About a month ago my 7 year old daughter (soon to be 8), came to me one night, with a nervous complaint of a lump behind her right nipple.  With a slight sense of unease, I got up, palpated the spot she was pointing to, and sure enough there was a hard, pea sized nodule lurking under her skin.  Thinking the lump was probably normal breast development, I sent my daughter back to bed with a kiss and an “everything is normal” hug, then immediately jumped on my computer Googling 7 year old girls with breast lumps.

To my relief, most of my research pointed me in the direction of early thelarche.   Thelarche is the development of breast tissue, otherwise known as breast buds, and is one of the signals of the onset of puberty.  According to a study in the journal Pediatrics, American girls are maturing earlier.  What was once a normal pubescent age of 10 or 11 is now being seen in 7 and 8 year olds.

However, when these signs and symptoms of puberty occur before the age of 8 in girls and 9 in boys, then precocious puberty could be to blame.  Early puberty has its problems and could lead to shorter growing times, and shorter overall height.  The psycho/social problems with early puberty could lead to poor body image and low self esteem.

Signs of precocious puberty in girls:

Breast growth
First Period
Pubic Hair
Rapid Growth
Acne

Signs of precocious puberty in boys:

Enlarged testicles/penis
Body odor
Deepening voice
Pubic Hair
Rapid Growth
Acne

The following morning I placed a call to my pediatrician, and after explaining to the nurse my daughter’s finding from the night before, I expected her to say, “That’s normal, nothing to worry about.”  Instead she said my daughter was too young for breast development, and needed to come in and see the doctor.  My stomach did a little flip as I made the appointment.  Was I missing something?  Was this normal development, or a new anxiety to keep me from sleeping at night?

My daughters experience got me thinking about my own development, or lack thereof.  I have no memory of breast bud development; I would have been horrified to touch my own growing flesh, let alone go to my mom about it.  When I was growing up girls didn’t do that sort of thing.  I was twelve when my period came, and I remember the shock and embarrassment that brought on.  I was horrified by the painful, hemorrhaging happening between my legs, and there was no way I was going to my mother.  My sister, (through my tears of objection), did it for me.

My daughter is a different breed, thank God.  She is the daughter of a nurse.  I don’t lie, or make up silly names, much to the chagrin of my husband and father.  When my daughter was three, she used to run around my parent’s house singing, “I have a vagina; I have a vagina!!”  My father, not quite understanding her sing song, turned to my smiling mother and asked, “What is she saying?”  To which my mother replied in her best sing song voice, “I have a vagina, I have a vagina!!”

There’s a look that father’s, not men, but father’s give when they hear the word vagina that makes them squirm in their seat, roll their eyes, and huff and puff a little bit as if some sort of taboo has been broken, fearing the word period, or perhaps feminism might slip out next.  This was the look my father gave that day.  It’s no wonder I was afraid to get my period.

So thankfully my daughter is comfortable in her own skin, and so far, not afraid to come to me for help.  But could she be facing puberty at age 7, when I could barely face it at age 12?

The pediatrician examined my daughter later that day, and felt the pebble like nodule of what?  She didn’t know.  “Wait three weeks, if it’s still there then I would like her to see a pediatric endocrinologist.”  Really, I thought?  Was this necessary?

With anxious weekly reminders from my daughter, we got to week three, and the lump was still present, along with what appeared to be soft breast tissue, or as my daughter likes to call it, “the hill.”  After a thorough examination by the endocrinologist, we were still no closer to an answer.   She too agreed that the lump seemed odd, but thought we should run some tests to determine if she was entering puberty.  Since when did the normal transition from child to adult become so complicated?

So what are the tests for puberty?  Here is a list of the most common ones:

1. Blood work is first collected to test for the hormones of puberty: LH (Luteinizing Hormone), FSH (Follicle Stimulating Hormone) Estrogen Levels, and Thyroid levels, (Testosterone levels in boys).
2. A bone X-Ray of the wrist is performed to measure the growth plates and determine bone age vs. stated age.
3. An MRI of the brain may be done to look for any abnormalities.
4. An ultrasound of the ovaries may be done in girls to rule out a cyst or tumor.

If the tests are positive and early puberty is diagnosed then there are treatment options which include a monthly injection of a hormone that blocks the onset of puberty.  This hormone is given until a more reasonable pubescent age and then discontinued, allowing the body to take its normal course.

This treatment option was discussed with me by the endocrinologist, and I have to say it weighed heavy on my conscience.  Medicate my child to prevent early puberty, or let nature take its course?  I was more than hesitant to have to make that decision.

After blood work and a wrist X-Ray, it was determined that my daughter was not in puberty; a relief on the one hand, but leaving me with the question, “Then what is that pea sized lump in her breast?”

Only an ultrasound will be able answer that question.

In the meantime I wait and I worry (a little), about what I’m putting my child through, and if I really have anything to worry about at all.

I can’t help but wonder if after all this testing, we’ll come full circle to find out her breast lump was nothing more than premature thelarche, and the premature wanderings down the inevitable path to a diagnosis of puberty.