Ask an Expert: CPP and Adoption

While the search for answers on what causes CPP is ongoing; researchers have uncovered interesting patterns between certain factors and an increased chance of developing CPP. One of those factors is adoption.

The details are a little fuzzy on the exact nature of the correlation between adoptees and CPP, but we know that it exists. We talked with two experts from the University of Minnesota Hospital: Dr. Bradley Miller, a pediatric endocrinologist, and Dr. Judith Eckerle, the Director of the Adoption Medicine Clinic, to learn more about the link between adoption and CPP.

Famine to Feast

Lifestyle factors such as exercise and access to nutritious foods have long been looked at for their impact on CPP development. Dr. Miller hypothesized, “One of the key things I think triggers puberty in children who are internationally adopted is going from famine to feast.” He explains that the famine-to-feast effect is psychosocial, involving psychological factors in addition to their social environment.

The idea of famine to feast in this scenario refers to nutrition, but it also can be applied to a nurturing environment. For children who grow up in somewhat unstable environments and then are adopted at age five or six, “that transition from famine to feast happens at a time when the body is saying ‘Oh, well puberty’s not that far away, maybe I’m just going to do it now.’

Increased Stress and Trauma

According to Dr. Miller, another potential reason for higher rates of CPP in international adoptees, is an increase in emotional stress and trauma in the lives of these children. This also includes prenatal stress, such as the health and nutrition of the parent during their pregnancy. Children adopted from other countries typically experience more early life transitions, increasing the stress they are exposed to. This stress can trigger early puberty symptoms, leading to CPP.

Monitoring for Signs of CPP

If you want to adopt or have an adopted child, it’s important to monitor their growth and know the signs of CPP. One way you can do this is by working with an adoption clinic, which addresses the unique issues an adopted child may face, including medical, developmental, and behavioral issues. Dr. Eckerle recommends “…a pre-adoption consultation, before [your] home study is even done, we are looking at a checklist of different things…” to evaluate the child’s experiences and how to best support them during this transition.

Consistent visits with your pediatrician are also important opportunities to monitor your child’s growth and development. Birth certificates may be inaccurate or even unavailable, so early bone age x-rays can also be helpful. Dr. Eckerle stresses the importance of time when evaluating children who have just been adopted. “This isn’t always common knowledge for general pediatrics, so for our kids with a history of early life transitions and stressors who present with precocious puberty, we don’t ‘watch and wait.’ This is totally appropriate for kids who don’t have this history, but when it gets applied to kids who have this other background (of adoption), we might miss our window to intervene.”

In other words, because of the correlation between adoption and CPP cases, it’s important not to be passive. More than just watching and waiting for signs of puberty, it’s important for you to be proactive about knowledge about medical issues that are specific to kids with a history of adoption or foster care and to be proactive in advocating for their health care needs.

Share this article with your pediatrician and ensure they know the increased risk for CPP when it comes to adoption.

CPP Treatment Can Help

Dr. Miller says CPP treatment can be a good solution to press pause on puberty, particularly in adoptees who may be struggling in other aspects of development and could benefit from giving themselves time to mature at the right pace. If you think your child might be experiencing CPP symptoms, talk to your child’s doctor to determine if CPP treatment is right for them.

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