1 Is your child under 8, and is she showing any of the following signs of puberty?

• Pubic hair
• Breast enlargement
• Periods

2 Is your child over 14 years old, and has she not yet started having her periods?

3 Are any of the following signs of puberty present?

• Pubic hair
• Armpit hair
• Breast enlargement

4 Has your child been treated at any stage with chemotherapy or radiotherapy?

5 Is she substantially underweight, or is she involved in a vigorous exercise programme?

6 Does your child have a long-term illness such as cystic fibrosis or arthritis?

7 Did your child start having periods that have now stopped?

8

Possible cause Puberty may have begun abnormally early in your child. In many cases, it is not known what causes the early onset of puberty, but in some cases it may be due to a problem in the hormone-producing control centres in the brain. Consult your doctor.

Action Your doctor may arrange for blood tests and may refer your child to a specialist. If your child has started puberty, she may be prescribed drugs to delay its progress. The drugs will ensure that the slowing down in growth that comes at the end of puberty does not begin before she reaches a normal adult height.

9

Possible cause and action Despite the absence of periods, your child is showing signs that puberty has started. Although she is developing later than normal, this is no cause for concern. She should continue to develop normally, and puberty should be completed within the next 5 years. There is probably no need to consult your doctor, unless you or your daughter are concerned.

10

Possible cause and action Your child's treatment may have affected the production of hormones. Consult your doctor, who will probably examine your child and may arrange for blood tests to measure her hormone levels. If necessary, your doctor may then refer your daughter to a specialist.

11

Possible causes and action Being very underweight or overexercising may affect hormone production in the part of the brain that controls the onset of puberty and the menstrual cycle. Consult your doctor so that a serious underlying cause such as an eating disorder can be excluded. Your doctor will advise you on your child's ideal weight and discuss the negative effects of overexercise at this stage of life. If your child is seriously underweight, your doctor will advise her on how to gain weight safely. Your child may be referred to a specialist if necessary.

12

Possible cause and action Some serious long-term illnesses can temporarily delay the onset of puberty. Discuss your concerns with your child's regular doctor.

13

Possible cause and action The onset of puberty is delayed in your child. Although there is often no obvious cause for late puberty, it tends to run in families and is more common in children who are short. Consult your doctor, who will examine your child and may arrange for blood tests to measure her hormone levels. If necessary, he or she may then refer your child to a specialist.

14

Possible cause It is quite common for girls to have irregular periods for the first few years. It may take up to 40 menstrual cycles before the body establishes a regular pattern. However, the possibility of pregnancy should always be considered.

go to Absent periods

15

Consult your doctor if your concern is not dealt with in this chart.