Objective: The purpose of this paper is to review the changing ages of pubertal onset, and discuss how it may impact chiropractic diagnosis and management in this pediatric population.
Methods: An open literature search was conducted, using scientific journal databases PubMed, Science Direct, Medline, Proquest, and Medscape. An open Internet search was also utilized.
Discussion: Puberty includes a range of events and the emergence of several secondary sexual characteristics. What has been considered the normal age ranges for puberty differ between gender (for females, 9-16 years of age and males, 13-15 years of age). Precocious puberty has been considered the onset of puberty prior to age 8 in girls, and 9 in boys. Recent studies, however, have shown the onset of puberty earlier than expected, particularly in the female population. Precocious puberty may occur secondarily to pathologies such as endocrine disorders or central nervous system insults. Furthermore, with the onset of puberty, there is commonly a rapid growth period, which could potentially lead to a surprisingly "early onset" for a number of orthopedic conditions. Chiropractors should be aware of emerging trends in the average age of onset of puberty and differentiate it from precocious puberty, which may require referral.
Conclusion: It is important that chiropractic practitioners are aware of the changing trends, potential pathologies and underlying disorders that may contribute to an early pubertal onset. In addition, chiropractors need to be aware of the common orthopedic conditions presenting during periods of rapid growth and development. These may go undiagnosed if the practitioner is unaware of current adolescent age ranges.
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