Breast Disorders in prepubertal Children

Emobileclinic Trending Topic

Neonatal disorders: it is the influx of maternal hormones through the placenta into the fetal circulation often causes the newborn’s breasts to be enlarged. In addition, some secretion (ie, witch’s milk) may be evident. These changes disappear with time.

Mastitis neonatorum or infections of the breast tissue may also occur during the newborn period. Treatment includes antibiotics. If an abscess occurs, needle aspiration should be performed. Surgical drainage should be considered only when needle aspiration is unsuccessful, because an operation may damage the breast bud and result in reduction of adult breast size.

Abscess: prepubertal girls may develop breast abscesses. The abscess manifests as a tender and erythematous mass. The most common organism causing breast abscesses in this population is Staphylococcus aureus. An increased number of skin and soft tissue abscesses caused by community-acquired methicillin-resistant S aureus (MRSA) have occurred in children.

Treatment involves antibiotics, needle aspiration, or surgical drainage. The decision for surgical drainage should be carefully made because future breast deformation may occur. 

Benign premature thelarche is defined as isolated breast development in females aged 6 months to 9 years. Physical examination for this entity should carefully seek out other signs of puberty, such as development of pubic hair, thickening of the vaginal mucosa, and accelerated bone growth. If no other signs of puberty are present, reassure the patient and family that this is a benign finding. Examine the child every 6-12 months. If other signs of puberty are evident, precocious puberty should be entertained as a diagnosis.

Precocious puberty: early onset of puberty is more common in girls than in boys and is predominantly mediated by premature activation of the hypothalamic-pituitary-gonadal axis. Central precocious puberty may be caused by hypothalamic hamartomas, trauma, or central nervous system (CNS) lesions; however, it is most commonly idiopathic. Treatment involves continuous administration of exogenous gonadotropins.

Peripheral precocious puberty is due to sex steroid secretion independent of gonadotropin release; causes include McCune-Albright syndrome.

When precocious puberty is suspected, tests for luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), thyroxine (T4), testosterone, and estradiol should be performed.