Definition

Girls enter puberty between the ages of 7 and 13. Boys enter this stage between the ages of 9 and 14. Delayed sexual development is when this stage is late.

Causes

Some children take longer than their peers to develop. They will catch up with time. This is the most common cause.

Other causes may be:

• Chronic illness
• Malnutrition or weight loss, such as with anorexia nervosa
• Hypogonadism—not enough male or female sex hormones
• Other endocrine diseases, such as hypothyroidism or Cushing disease
• Chromosomal abnormalities, such as:
  • Turner syndrome (girls)
  • Klinefelter syndrome (boys)
  • Prader-Willi syndrome (boys and girls)
  • Noonan syndrome (boys and girls)
• Hypopituitarism—destroys the ability to make hormones that stimulate male or female sex hormones

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Risk Factors

This problem is more common in children who were born with certain birth defects, such as cleft lip and palate, and heart defects.

Other things that may raise the risk of this problem are:

• Family history of delayed puberty
• Being underweight

Symptoms

One common symptom for both boys and girls is being short for their age. Other problems by gender are:

• In boys:
  • Lack of testicular enlargement by age 14
  • Sex organs that do not fully develop within 5 years after they started to develop
• In girls:
  • Lack of breast development by age 13
  • Lack of menstruation 2 and one-half years or more after initial breast development

Diagnosis

You will be asked about your child’s symptoms and health history. A physical exam will be done. Your child's milestones and growth record will be reviewed. This may be enough to make the diagnosis.

Your child's hormone levels may be tested. This can be done with blood tests.

An x-ray of the left wrist bones may be taken. This helps to find out if your child is still growing.

Treatment

Most children do not need treatment. The child’s height, weight, and sexual development will continue to be monitored.

Some children will be treated based on the cause, such as treating a chronic illness. For others, choices may be:

• Counseling to help a child cope with problems like low self-esteem
• Sex hormones to help start sexual growth in children who are very delayed

Prevention

There are no guidelines to prevent this problem.