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PEDIATRICS Vol. 104 No. 4 October 1999, pp. 936-941

SPECIAL ARTICLE:
Reexamination of the Age Limit for Defining When Puberty Is Precocious in Girls in the United States: Implications for Evaluation and Treatment

Received Feb 8, 1999; accepted Mar 29, 1999.

Paul B. Kaplowitz*, Sharon E. OberfieldDagger , and the Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society

From the * Department of Pediatrics, the Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia; and the Dagger  Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York.

In 1997 a study from the Pediatric Research in Office Settings network, based on pubertal staging of >17 000 girls between 3 and 12 years of age, indicated that breast and pubic hair development are occurring significantly earlier than suggested by our current guidelines, especially in African-American girls. In response to this article, the Lawson Wilkins Pediatric Endocrine Society undertook a comprehensive review of this topic. The primary conclusions of this review are:

1.  The current recommendation that breast development before age 8 is precocious is based on outdated studies. Until 1997, no data were available on pubertal staging in US girls that could have documented a trend to earlier maturation.
2.  The 1997 study indicates that stage 2 of breast and pubic hair development is being achieved ~1 year earlier in white girls and 2 years earlier in African-American girls than previous studies have shown.
3.  Concerns that girls with moderately precocious puberty will be significantly short adults are overstated; most have adult height within the normal range.
4.  Therapy with gonadotropin-releasing hormone agonists has not been proven to have a substantial effect on adult height in most girls whose puberty starts between 6 and 8 years of age.
5.  New guidelines propose that girls with either breast development or pubic hair should be evaluated if this occurs before age 7 in white girls and before age 6 in African-American girls. No changes in the current guidelines for evaluating boys (signs of puberty at younger than 9 years) can be made at this time.normal puberty, breast development, pubic hair.

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