My Young Daughter Breast
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This starts with the appearance of a 'button' of breast tissue behind the nipple, which may be tender...
My nine-year-old daughter has a lump in her left breast, which she says is tender.
She told me that a schoolmate accidentally knocked her but I'm not sure if she could be starting to develop breasts.
Could you tell me if this could be happening and also if this 'lump' could just be the first stage of her development?
The first sign of puberty in a girl is usually breast development. This starts with the appearance of a 'button' of breast tissue behind the nipple.
This may be slightly tender in some girls and sometimes causes anxiety (in either the child or her parents) because it feels like a lump.
One breast may start to develop weeks or even months before the other one and only later will the breasts start to change shape and enlarge.
Around this time other changes of puberty will become apparent, such as the appearance of pubic hair and the start of periods.
It's not unusual for the first signs of breast development to occur in a nine-year-old girl, so it's probable that this is the explanation for the lump in your daughter's breast.
True, a blow to the breast could cause bruising and the subsequent appearance of a lump, but I think this is less likely to be the cause of your daughter's breast symptoms than the early signs of puberty.
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The onset of breast development in girls less than 8 years of age may be the first sign of precocious puberty or more likely a condition referred to as benign premature thelarche. Benign thelarche is most commonly seen in girls who are under 2 or older than 6 years of age. In those girls under 2 years, breast tissue is thought to be a consequence of infant gonadotropin secretion and ovarian hormone production.
History and physical findings that support benign development include presence of breast tissue since birth, waxing and waning size of breast development, absence of other pubertal signs and no evidence of linear growth acceleration. Additionally, benign thelarche in girls under two years rarely exceeds Tanner stage II development.
In girls who are 6 years of older, benign thelarche or otherwise known as nonprogressive precocious puberty may be a consequence of temporarily increased ovarian steroid secretion and/or highly sensitive estrogen receptors. When breast development occurs without other signs of puberty in girls older than 6 years, limited work-up is indicated but monitoring of development and growth over subsequent months is necessary. Intervention is considered only if development progresses rapidly and there are psychosocial and final height concerns.
Obtaining a bone age at baseline is very helpful for future reference to assess the tempo of pubertal development. If at baseline, there is only a small amount (Tanner II) of breast development and no evidence of bone age advancement, no other evaluation is necessary. Follow-up should occur at 3-4 month intervals. If there is rapid progression of breast development, other signs of puberty, or accelerated advancement of bone age, referral to a pediatric endocrinologist should be considered. Measuring random gonadotropin (FSH/LH) or estradiol levels are rarely helpful as early pubertal values will overlap with prepubertal values.
Rarely a prepubertal aged girl will present with rapid breast development over 1-2 months followed by vaginal bleeding. This history suggests the presence of an ovarian follicular cyst and a pelvic ultrasound performed as close to the episode of bleeding should be obtained.
Benign thelarche does not occur as often in girls between ages 2 and 6 years, so onset of breast development in girls within this age range should be referred to a pediatric endocrinologist for evaluation.
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