Girls Approaching Puberty Before Age 10 - A New ‘Normal’?

One day last year when her daughter, Ainsley, was 9, Tracee Sioux pulled her out of her elementary school in Fort Collins, Colo., and drove her an hour south, to Longmont, in hopes of finding a satisfying reason that Ainsley began growing pubic hair at age 6.

Ainsley was the tallest child in her third-grade class. She had a thick, enviable blond-streaked ponytail and big feet, like a puppy’s. The curves of her Levi’s matched her mother’s.

“How was your day?” Tracee asked Ainsley as she climbed in the car.

“Pretty good.”

“What did you do at a recess?”

“I played on the slide with my friends.”

In the back seat, Ainsley wiggled out of her pink parka and looked in her backpack for her Harry Potter book. 

Over the past three years, Tracee — pretty and well-put-together, wearing a burnt orange blouse that matched her necklace and her bag — had taken Ainsley to see several doctors. 

They ordered blood tests and bone-age X-rays and turned up nothing unusual. “The doctors always come back with these blank looks on their faces, and then they start redefining what normal is,” Tracee said as we drove down Interstate 25, a ribbon of asphalt that runs close to where the Great Plains bump up against the Rockies. “And I always just sit there thinking, What are you talking about, normal? Who gets pubic hair in first grade?” 

Fed up with mainstream physicians, Tracee began pursuing less conventional options. She tried giving Ainsley diindolylmethane, or DIM, a supplement that may or may not help a body balance its hormones. 

She also started a blog, the Girl Revolution, with a mission to “revolutionize the way we think about, treat and raise girls,” and the accompanying T.G.R. Body line of sunscreens and lotions marketed to tweens and described by Tracee as “natural, organic, craptastic-free products” containing “no estrogens, phytoestrogens, endocrine disrupters.”

None of this stopped Ainsley’s body from maturing ahead of its time.

Read more of this article here: Puberty Before Age 10 - A New ‘Normal’? - NYTimes.com

Juvenile Huntington's Disease: Symptoms of a Deadly Condition

Huntington's disease is a genetic, incurable neurological disorder that leads to a movement disorder, dementia, and behaviour disturbance and affects one in 10,000 individuals, according to the Huntington's Disease Society of America's Juvenile Huntington's Disease Handbook.

Symptoms don't usually begin until mid-adulthood and less than 10 percent of individuals with the disease develop it before age 20.

However, Fred Taubman, spokesman for the Huntington's Disease Society of America, said that Juvenile Huntington's disease, which affects less than one in 100,000 , has only started being diagnosed over the past decade.

The adult diagnosis of Huntington's disease is usually made in a person who experiences memory or cognitive changes (dementia), and chorea (dance-like movements), often with behavioural or psychiatric problems such as depression, irritability, or mood swings.

That person also usually has a family history of the disease. However, symptoms may be a little different in a child, particularly those under 10.

Symptom groups
HDSA's handbook says that while there is no symptom or group of symptoms that are absolutely required for the diagnosis of Juvenile Huntington's disease, most affected children have several of the symptoms listed below at the time that the diagnosis is made. They include:

• Positive family history of the disease, usually in the father - The reasons for the father being the more affected parents still remains unclear.
• Stiffness of the legs
• Clumsiness of the arms and legs
• Changes in oral motor function
• Chorea - This typically occurs more during adolescence.
• Decline in cognitive function - Adolescents are more likely to lose attention and concentration, while younger children will begin to lose skills such as speech, reading, math and even throwing a ball.
• Changes in behaviour and behavioural disturbances - In younger children, when aggressive or disruptive behaviour is related to the disease, changes/disturbances are usually seen along with changes in cognitive function and declining motor skills. However, behavioural problems in adolescents with the disease are more severe, including arson, theft, sexual promiscuity, physical or sexual abuse of younger siblings, severe drug or alcohol abuse, and depression with suicide attempts.
• Seizures - Seizures are said to occur in about 25 percent of children with Juvenile Huntington's disease, and may be a presenting symptom. They may be of any type, and may or may not be severe. NB: The physician should never simply assume that seizures are caused by the disease. Any child experiencing seizures should have cerebral imaging studies and an electroencephalogram (EEG), as well as appropriate laboratory studies to rule out metabolic causes such as low blood sugar or drug or toxin ingestion.

TREATMENTS
There are different treatments for all the different symptoms listed, but one treatment rule underscores all: because Juvenile Huntington's disease progresses gradually over years, it remains important to attend to the child's general health needs, such as immunizations, dental care, and other age-appropriate evaluations.

That means every child with the disease should have a pediatrician or family doctor who takes care of those needs. As the disease progresses, a general physician can help a family watch for and treat the expected medical complications of HD.

Here are treatments for each of the symptoms that were previously outlined, minus genetic history, according to HSDA's handbook:

• Stiffness of the legs - Medications such as Baclofen, Tizanidine, Diazepam (and other benzodiazepines) and Dantrolene. For more twisted-looking stiff muscles, Anticholinergic agents (Trihexyphenidyl, Benztropine), Carbidopa-levodopa, Dopamine agonists (Pramipexole, Ropinirole) and a Botulinum toxin (Botox) injection can be used. Physical and occupational therapy are also good options.
• Clumsiness of the arms and legs - No medications improve control of voluntary movements, such as clumsiness, but both physical therapy and occupational therapy consultation are very useful.
• Chorea - Medications such as dopamine-blocking agents (Haloperidol, Fluphenazine, Olanzapine, Risperidone), dopamine-depleting agents (Tetrabenazine, which is not yet approved in the US), benzodiazepines (Diazepam, Clonazepam, Lorazepam) and other agents and treatments such as Amantadine can be used.
• Changes in oral motor function - speech language pathology
• Decline in cognitive function - No medications have been proven to improve cognitive function in the disease, but many of the cognitive symptoms can be reduced using simple techniques such as breaking tasks down into step-by-step tasks or using checklists to help the child keep on track.
• Changes in behaviour and behavioural disturbances - Depression is the most common change in behavior/behavioral disturbance. If left untreated, it can be life-threatening. Sometimes the family doctor or pediatrician will feel comfortable treating a mild depression with medications, while counseling may be helpful at other times. The two can even be used together. Severe depression requires a psychiatric specialist, and on rare occasions, even a young child may need to be hospitalized. Severely depressed individuals should be asked whether they have suicidal thoughts or plans.

• Seizures - Children with the disease who have seizures usually have what HSDA calls generalised or myoclonic epilepsy, although other seizure types are possible, such as focal or partial complex seizures. Valproic acid and lamotrigine are considered first choices for treatment of myoclonic epilepsy, although other anticonvulsant drugs, such as Phenytoin, carbamazepine, levetiracetam, topiramate and zonisamidecan be used. Selection of a medication should be made carefully after evaluation is completed.

Read HSDA's handbook for more information about symptoms and treatment, including alternative therapies and medications to the ones outlined above.

Because Juvenile Huntington's disease is rare and differs from the typical adult-onset disease, the affected child's family and caregivers will more than likely face unique challenges, including finding financial, emotional and spiritual support and stability.

One of the biggest challenges, though, is providing an educational program that meets the child's changing needs, according to the handbook.

As soon as a child is diagnosed, it's suggested that the family contact the child's school and begins to develop an Individual Education Plan (IEP) for him or her. Although more common in the US it is still advisable to contact the education authorities to determine their policy on Juvenile Huntingdon's.

US IEP
The US IEP is a plan that is reviewed and updated at least once a year, outlining how the school will address disabilities caused by the disease that interfere with the child's education.

U.S. public schools are required by law to provide for the education of all children through the high school level up to age 21. Because Juvenile Huntington's disease is a disease of many interrelated symptoms, including movement, cognitive and behavioral disabilities, an IEP may include adjustments or variations in academic instruction, physical education, meals, seating, transportation and behaviour control.

Sleep Problems impairs the health of young diabetics

Young people with type 1 diabetes mellitus (T1DM) may have difficulty getting a good night's sleep, resulting in difficulty controlling blood sugar and decreased performance in school, according to a study published in the January issue of SLEEP.

Michelle M. Perfect, Ph.D., of the University of Arizona in Tucson, and colleagues used home-based polysomnography, actigraphy, and questionnaires to track the sleep health of 50 patients, aged 10 to 16 years, with T1DM; results were compared with a control group without diabetes matched for sex, age, and body mass index.

The level of glucose control was simultaneously assessed using continuous glucose monitors and hemoglobin A1C values.

The researchers found that, overall, young patients with T1DM spent about 21 minutes (or 5 percent) less time per seven-hour night in deep sleep than individuals without diabetes.

Even those with mild sleep difficulties experienced more hyperglycemia and emotional and behavioural difficulties, reduced diabetes-related quality of life, lower grades, depression, sleep-wake behaviour problems, poor sleep quality, sleepiness, and lower math scores.

Patients with sleep apnea had associated higher blood sugar levels. As sleep is a potentially modifiable behaviour, the authors suggest that improving clinician awareness of potential sleep problems could help these children and adolescents improve their quality of life.

"Overall, this study supports the need to inquire about sleepiness and sleep habits as part of the clinical care of youth with T1DM.

Clinicians and school-based professionals need to be aware that reports of daytime sleepiness, disrupted sleep, or poor sleep habits, may affect patients' daytime functioning, including the possibility of interfering with their diabetes self-care, quality of life, and school performance," the authors write.

Transitioning Teenagers into Further Reading - The Dutch View

I have just spent some time with Manu Hartsuyker, a freelance film producer and director in the Netherlands. She is not only a great documentary maker, but has also given herself over to helping others, both here in Europe and in Africa, South East Asia, etc.

Along with others, she has established a local initiative and supportive effort to transition young adults and teenagers into further reading and to promote reading as a pleasureable activity in young adults. Something I am very interested in and I know you will be too.

Clearly there is a lot of competition and distractions out there for teenagers, more than there has ever been. Things that capture the imagination of children and young adults are many-fold. The primary two are TV and video games, with puberty and match-making running a close third.

I would not like to say where reading and the exploration of the world and the human condition comes in, especially through the written word and story telling, but I suspect it is quite far down in the top 10 of teenager activities.

From Manu's perspective it is fortunate that in the Netherlands, the government and authorities are so enlightened. They encourage the establishment of charitable initiatives and the efforts of volunteers, giving freely of their own time, to help support others in whatever way they can.

The NL government does this by allowing the group to set themselves up under a charity status and is therefore outside the normal taxation burden of a small company or similar organisation. But the group is covered by this protection only for a limited time, 3 - 5 years.

Alas, Manu's group is coming to the end of this period and is now exploring ways of encouraging donations and sponsorship to allow them to continue thier work. Currently they are gathering ideas and suggestions that will help them continue and I believe they should be encouraged.

If you have any suggestions as to how the group can do this or things you have tried that have worked for your group, please send me a comment on my blog or go directly to Manu's website - www.leesmij.nl - where you will be able to find more information.

Please be aware that the website is still being worked on and is occasionally off-line. If this is a problem for you then please contact me here and I will pass your message on or arrange for Manu to contact you.

Thank you for your time and any suggestions you may have.