Puberty is the time
when a child's body starts to change to an adult's. Normally, these changes begin
in girls when they're between 8 and 14 years old. In boys, they start between the
ages of 9 and 15. This wide range in age is normal, and it's why kids may develop
several years earlier or later
than many of their friends.
Sometimes, though, kids pass this normal age range for puberty without showing
any signs of body changes. This is called delayed puberty.
Doctors usually can help teens with delayed puberty develop so they can catch up
with their peers.
These changes are caused by the sex hormones testosterone (in boys) and
(in girls) that their bodies start making in much larger amounts than
What Happens in Delayed Puberty?
Signs of delayed puberty in boys include:
the penis and testicles not starting to grow larger by age 14
genital growth that takes longer than 5 years
short stature compared with their peers, who now are growing faster
In girls, signs include:
no breast development by age 14
not starting to menstruate within 5 years of when breasts start to grow or by
What Causes Delayed Puberty?
Delayed puberty, which is more common in boys, can happen for different reasons.
Most often, delayed puberty is a pattern of growth and development in a family.
A child's parents, uncle, aunt, brothers, sisters, or cousins might have developed
later than usual too. This is called constitutional delay and usually
doesn't need any treatment. These "late bloomers" in time will develop normally,
just later than most of their peers.
Some medical problems can cause delays in puberty:
Some kids and teens with chronic illnesses like diabetes,
cystic fibrosis, kidney
disease, or even asthma
may go through puberty at an older age. That's because their illnesses can make it
harder for their bodies to grow and develop. Proper treatment and better control of
these conditions can help make delayed puberty less likely.
Being malnourished — not eating enough food or not getting good
nutrients — can make someone develop later than peers who eat a healthy, balanced
diet. This can happen because of food insecurity, as well as disordered eating or
excess physical activity. Teens with the eating
disorder anorexia nervosa, for example, often lose so much weight that their bodies
can't develop properly. Girls who are extremely active in sports may be late developers
because their level of exercise keeps them so lean. Girls' bodies need enough fat
before they can go through puberty or get their periods.
Chromosome disorders can delay puberty in some people. Chromosomes are made up
of DNA that contain our body's
construction plans. So when they have problems, it can affect normal growth processes.
is when one of a female's two X chromosomes is abnormal or missing. This causes problems
with how her body grows and makes sex hormones, and how her ovaries
develop. Women who have Turner syndrome are shorter than normal, may not go through
puberty in the usual way, and may have other medical problems. Sometimes, puberty
starts at a normal time, and then stalls or stops after a few years.
syndrome is when males are born with an extra X
(XXY instead of XY). This condition can affect testicular function and
sexual development. These boys usually are tall for their age, might have learning
problems, and may have other medical problems. Puberty usually starts at a normal
time, but then stalls.
How Is Delayed Puberty Diagnosed?
If a boy or girl hasn't shown signs of puberty as they move into the teen years,
Do an exam.
Take a medical history, including whether others in the child's family had a similar
Ask about any medicines the child takes.
Check the growth chart
to see if there's a pattern that points to a problem.
They also might:
Order blood tests to check for thyroid,
pituitary, chromosomal, or
If doctors find a problem, they usually refer families to a pediatric endocrinologist,
a doctor who specializes in treating kids and teens who have growth problems, or to
another specialist for more tests or treatment.
How Is Delayed Puberty Treated?
Often, the doctor will find no underlying physical problem. Most kids with delayed
puberty are just developing a bit later than average and will catch up.
Some late bloomers struggle with waiting for the changes of puberty to start. So
doctors may offer hormone treatment:
Boys might get a short course of treatment with
(usually a monthly injection for 4–6 months) to get the changes of puberty
Girls might get low doses of estrogens for 4–6 months to start breast development.
After treatment ends, the teen's own hormones usually take over to complete the
process of puberty. If they don't, the doctor will discuss long-term sex hormone replacement.
How Can Parents Help?
It can be hard for kids and teens to watch their friends grow and develop when
the same thing's not happening to them. They might get teased at school or not be
able to play a sport they like. Their body
image and self-esteem can
A healthy body image comes from accepting your body, liking it, and taking care
of it. To boost a child's body image:
Engage them in activities that they enjoy and can master.
Help them get plenty of sleep and
eat a healthy diet.
Make sure teens are active every day.
Reassure them that their growth and development is normal for them, and they will
catch up with their peers.
And be a good body-image role model yourself. When a parent talks about their body
in positive ways and takes good care of it, kids pick up on this and do the same for
Remind your child that a late start to puberty is a problem that usually gets solved,
and that in time they will catch up. But if your child seems depressed
or has school or other problems, finding a counselor or therapist
to talk to can help.