Writer and broadcaster

“My son has put on weight and grown breasts and body hair – and he’s only nine.” The Guardian

Dear Annalisa

My son was nine earlier this month. About six months ago, he suddenly put on a lot of weight and hair under his arms and his genitals began to grow. He has a fairly healthy diet and does a lot of exercise. I took him to our family doctor, who weighed him and said he wasn’t worried; the fact that I had my first period at 10 explained everything.

Six months later, he has put on even more weight. He has breasts and the flab around his stomach leaves me in tears. His father and I are health conscious and go to the gym four or five times a week. We don’t know what to do. Our son refuses to go swimming without a shirt on and wants to stop athletics because he can’t keep up with the other children.

In July, he complained of aches and pains in his bones. This time, the GP said it could be growing pains or because he’s overweight. He said most parents with overweight children simply give their children too much or the wrong food. We kept a food diary for a month and went back but I got the impression that he wasn’t convinced. I insisted on a referral to a paediatrician. He agreed but made it clear he thinks my son’s weight gain is my fault. This morning, I received a hospital appointment for the weight management clinic.

I feel his weight gain and hair growth is connected, but my GP has made me feel like a neurotic woman. My son, however, is suffering – I see his confidence being eroded. He refuses to eat breakfast and we have resorted to threats, which leaves us all depressed. He’s usually an active, happy boy with lots of friends in and out of the house but hasn’t invited anyone over since school started in September. He’s been invited to five birthday parties and has asked me to make excuses for all but one. Please help.

K, via email

Your GP is right: early, or late, puberty can run in families. (Early onset puberty is classed as before the age of nine in boys, eight in girls.) But I wouldn’t be so sure that “explains everything”. You say you and your husband go to the gym four or five times a week, so I want to check how subjective your view is. And how much weight is “a lot of weight”. That said, I do believe in a parent’s instinct, and if you think something is not right, you must press for a proper assessment.

I showed your letter to Professor Peter Hindmarsh, who is professor of paediatric endocrinology at University College London, and it is with his help that I am replying. Obviously, I want to make it clear that it would be irresponsible to make a diagnosis in this column and I am not offering one. A doctor needs to see your son and run tests to find out if anything is amiss and, if so, what.

At the start of puberty, a child can start to put a little weight on and grow hair, but in boys, says Professor Hindmarsh, “It is usually an increase in muscle mass, not fat mass”.

Growing hair in the places you mention is commensurate with puberty. In boys, growing breasts (if it’s not simply a bit of excess fat) is not. I am not happy with your GP brushing off your son’s pain as just growing pains, either. Thus I would urge you to go back to your GP (is there another one at the surgery? If you need back up, take your husband with you) and insist on an appointment to see a paediatric endocrinologist (some weight management clinics include one so check to see if the clinic you are going to does. If not, ask for a straight referral).

You are entitled to a referral to a specialist and, really, your GP cannot tell if something needs to be attended to or not, simply by putting your child on the scales.

I can imagine your son is confused and worried, as you are too. Until you have some concrete answers, you need to manage your worries so as to limit how much this filters through to him. Because your son feels out of control of the situation, he is trying to control what he can – in this case, his eating and extra-curricular engagements.

I know it’s hard, but you might have to fake a bright and breezy approach.

Obviously you don’t want your son to turn into a recluse, so I would talk to him and say something like, “We’re going to get you some tests to make sure something isn’t out of balance in your body. So until we know, let’s eat healthily and try to live normally.”

It may help him to get some books on puberty (my favourite is What’s Happening to Me? by Alex Frith and Nancy Leschnikoff, published by Usborne) to explain the perfectly normal changes that do happen around his age. Although I would encourage your son to carry on as normal, if he really doesn’t want to go out, don’t force him and don’t punish him. Keep me posted.

This article was first published in The Guardian Family section on 25th October 2013.