All children grow at a different tempo, with some maturing earlier than others and some later. This difference is most apparent during puberty. The NCHS growth charts now extend to age 20 years. Tanner and Davies (1985) took the
Table 23-2 Sexual Maturity Stages in Boys and Girls 1985)u Because ^fh^f two a^Mond years of prepuberta1
growth and a peak height velocity greater than that of girls, their ultimate height is usually taller. Head, hands, and feet are first to reach their adult size, followed by leg length, trunk length (which accounts for much of the spurt), and body breadth. Pubertal boys develop greater shoulder breadth than do pubertal girls, who develop wider hips. Adolescents can be reassured that their bodies eventually will become more proportionate with their hands and feet. Boys ultimately gain greater muscle size and strength than do girls, while losing limb fat. This results from their increased secretion of testosterone, which also increases red cell mass and hemoglobin (Tanner, 1986).
The adolescent growth spurt in skeletal and body dimensions is associated closely with the development of the reproductive system. Although the onset and rate of maturation vary according to the individual, the sequence is usually the same within genders (Figs. 23-1 and 23-2). Girls who demonstrate signs of puberty before 7 to 8 years of age and boys who show signs before 9 years should be evaluated for precocious puberty. Conversely, girls who do not show signs of puberty by age 13 and boys by age 14 should be evaluated for pubertal delay (Plotnick, 1999).
The first sign of puberty in boys is an increase in growth of the testes and scrotum, with reddening and wrinkling of the scrotal skin. Pubic hair appears within 6 months, followed by phallic enlargement in 12 to 18 months and peak height velocity 2 to 2.5 years after testicular enlargement (Copeland, 1986). Axillary hair usually appears 2 years after the beginning of pubic hair growth (stage 4 pubic hair), but there is considerable variability. Some boys may have enlargement of the breasts midway through adolescence. Following the attainment of peak height velocity, boys develop mature spermatozoa, full facial hair, and voice change. However, breaking of the voice is a late and often gradual process.
In girls, the breast bud is the first sign of puberty, and the pubertal growth spurt typically occurs concurrently, peaking at stage 3 breast and pubic hair. The uterus and vagina develop simultaneously with the breast, but menarche usually does not occur until stage 4 breast and pubic hair. Although the peak height velocity has been passed, girls may grow an average of 6 cm more after menarche. Early cycles may be irregular and anovulatory, but early sterility should never be presupposed (Tanner, 1986).
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