Hirsutism in Babies, Toddlers and Kids
Hirsutism, the presence of male pattern hair growth, is a medical condition that is commonly associated with women of reproductive age. But pre-adolescents and pre-teens may also be affected by it. There is not much medical research on hirsutism in babies and toddlers at this point in time. As with adult hirsutism, the growth of excessive body hair in young women is characterized by hair growth in areas that follow a male-pattern such as the face, chin, back and chest. The most common cause hirsutism in women of all ages is the result of a hormonal imbalance. The same is true for adolescents.
Hormones found within the body regulate everything from our stress levels to our metabolism. They trigger our ‘fight or flight’ response, govern how our body uses water and monitor blood sugar levels. But hormones also control the onset of puberty. So in cases where they are activated prematurely, unwanted side effects like hirsutism may follow.
Precocious Puberty
The average age for girls to begin puberty is 11 while for boys the average age is 12. At this crucial time, symptoms like a deepening voice, the development of facial or pubic hair and acne may arise. These physical changes that the body undergoes mark the onset of puberty.
The hormones in charge of regulating puberty follow a tightly regulated process. If they are activated early (ie. at an extremely young age such as 8 years old), this might be a medical condition known as precocious puberty. Precocious means ‘early.’
Precocious puberty is defined as the onset of secondary sexual characteristics before the age of eight years in girls and nine years in boys. Secondary sexual characteristic are:
- Facial hair (In young girls, facial hair that usually grows first on the upper lip is a symptom of precocious puberty)
- Breast growth
- Pubic or underarm hair
- First period
- Rapid growth
- Acne
- Adult body odor
If any of these symptoms are noticed in young girls or boys before the onset of puberty would be expected, a pediatrician should be seen.
Causes of Precocious Puberty
Many factors can cause hormones to activate prematurely in adolescents such as:
- Infections
- Tumors – a tumor in the adrenal glands or the pituitary gland may secrete the hormones estrogen or testosterone
- Ovarian cysts / tumors
- Brain abnormalities or injuries
- Radiation exposure (ie. chemotherapy)
- Other medical conditions like McCune–Albright syndrome
- Idiopathic – Sometimes, despite undergoing numerous tests the cause of precocious puberty may not be found
Risk Factors
A number of factors may increase a child’s risk of starting puberty early. This includes:
- Female gender – girls are much more likely to develop precocious puberty than boys
- African American ethnicity – precocious puberty appears to affect African-Americans more often than children of other races.
- Obesity in children
- Having other medical conditions like McCune-Albright syndrome or congenital adrenal hyperplasia
- Having received radiation therapy for treatment for tumors or leukemia
Diagnosis
A pediatrician will start the diagnostic process with a history and physical examination. They may ask the following questions about the child’s development:
- When the hair growth was first noted and if it is present in other parts of the body
- Any other physical changes noticed ie. breast development, body odour, acne
- Does your child have any other symptoms
- Is there a history of early puberty in the family
- The child’s birth history and recent medical history
- Any other medical problems present
Diagnostic tests that will be carried out will include:
Blood Tests
To check levels of hormones within the body such as:
- Thyroid test
- Gonadotropins: Luteinizing hormone and follicle-stimulating hormone
- Other hormones such as: Estradiol, testosterone, dehydroepiandrosterone sulfate (DHEAS)
- A gonadotropin-releasing hormone (Gn-RH) stimulation test
Imaging Tests
Bone age X-ray – This test looks to see if your child’s bones are maturing too early. Pediatricians frequently use bone age x-rays to evaluate children for advanced or delayed growth and physical development
Ultrasound scan – before advancing to other imaging techniques, an ultrasound scan may be carried out.
MRI or CT scans – These may be used to rule out a tumor. Both CT and MRI scans are non-invasive tests that provide a detailed picture of what’s going on inside the body
After carrying out these test you doctor will have a better idea of what may or may not be causing the hormonal imbalance. In some instances, all of the tests results may come back normal. If this is the case it is important to remember that for an older child, early development might simply be normal for them.
In other instances, test results may be normal but a cause may never be found. Treatment options can still be discussed if both the parent and child agree on that course of action.
Treatment
Treatment of precocious puberty and hirsutism will depend on the primary cause. Any treatment of young adults or teenagers always comes with an extra layer of caution because they’re undergoing the critical developmental stage. So medication options that are discussed with the doctor will always include the following considerations:
- Your child’s age
- How slow or fast they’re developing
- The chance of early menstruation
- Concerns about their height as an adult
Treatment
If a diagnosis has been pinpointed then treatment will primarily focus on dealing with the primary cause. For cosmetic reasons, young women may want to deal with excess hair growth using traditional methods such as waxing, depilatory creams or shaving.
Treatment should only be started if a firm diagnosis has been given by a healthcare professional. In some instances a diagnosis will not be found but testing will have ruled out anything of concern.
For children with some forms of precocious puberty in which no underlying medical condition has been found, treatment will be geared towards medications that delay further pubertal development. The goal is to slow down the effects of early puberty and also decrease hirsutism.
Early puberty can be hard diagnosis to make, even for the experts. And for young children dealing with such symptoms extra support may be required. So pediatricians will always go through the entire process with extra care and patience.
