“Puberty is considered delayed (delayed puberty) if it hasn't occurred by the age of 13 years in girls and 14 years in boys.”

If you suspect your child has missed puberty, and you are lucky enough to have access to your child’s birth family, then ask them when family members experienced puberty. This method worked well for us when our daughter was about 13. We knew she might have a problem entering spontaneous puberty because of her pituitary dwarfism. When she got to be 13, and still had none of the early signs of beginning puberty, we asked her birth sisters, aunt, and grandmother when they had experienced puberty. We definitely knew we had a problem when they all answered around 11 years old.

There are general guidelines to help you decide if your child is experiencing delayed puberty, so you have an idea of when to seek medical intervention, especially if you lack family history.
For girls they are:
1. She doesn’t show any signs of breast development by the age of 13.
2. More than five years pass by, between breast development and her first menses.
3. She hasn’t grown any pubic hair by the age of 14.
4. She hasn’t had a menstrual cycle by the age of 16.
For boys they are:
1. He shows no signs of testicular enlargement by the age of 14.
2. More than five years pass by to complete genital enlargement.
3. He hasn’t grown any pubic hair by the age of 15.

You may want to consult with a pediatric endocrinologist for a diagnosis of delayed puberty and a possible treatment plan. Doctors usually want a complete medical history, although I’ve become quite comfortable after 14 years of fostering with saying, “I have no medical history.” Even though your child may have outward signs of delayed puberty, the doctor will probably want to run tests.

The blood test will measure hormone levels, and may check for chromosomal abnormalities, diabetes, and anemia. When I took my daughter to the hospital for six hours of blood test, we received a bill for the following; FSH, LH Luteinizing Hormone, Estradiol, and Leuprolide ACET. Another test doctors may request is a bone x-ray of the hand or wrist to determine bone maturity. During puberty, bones will fuse together so they can no longer grow. My daughter has had an x-ray of her hand and wrist, to check her bone age, every six months while she was growing up. Her bones still had not fused at her 17.5-year check-up.

Related Reading:
Delayed Puberty Pituitary Dwarfism

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