BY HALEY WEISS
GOOD QUESTION
ITALY NOTICED FIRST. IT WAS THE FIRST COUNTRY TO lock down during the COVID-19 pandemic, and later in 2020, researchers at Florence’s Anna Meyer Children’s University Hospital were the first to point out a puzzling trend: more young girls than ever before had been showing up at the hospital with clear signs of early-onset puberty.
The cases weren’t unique, but their frequency was. Since early-onset—or “precocious”—puberty first gained widespread clinical attention in the 1990s, it’s become steadily more common worldwide. Defined as the appearance of secondary sex characteristics such as breasts, pubic hair, and vocal changes in girls 8 or younger and boys 9 or younger, precocious puberty has been difficult for researchers to attribute to a single cause. But a mysterious, pandemic-generated spike in cases has provided experts with a new opportunity to revisit their dominant theories in hopes of an answer. Case studies have now rolled in from clinics around the world, many of which saw at least a two- or threefold increase in precocious-puberty diagnoses after March 2020. In China’s Henan province, for example, doctors at 22 facilities saw five times as many cases in 2020 as they did in 2018.
There’s no conclusive answer about what causes premature development, though research shows that the constellation of factors at play includes stress and trauma, as well as lifestyle habits like poor diet and lack of exercise that are tied to weight gain in children. Pandemic measures saddled children with this exact package of pressures.
Precocious puberty is most often diagnosed in girls, because “puberty in girls is more visible,” says Sena Orsdemir, a pediatric endocrinologist at the Loma Linda University Children’s Hospital. Growing breasts is often a public experience, and developing early can mean a minefield of unwanted attention. Then there’s the distress of watching their bodies evolve, which can be jarring even for those old enough to have received proper context and education. “First- and second-graders, they’re not mature enough to handle this type of body change,” says Orsdemir. “That is a big stress for a young girl.” Perhaps as a result, early puberty has been linked to mood disorders and some behavioral issues. Precocious puberty can also put children at risk years later for diabetes, cardiovascular disease, and certain reproductive cancers.
Though some cases ar
