Lydia Onyango's daughter was only eight years old when she felt something wet in her underwear.
Thinking it was urine, she went to the washroom, only to discover blood. As expected, the girl sought answers from her mother. Lydia recalls her daughter's naive expression when she confided in her.
“She was confused and shocked. She was just in class three and her menses had started,” she says.
Though the minor was experiencing a phenomenon called precocious puberty, the mother had no clue.
"She never showed any serious health issues so I never took her to a hospital. Besides, her teacher was supportive and had spoken to her about menstruation and puberty. That helped her move on without much difficulty,” she says.
Like Lydia’s daughter, a growing number of children are showing signs of puberty at significantly younger ages.
Roselyn Mungai, a mother, also had a similar experience like Lydia’s.
When Roselyn first noticed blood stains on her seven-year-old daughter’s dress, she assumed it was dirt.
The girl had just celebrated her seventh birthday, and the thought that she had started her period never crossed her mother’s mind. To her, she was still a child.
“I did not even pay attention to it. As usual, she went to shower and then put on clean clothes. After some time, her pants got stained again. I was now sure my mind was not playing tricks on me. The girl had started her menses,” recalls Roselyn.
Roselyn, 34, says it was hard to break the news to her daughter, who, for obvious reasons, did not seem to know what was happening to her.
“When I told her to go and change her pants, she gave me an innocent look. I tried my best to explain to her that her body was experiencing some changes,” she explains.
“She started to keep to herself and even refused to go to school the following day,” the mother says.
As a concerned parent, she took her to a paediatrician, who confirmed that she was having her first menstruation.
Puberty is a natural process of growing up in a girl’s life, but it can be quite confusing and distressful when if it occurs at a young age.
Even for parents, discovering that their child is entering early puberty can be distressful.
Parents like Lydia and Roselyn whose children have experienced puberty at a young age have been forced to start discussions early to ensure their children don't fall prey to sexual abuse.
A study by Mendle found that girls who entered puberty significantly earlier than their peers were at higher risk of mental health concerns and were more likely to become depressed during adolescence, which can persist into adulthood.
However, it's not just menstruation that marks the start of puberty.
At nine years old, Joan Vaati recalls having gone through a challenging period as a child.
“Imagine seeing tiny buds popping from your top. I was just a month away from my eighth birthday when I noticed that my breasts were growing. As a child, I was curious and worried,” says Joan.
“To hide them, I would spend a whole day in a pullover. I felt embarrassed and that almost affected my self-esteem.”
Luckily for her, her mother was supportive and helped her to deal with the situation.
In Kenya, the median age for menarche-first menstrual bleeding is 14 years. Within the population of menstruating girls, 87.7 per cent receive information on menstruation from their mothers and 15.5 per cent from their teachers.
However, the majority of conversations between parents and daughters focus on avoiding teenage pregnancy, so little attention is given to menstruation.
With puberty beginning at younger ages, especially among girls, specialists say there is an urgent need for greater awareness and education among families to ensure the minors are helped to cope.
Early puberty, also known as precocious puberty, is when a child’s body begins to change towards an adult’s body earlier than expected, causing a growth spurt that makes them taller than their peers. This change is known as puberty.
Puberty usually begins with breast development called thelarche, followed closely by the growth of pubic hair called pubarche.
Menstruation, called menarche, begins about two years after the start of breast development in the normal puberty process.
While the age range for puberty varies, Njeri Karianjahi, an adolescent medicine specialist at Getrudes Children’s Hospital, says the average of menses is around eight years old and is considered premature if it occurs earlier.
According to Dr Karianjahi, premature puberty, particularly in girls, is caused by the brain sending signals earlier than it should. It can also be linked to genetics.
“Certain conditions, such as infections, hormone issues, tumours, brain issues or injuries, may cause precocious puberty,” says Dr Karianjahi.
“As a mother, if you have a six or seven-year-old with adult body odour and in need of deodorant, then there is a problem,” says Dr Karianjahi. Other symptoms include acne, pubic or underarm hair, and short stature.
The expert notes that early signs of premature puberty may not be visible by merely looking at the child.
Renson Mukhwana is a paediatric endocrinologist at Getrudes Children’s Hospital. A paediatric endocrinologist is a doctor who specialises in the diagnosis and treatment of children with growth disorders. Dr Mukhwana says a series of tests, including blood tests and a specific scan, are done to tell if a child is undergoing early puberty.
“Blood tests are done to check hormone levels. We also do X-rays of the hand, called a bone age X-ray, to see if the bones are growing too fast. We also conduct CT scans, magnetic resonance imaging (MRI), and ultrasounds to look for tumours, abnormal growths, or other problems,” says Dr Mukhwana.
The type of treatment that is prescribed to an affected child, depends on what is causing the problem points out Dr Mukhwana.
“For example, if a two-year-old girl shows signs of puberty, we will block the process until she is eight years old. The treatment includes monthly injections or formulations administered every three months from the time of diagnosis until she reaches the normal puberty period,” he explains.
The treatment, he says, costs Sh10,000 every month or Sh20,000 every three months, which is expensive for the average person.
“The procedure is not available in public hospitals because it is not a priority issue,” says Dr Mukhwana. However, when no cause can be found, he says treatment may not be needed, depending on the child's age and how fast puberty is manifesting.
Premature puberty may affect the child emotionally and socially, according to child therapists. Children with premature puberty may be confused or self-aware of the changes in their bodies.
To help them cope with these changes, Dr Njeri advocates for guidance and counselling from parents and specialists.
“Girls may be moody and irritable. Children who experience early puberty are at a higher risk of sexual abuse; therefore, it is critical to educate and empower them. Seek the help of a child counsellor or psychologist to help walk the journey,” says Mrs Jane Ngatia, a counselling psychologist at the East Africa Institute of Professional Counselling.
Although dealing with early puberty can be challenging for parents and children, with the right support or medication, Dr Karianjahi says the child will cope well.
“Even though parents cannot do much to stop premature puberty, starting the conversation when the children are young and keeping lines of communication open can make the transition less scary,” says Dr Karianjahi.
“These are normal changes in the body that indicate that everything is working although just a little bit too early or too fast. Reassure your child that they are OK and that they don’t need to be embarrassed or afraid,” says Mrs Ngatia.
Premature puberty is not a widespread condition, and obtaining accurate data can be challenging. Globally, there is one case of premature puberty in 100,000 to 200,000 individuals, highlighting the need for more awareness to help mitigate its effects, which include sexual harassment.
