Thank you sumi.
Good explaination and informative. Very impressive that pediatricians are taking active roles to educate the parents on these matters. I also read the article on baby led weaning and it was an excellent write up. Keep up the good work Dr Charlotte.
Thank you Dr. Rajedran..i am glad you like my articles.
Good…can learn more on here….ady follow thanks
Glad you found the website useful.
How many yrs old children can talk??
Thank you JC for your comment. Perhaps your question would best be answered in our upcoming articles on development.
http://doktorbudak.com/2013/07/25/my-child-has-speech-delay-is-he-autistic/
This may help you, JC Yeoh
Dr Charlotte Jane Joseph, super explanation. As said by other is complete and yet very easy to understand, the “Worry Mommy” above is surely much lesser worry. One additional thing I would like to comment here, I want to honor and salute you and your Doctor colleagues for this absolutely commendable effort that you all are putting to relief “Worried Mommies and Daddies” with your professional advise. Being this volunteer effort everybody should praise you all for what is done here. Being a Doctor is already a “heavy duty” job/profession/vocation if you are doing it seriously as I know you are. On top of your tiring work, you are still willing to help others through this Q&A worry-release website. I’m really honored to know you Dr. Charlotte Jane Joseph awesome thing you and all your colleagues have done here!
Thank you Dr. Daniele for your kind comments.
Well written and easily understood article, very well researched also
Amazing explanation! It is such a new knowledge to those mother who face this kind of situations. This article will help it out. Well done!!!!
Thank you tham…i recognize your name from my previous article. I appreciate you spending time reading my articles and commenting on them.:)
thank you for the interesting article… well explained and easily understood
Dear Sharindran,
Thank you for your comment.
Please do post any questions which you may have and we will try to answer them.
I learnt something new…and this info would help in a GP/OPD setting as well as that is were patient’s first present and with this knowledge attending doctors would know how to explain, reassure and maybe do the necessary referral.
Thank you Ahneez, glad that i was able to provide information which could be helpful for your practice. I do hope you have read my previous article “baby led weaning” which could be helpful to you as well.
Well,Dr Jane hope your article will help others out there..great job
Thank you anuja, please do visit our blog site for new articles.
Does the hormones injected in dairy cows result in the cows milk to have traces of hormones that contribute to early development of breasts In young girls?
Dear Sheila,
Thank you for your question. There have been no recent studies to support this claim however there are individuals who feel that the hormones in cows milk as well as the oestrogen in soya milk could predispose to premature thelarche. Hence “organic milk” is recommended by these individuals.
The American Council on Science and Health stated in their June 2001 publication “The Role of Milk in Your Diet”:
“Experts aren’t sure whether girls really are entering puberty earlier. If they are, the most likely explanation is that today’s girls are heavier than their mothers were at the same age. Puberty tends to occur earlier in heavier girls.
There is no research demonstrating that milk or dairy products play a role in early puberty. Milk has always contained hormones in very small amounts; their presence is not a result of any changes in animal husbandry practices. Today’s girls drink less milk than their mothers did. Thus, it seems very unlikely that milk is responsible for any change in the age at which girls enter puberty.”
I hope this helps 🙂
Guess we have to consider better nutrition and sedentary lifestyle? Thanks for the posts.
It was very well written and i enjoyed reading your last articel on baby led weaning as well.
Thank you Rainie, i am glad you liked my article:)