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. Follow-up should occur at 3-4 month intervals. 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. Obtaining a bone age at baseline is very helpful for future reference to assess the tempo of pubertal development. Intervention is considered only if development progresses rapidly and there are psychosocial and final height concerns.
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. 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. What is nonprogressive precocious puberty? Additionally, benign thelarche in girls under two years rarely exceeds Tanner stage II development. 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. In those girls under 2 years, breast tissue is thought to be a consequence of infant gonadotropin secretion and ovarian hormone production. Benign thelarche is most commonly seen in girls who are under 2 or older than 6 years of age. 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. From a healthcare professional: I have a six year-old girl with breast buds.