Puberty is the product of Change

This is a stage in ones life that changes occur rapidly. Between early childhood and 8-9 years
of age the part of the brain that secretes the sex hormones are dormant. After this stage the hormones start to secrete and produce its effect. The onset of puberty is more related to skeletal maturity than to chronological age.

In girls, the breast bud is usually the first sign of puberty (10-11 year)
followed by the appearance of the pubic hair 6-12 months of age later and menarche will
follow between 2-2.5 years but may take as long as 6 years, In the United States the
peak age of menarche is 12.75 years old. There are however a wide variation in the stages
of development.

In boys, the first sign of puberty is testicular enlargement. Pubic hair then appears.
Growth acceleration in boys occur 2 years after the girls but can still continue till they are 18 years old. The pattern of sexual development follows parent's genetic pattern. If both parents develop early the chances that the children will also develop early is a highly likely.

What is considered pubertal delay?

• no signs of pubertal development by age 14 years old, in girls
• greater than 5 year interval between thelarche (breast development) and adrenarche (pubic and axillary hair development) in girls
• no signs of testicular enlargement by age 14 years old
• greater than 5 years for genital development
• primary amenorrhea no menarche by 16 years old with presence of secondary sexual characteristics
• primary amenorrhea no menarche by 14 years old without secondary sexual characteristics

What is defined as precocious puberty?

• traditionally defined as any sign of secondary sexual maturation before 8 years old in girls and 9 year old in boys

**recent data suggest early puberty may not even warrant extensive work-up if it occurs after 6 years old in African American girls and after 7 years old in white girls**

Protect your child from the Sun's rays

The temperature has been heating up again here in Arizona. The scorching heat went up to 110 degrees F last weekend and we can not but re-emphasize to everyone the importance of sun protection. It has been tempting to go dip in the pool during the middle of the day but that sun's rays are at its peak at this time

According to the American Academy of Pediatrics the sun's invisible ultraviolet rays are what cause damage to your child's skin even on foggy or hazy days . Hats and umbrellas do not completely protect children because UV lights reflect off the sand, water and other surfaces.

To protect against sun damage the AAP offers the following suggestions:

• Keep children away from the sun between 10am to 4pm
• use sunscreen with a sun protection factor(SPF) of at least 15. Apply 30 minutes before going outside and reapply every 1.5 to 2 hours especially while in water
• dress your child in a light cotton outfit with long sleeves and long pants and a wide brimmed hat
• use a beach umbrella to keep the child in the shade
• keep babies under 6 months of age away from the sun. Sunscreen maybe used in small areas of the body such as the face and the back of the hands
• the skin is not the only thing that needs protection but sunglasses are very important to protect your eyes

HAVE A SAFE AND FUN SUMMER!!

The Importance of Immunizing your Child

Please take a look at the link from the American Academy of Pediatrics on the Importance of immunizing your child and following th recommended schedule. www.ProtectTomorrow.org.

Periorbital cellulitis and Orbital cellulitis

Postorbital cellulitis

Periorbital cellulitis

Periorbital or preseptal cellulitis is the inflammation of the eyelids and the other soft tissues outside the orbit. This can be caused by trauma, or by an infected wound or an abscess in the lid. This can also be caused by a stye, conjunctivitis, infected blocked tear duct and insect bite. The most important thing to consider is to differentiate this with orbital cellulits which involves the inflammation of the tissues of the orbit with proptosis and limitations of eye movement. Sometimes it is hard to differentiate the two especially when the eyes are really swollen and it is hard to examine the movement of the eye. We then order a CT scan of the head and the orbits to determine if there is extension in the orbits. Orbital cellulitis follows a direct infection from a wound, deposition of organisms from the eyelids, conjunctiva, metastatic involvement from a tumor. The most common cause in children is paranasal sinusitis. Orbital cellulitis have complications which result in meningitis and cerebral abscess . Prompt hospitalization with intravenous antibiotic therapy and surgical drainage of the infected sinuses are part of the treatment.