DR FLO: Isn’t it too early for my daughter to be budding breasts?

Dr Flo, my six-year-old daughter’s breasts have started growing. I consulted a doctor who said that it is okay, but I’m worried because my daughter is not fat, but her breasts are protruding. Is this really normal? Priscilla

Dear Priscilla,

Normal breast development starts while a baby is in the uterus. By the time a girl is born, she has nipples and milk ducts.

The development stops until puberty, when the ovaries start making oestrogen. At this point, there is increase in the size of the breasts due to gaining fat tissue and growth of milk ducts. The ducts also form glands around the time when periods start.

This can happen any time from age eight to early teenage. There are usually changes in the breasts caused by hormones e.g. during the menstrual cycle, taking hormonal medication and also during pregnancy.

When the breasts are growing, there are small firm lumps under the nipples, which may be painful, and there may be itchiness around the nipples and the chest.

If your daughter has these symptoms, then it is possible that she is precocious i.e. developing faster than her age. She may also have other signs of puberty, like growth of hair in her armpits and groin.

You can see a gynaecologist and have some hormone tests done to determine whether or not your daughter has reached puberty early. If this is the case, nothing can be done to reverse the body’s development and it is nothing to worry about. If the growth is attributable to general growth and increase in weight, it is also nothing to worry about.

If the growth is suspicious in any way, further tests will be done.

My other daughter, a two-year-old, always bangs her head hard on the wall or floor when she is angry. I’m worried that this might have negative health effects. Am I right and how can I get her to stop banging her head? Priscilla

Hitting the head on the wall or floor when angry is part of temper tantrums in toddlers aged 18 months and can go on all the way to age four. This happens because the child is angry or frustrated but lacks the words to properly express herself. So she will hit herself or other people, roll on the floor, scream, shout, cry or bite. Unless there are other serious behaviour problems, this is normal for a two-year-old. Rarely will a child hurt themselves during a tantrum.

To manage temper tantrums, start by finding out the cause of the tantrum and sort it out reasonably, if possible. Wait for it to stop without losing your temper or shouting, look for a distraction, talk to them if possible, or put them in another room briefly.

It is very important to let your child know that while you love them, their behaviour is not acceptable. Be firm and consistent with the rules, and if you say you will punish bad behaviour make sure you do, every time. In the same way, you can give rewards in terms of praising the child or giving them something they really want when they have behaved well.

Dr Flo, I am worried about my friend. She got married in 2011 and first conceived in 2013, but it was an ectopic pregnancy, so she underwent surgery to remove it. In 2015 she was diagnosed with fibroids and had surgery to remove them. In 2016 she conceived again – another ectopic pregnancy that was neutralised. She recently changed gynaecologists and was diagnosed with fibroids again. She is awaiting the second surgery to remove them. She is now 39 years old. Do you think she will be able to conceive again? Mary

Dear Mary,

In an ectopic pregnancy, the fertilised egg implants outside the uterus. Most of the time, the pregnancy implants in the fallopian tubes, and will cause rupture of the affected tube if it grows beyond a particular size.

When it is diagnosed, the pregnancy may be “neutralised” using medication (methotrexate) or surgery.

 The surgery involves removal of the pregnancy and the affected part of the fallopian tube. This means that after surgery, someone should not be able to conceive from the ovary on the affected side, because the path that the egg takes from the ovary to the uterus has been interfered with.

If this happens on both sides, then, it becomes impossible to get pregnant naturally, because both tubes have been interfered with.

Fibroids are abnormal non-cancerous growths that develop in or on the uterus. There may be one or several, they can vary in size, and they either may not cause any symptoms or they may cause abdominal pain, heavy and/or prolonged bleeding, or back pain.

Fibroids may grow inside the uterus (intramural fibroids), under the inner lining of the uterus (submucosal fibroids) or on the outside of the uterus (subserosal fibroids). Treatment of fibroids depends on how severe the symptoms are, and if there are no symptoms, or the symptoms are minimal, then no treatment is necessary.

With fibroids, their effect on the ability to conceive is dependent on where they are, for example, submucosal fibroids are more likely to cause problems with conceiving than the other types. Many people have still been able to conceive though they have fibroids.

For your friend, the primary concern is that she has had two ectopic pregnancies, and if both of them were in the fallopian tubes, then both tubes are damaged. This means that she cannot conceive naturally but can get pregnant through assisted reproduction like in vitro fertilisation (IVF).

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