Accelerated growth in children.

Many tall-statured children will display variations of normal growth patterns, such as familial tall stature or familial rapid maturation. However, precocious puberty and a number of rarer diseases that can cause accelerated growth require the earliest possible detection and treatment to ensure that underlying problems are appropriately treated and optimum final adult height is attained. Most of these syndromes are rare. Nevertheless, the pediatric nurse practitioner should be acquainted with them to make timely and appropriate referrals to endocrinologists, geneticists, cardiologists, or orthopedists.

Evaluation of abnormal genital bleeding.

Irregularities of the menstrual cycle, including abnormal genital bleeding, can occur throughout a woman's life cycle. An understanding of the normal menstrual cycle is necessary before evaluation and management of an irregular cycle. Several disorders are defined and described, including appropriate evaluation and management protocols.

Perceived self-esteem among children diagnosed with precocious puberty.

Self-esteem is known to be altered in children with chronic illness. Do accelerated normal changes, such as those that occur in children with precocious puberty, also alter the child's self-esteem? Twenty-eight children with precocious puberty participated in a nonrandomized descriptive pilot study using a structured interview, the Piers-Harris Children's Self-Concept Scale, and self-portrait drawings. Results indicate that the overall self-esteem of the majority of children was within normal limits as measured by the Piers-Harris Children's Self-Concept Scale, but closer analysis found that many of the children had difficulty with peer relationships and increased levels of anxiety. These findings were supported by the results of the structured interview and the children's self-portraits. Nursing implications from this pilot study are discussed.

Precocious puberty: identifying early sexual development.

Primary care providers should have the ability to identify normal and abnormal variations of sexual development in children. The incidence of precocious puberty is approximately one child in every 10,000 children in the United States. While etiologies vary, precise differential diagnosis is essential because it will determine the course of treatment required. New forms of therapy using long-acting luteinizing releasing factor agonists are currently being investigated. Developmentally appropriate explanations for affected children regarding the diagnosis and treatment plan are a crucial component of care. Ongoing educational and emotional support for the child and family are essential as they learn to cope with early sexual development.