In this world, every person comes with already formed sexual characteristics of a primary nature. And only later (when the child is 9 years old, or maybe more), secondary sexual characteristics appear (for example, hair in the armpits and genitals, enlarged mammary glands, as well as menstruation). The main thing in this process is progression. What is meant? And the fact that menstruation cannot appear before breast enlargement or hair growth of the pubis and armpits has occurred. And all this together can not appear in a child aged 1-3 years. If this happened, then logical questions arise about the normality of this process at such an early age.
Should I immediately panic? In this situation, you need to calm down: it is just that your child most likely has premature sexual development (PPR). By the way, the most common manifestation of PPR of a benign nature is an isolated telarch (that is, an increase in the mammary glands). Moreover, sometimes, enlarged mammary glands can be determined by palpation, even in newborn babies. And one more thing: very often a similar ailment is observed in premature infants.
Can an isolated one-year-old telarch be observed? And what to do in this situation? Which doctor should I go to? There are many questions, let's understand.
Physiological isolation of a telarch in a child
The mammary gland can be safely attributed to the target organ, which gives an instant response to any hormonal failure of a steroid or peptide nature in the form of a change in the available volume and structure.
Already during the period of the baby's stay in the womb (or, to be more precise, in the third trimester), she has the first receptors that respond to hormones such as estrogens. And after childbirth (after 3-4 months), a reaction to progesterone is also observed.
The undeveloped mammary gland has an oval shape with a diameter of about 10 mm. It is practically not palpable, since it has a rather soft structure. Sometimes, due to the specific location of the ducts and the specific structure of the gland itself, the perigastric tissue can be pulled.
80% of newborns have enlarged mammary glands immediately after their birth. And this concerns not only girls, but also boys. This happens due to the increased work of the pituitary system. As a rule, by the end of 2-3 weeks everything normalizes: the mammary glands either decrease or remain the same size, but at the same time they no longer increase.
On a note! In 2% of infants, a decrease in mammary glands can be observed only by 8-10 months. But this is also not a big deal, since it is not a pathology.
ICD-10 isolated telarch code
What is ICD-10? This is the International Classification of Diseases, the tenth revision, which was carried out in the period from September 25 to October 2, 1989 in Geneva. This event is being implemented by the World Health Organization (WHO).
An isolated telarch (according to ICD-10, the disease is assigned code E30.8) is defined as āother puberty disordersā. Premature enlargement of the mammary glands can occur between the ages of one to three years, or from six to eight years (and, as a rule, menstruation, hairiness of the pubis and armpits are absent).
Over time, a regressive process of development of secondary sexual characteristics may begin, and the child will develop in accordance with his age. Otherwise, telarch can contribute to the activation of structures of a hypothalamic nature and lead to complete SPR.
In addition to an isolated telarch (code for ICD-10 - E30.8), a child may experience premature puberty. It is expressed in the fact that at the age of 10-11 years the girl may begin menstruation (menarche). Possible causes of such a violation:
- Decreased ovarian reserve capacity.
- All kinds of stressful situations that led to mental trauma.
- Failure of a hormonal nature.
- Features of the human constitution (for example, overweight).
- Excessive enthusiasm for physical activity.
- Insufficient amount of nutrients consumed.
- Genetic predisposition.
In addition to isolated telarch, other conditions suggesting premature puberty of a general nature (for example, pituitary hyperfunction) are noted in the ICD.
The causes of the disease
Isolated telarch may be caused by the following reasons:
- An increase in the secretory activity of the ovaries, which occurs on an ongoing basis.
- The release of estrogen occurring periodically.
- Hypersensitivity of the mammary glands to hormones such as estrogens.
- Cystic (follicular) changes in the ovaries, which are temporary in nature.
- Hereditary predisposition.
- Van Wick ā Grombach syndrome, which is characterized by a combination of hyperprolactinemia and primary hypothyroidism.
- The intake of hormones (estrogens) either with food, or as part of certain medications.
- SMOB (i.e., McCune-Albright-Breitsev Syndrome), which is characterized by a rather rare form of SPD along with bone dysplasia of a fibrous nature and skin pigmentation.
- A violation in the work of the human endocrine glands located above the upper part of the kidneys (i.e., the adrenal glands).
- Hypersensitivity of the mammary glands to hormones.
- The presence of stressful situations, after which the child has a hormonal failure.
- A complex of hereditary anomalies (that is, Russell-Silver syndrome), which is characterized by congenital dwarf growth, a small mass of the born baby, a triangular face, and also a delay in overall development. This happens due to impaired fetal development at the embryonic stage.
- Tumors of the ovaries and adrenal glands androgen-producing nature. True, such ailments are extremely rare for girls.
Symptoms of the disease
In a girl, an isolated telarch can manifest itself as follows:
- First, a small seal appears on both sides (sometimes the areola) on both sides (sometimes only on one side), characterized by painful sensations.
- After six months, or maybe a year, the compaction increases significantly in size, becomes softer and goes beyond the areola.
- The mammary gland at this stage of its development is adipose tissue, which is penetrated by microvessels and ducts of the glands.
- Connective tissue grows, creating a feeling of fullness in the child and causing pain in the area of āāthe mammary glands.
- The breast itself takes on a cone shape.
- A nipple that rises above the breast may change color.
Important! Any discharge from the chest is not observed.
As a rule, the bones and external genitalia of a child are developed according to his age. True, there is a very slight swelling of the vulva. But this manifestation is temporary.
At the doctor
If you find the first signs of breast growth in a child, then the most appropriate solution will be to consult a pediatric gynecologist or pediatrician. He, in turn, will hold the following events:
- He will carry out a general examination of the child and compare the actual degree of his puberty and physical maturity with standards appropriate to his age (on the Tanner scale).
- He will listen to the patientās complaints and clarify the psychological characteristics of the sick child, that is, he will collect a complete medical history.
- It will measure blood pressure.
- Will palpate the enlarged mammary glands.
- Appoint an ultrasound examination. During this procedure, disorders in the functioning of the thyroid gland or ovaries can be diagnosed.
- Determines bone age.
- He will appoint a consultation with an endocrinologist who can direct the child for blood donation (possibly for thyroid hormones) and will examine his patient.
- Will give an objective conclusion.
If the cause of the childās developmental disorder is determined, then it is simply eliminated. If not, then the girl should be constantly monitored by doctors.
If during the year the mammary glands have decreased and no longer cause the child discomfort, then we can safely say that the girlās isolated telarch passed. In some cases, the mammary glands remain enlarged until natural puberty (that is, until the period of puberty). In this case, it is worth being alert and attentive to changes in the childās psychoemotional and physical development in the future.
Important! In any case, girls who have revealed the first signs of an isolated premature telarch (regardless of whether it is confirmed or not), must be examined twice a year by a specialist.
There is one more point to pay attention to - this is the vaccination calendar. If the child is diagnosed for telarch, then vaccination should be postponed for a while. This must be done in view of the fact that the immune system is rather weakened during such hormonal surges. Therefore, remember: isolated telarch and vaccinations are incompatible. Otherwise, an allergic reaction or a rather poor tolerance to vaccination may be observed.
Instrumental and laboratory research methods
Isolated telarch can be diagnosed by conducting the following studies:
- To exclude the possibility of a neoplasm in the ovaries, ultrasound of the pelvic organs is performed (that is, the uterus, its appendages, neck and bladder). During the procedure, follicles 0.4-0.8 mm in size can be detected.
- If signs of an isolated premature telarch are observed, ultrasound of the mammary glands and thyroid gland should be done. During the procedure, the growth of the gland itself, as well as its ducts and blood vessels, is determined.
- Such a standard examination method as ultrasound of the abdominal organs (that is, tissues of the abdomen and internal organs) will not be out of place to exclude other possible causes of the disease.
- MRI diagnosis, which allows to identify a head tumor. It was this pathology that could become a provoking factor in the appearance of telarch.
- Determination of blood levels of hormones such as LH (luteinizing, responsible for the production of estrogen), FSH (follicle-stimulating), TSH (thyrotropic, which determines the functioning of the thyroid gland), prolactin, estradiol, T3 and T4 (free hormones responsible for oxygen metabolism and production proteins in the human body). With their increased content, it is necessary to perform tests with a GnRH agonist, which is carried out exclusively in the morning.
Girls whose breast enlargement started at the age of 2-3 years should be examined more thoroughly, since there is a high probability that they may have progressive puberty.
Additional studies may be prescribed:
- An examination by an ophthalmologist who will conduct not only an examination of the fundus, but also determine visual acuity.
- Molecular examination of a genetic nature.
- A study to determine the karyotype.
Important! A single plasma study is ineffective when it comes to diagnosing SPR.
General tips for telarch
Here are some recommendations that will not be superfluous:
- At the first signs of an ailment, you need to seek help from a medical institution such specialists as a pediatrician, pediatric gynecologist or neurologist.
- It is mandatory to conduct blood tests.
- Instead of radiography, it is better to use the method of ultrasound mammography to diagnose the disease, since the first method involves the presence of radiation exposure.
- To prevent the transition of the isolated form of telarch to full, it is necessary to carry out in full all the activities that are carried out in a dispensary.
- Girls who have had an isolated telarch should be closely monitored by physicians until their natural puberty, that is, they must undergo a full examination twice a year (even if they have a reduction in the mammary glands).
Can telarch be cured
Naturally, an isolated telarch can be treated quite quickly with the help of medication hormones. But the problem is that taking such drugs at such an early age can affect the overall health of the child. Therefore, children are prescribed non-hormonal drugs such as Mastodinon and Cyclodinone, which are made on the basis of natural herbal ingredients. The first preparation includes a stalk leaf (cornflower), cyclamen, Abraham tree, iris, chilibuha and lily (brindle); and in the second - common thistle. Both drugs are available in drops and tablets.
Only in the absence of positive results in the treatment of non-hormonal drugs can hormones be prescribed.
In the absence of therapy
If you do not treat an isolated telarch (in a girl 1 year old or older), complications and consequences may arise:
- At such a young age, such an ailment can lead to a serious deterioration in the general condition of the child.
- Certain changes can occur in the chest, which will only worsen with age. For example, mastopathy is possible, as well as degeneration of tissues of a fibrous and cystic nature.
- A failure of the hormonal level will only progress, and it will not lead to anything good: there is a high probability of a violation of puberty in general.
Prevention
Everyone knows that any pathology, even the most serious, is easier to treat at the initial stage of its development. Therefore, parents need to be more attentive to their children, and to be more specific, then to all those changes that occur with the child in terms of their physical and psycho-emotional development. Undressing your baby before washing or just changing clothes, do not be lazy and examine her body. Let her perceive everything as a game, do not scare her.
In the case of the first signs of an isolated telarch syndrome, there is no need to panic. The most important thing is to explain to the child that there is nothing wrong with this situation, that is, do not cause the daughter to fear or disgust what is happening. After all, this can affect a personās personality negatively, especially during his natural puberty.