Normal Pubertal Development
Males
Females
Order of development: females (average age in years in parenthesis for Caucasian and African American):
1. Breast budding (thelarche) is usually first sign (9.9, 8.9)
2. Pubic hair (pubarche) may be initial sign in 15% (10.5, 8.8)
3. peak height velocity is (12.2)
4. Menarche occurs about 2 years (range 1-5yrs) after thelarche (12.9, 12.2)
5. Note: (you do not complete breast, testicle, genital, or pubic hair development until after reaching peak height velocity)
Order of development: males (average age in years in parenthesis)
1. testicular enlargement is earliest sign (11.8)
2. pubic hair (12.2)
3. genitalia (13)
4. peak height velocity occurs at average age of 14 years (13.8)
5. Note: (you do not complete breast, testicle, genital, or pubic hair development until after reaching peak height velocity)
Female Breast development:
I - preadolescent: there is elevation of the papilla only
II - breast bud stage: there is elevation of the breast and the papilla as a small mound
III - breast and areola are both enlarged and elevation is more than in stage II
IV - the areola and papilla form a secondary mound projecting above the contour of the breast
V - mature: the papilla only projects, with the areola recessed to the general contour of the breast
Pubic hair development, Male or Female
I - preadolescent: the vellus over the pubes is not further developed than that over the abdominal wall
II - sparse growth of long, slightly pigmented, straight or slightly curled hair, chiefly at the base of the penis or along the labia
III - the hair is considerably darker, coarser and more curled. It spreads sparsely over the junction of the pube
IV - hair is now adult in type but the area covered is still considerably smaller than in the adult (no spread to the medial surface of the thighs)
V - hair adult in quantity and type with spread to the medial surface of the thighs
Male Genital development
I - preadolescent: testes, scrotum, and penis are about the same size and shape as early childhood
II - scrotum and testes are slightly enlarged. Skin of the scrotum is reddened and changed in texture. There is little or no enlargement of penis at this stage.
III - penis is slightly enlarged (mainly in length). Testes and scrotum are further enlarged.
IV - penis is further enlarged, with growth in breadth and development of the glans. Scrotal skin is darker than stage III.
V - genitalia are adult in size and shape
When to be concerned
Hormones
Root, AW. Precocious Puberty. Pediatrics in Review 2000. 21;1:10-19
CHLA Board Review 2005