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American Academy of Pediatrics
Special Article

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

Paul B. Kaplowitz, Sharon E. Oberfield and the Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society
Pediatrics October 1999, 104 (4) 936-941; DOI: https://doi.org/10.1542/peds.104.4.936
Paul B. Kaplowitz
From the *Department of Pediatrics, the Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia; and the
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Sharon E. Oberfield
‡Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York.
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Abstract

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  The current recommendation that breast development before age 8 is precocious is based on outdated studies.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.

  • Received February 8, 1999.
  • Accepted March 29, 1999.
  • Copyright © 1999 American Academy of Pediatrics

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Pediatrics
Vol. 104, Issue 4
1 Oct 1999
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Reexamination of the Age Limit for Defining When Puberty Is Precocious in Girls in the United States: Implications for Evaluation and Treatment
Paul B. Kaplowitz, Sharon E. Oberfield, the Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society
Pediatrics Oct 1999, 104 (4) 936-941; DOI: 10.1542/peds.104.4.936

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Reexamination of the Age Limit for Defining When Puberty Is Precocious in Girls in the United States: Implications for Evaluation and Treatment
Paul B. Kaplowitz, Sharon E. Oberfield, the Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society
Pediatrics Oct 1999, 104 (4) 936-941; DOI: 10.1542/peds.104.4.936
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  • Table of Contents

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  • Article
    • Abstract
    • HOW IS THE NORMAL AGE RANGE OF PUBERTY IN GIRLS DEFINED?
    • WHAT IS THE EVIDENCE THAT PRECOCIOUS PUBERTY LEADS TO BEHAVIOR PROBLEMS?
    • WHAT IS THE EVIDENCE THAT PRECOCIOUS PUBERTY COMPROMISES ADULT HEIGHT?
    • WHAT IS THE EVIDENCE THAT TREATMENT OF GIRLS WITH PRECOCIOUS PUBERTY STARTING BETWEEN 6 AND 8 YEARS OF AGE IS BENEFICIAL?
    • RECOMMENDATIONS CONCERNING CHILDREN NEEDING EVALUATION FOR EARLY PUBERTY
    • SUMMARY
    • ACKNOWLEDGMENTS
    • Footnotes
    • REFERENCES
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