Many things could delay the start of puberty in teen


April 21, 1992|By Dr. Modena Wilson and Dr. Alain Joffe

Q: My 14-year-old daughter is not showing any signs of going into puberty. I think it's because she's tall and thin. Are there certain foods she should eat to help her gain weight?

A: You've probably noticed that there is considerable variation in physical development among your daughter's friends. Some enter puberty as early as 9 or 10 while others may just be starting at 13. In general, most experts believe a teen-age girl should display visible signs of puberty by age 14.

It may be that your daughter's body shape accounts for her lack of development. There is some evidence to suggest that onset of puberty correlates with the amount (percentage) of fat in the body. If your daughter has not reached that critical level, her "biological clock" may not yet be turned on. There is also a genetic basis since teen-agers with delayed development often have parents who also entered puberty later than their peers.

Given your daughter's age, a thorough physical examination is warranted. There are a number of diseases which can cause a delay in puberty without having any other obvious manifestations. These include hormonal, gastrointestinal and genetic causes. Your doctor should be able to determine whether there is a problem based on careful history (are there other family members who went into puberty late?), an examination and a few laboratory tests.

Chances are if you're wondering what's going on, your daughter is also. This will give her the opportunity to express her concerns and be reassured about her development.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center. Dr. Joffe is director of adolescent medicine.

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