How many stages does puberty have?

Answer 1

Puberty is assessed along the "Tanner Scale" by medical professionals. # Tanner Stage 1 (Prepubertal) ## Height increases at basal rate: 5-6 cm/year ## Breast ### Papilla elevation only ## Pubic Hair ### Villus hair only ### No coarse, pigmented hair # Tanner Stage 2 ## Height increases at accelerated rate: 7-8 cm/year ## Breast ### Breast buds palpable and areolae enlarge ### Age 10.9 years (8.9-12.9 years) ## Pubic Hair ### Minimal coarse, pigmented hair mainly on labia ### Age 11.2 years (9.0-13.4 years) ## Modifications based on increasingly earlier Puberty ### White: Stage 2 changes may appear one year earlier ### Black: Stage 2 changes may appear two years earlier # Tanner Stage 3 ## Height increases at peak rate: 8 cm/year (age 12.5) ## Breast ### Elevation of breast contour; areolae enlarge ### Age 11.9 years (9.9-13.9 years) ## Pubic Hair ### Dark, coarse, curly hair spreads over mons pubis ### Age 11.9 years (9.6-14.1 years) ## Other changes ### Axillary hair develops (13.1 years) ### Acne Vulgaris develops (13.2 years) # Tanner Stage 4 ## Height increases at 7 cm/year ## Breast ### Areolae forms secondary mound on the breast ### Age: 12.9 years (10.5-15.3 years) ## Pubic Hair ### Hair of adult quality ### No spread to junction of medial thigh with perineum ### Age: 12.6 years (10.4-14.8 years) # Tanner Stage 5 ## No further height increases after age 16 years ## Breast ### Adult breast contour ### Areola recesses to general contour of breast ## Pubic hair ### Adult distribution of hair ### Pubic hair spreads to medial thigh ### Pubic hair does not extend up linea alba # Other Milestones ## Adrenarche: Age 6 to 8 years ## Menarche: Age 12.7 years (10.8-14.5 years) ### Delayed >1 year if low body fat (e.g. athlete) ## Peak height velocity: 11.5 years (9.7-13.3 years) ## Basal growth occurs up until Tanner Stage 2 ### Basal Growth rate: 5.0 to 6.0 cm per year ### Girls who mature average time: 8.3 (6.1-10.4) cm/yr ### Girls who mature early: 9.0 (7.0-11.0) cm/yr ### Girls who mature late: 7.5 (5.4-9.6) cm/yr ## Pubertal Growth # Growth in Girls # Tanner Stage 1 (Prepubertal) ## Height increases at basal rate: 5-6 cm/year ## Testes ### Smaller than 4 ml or long axis <2.5 cm ## Pubic Hair ### No coarse, pigmented hair ## Penis Stage ### No growth # Tanner Stage 2 ## Height increases at basal rate: 5-6 cm/year ## Testes ### Size 4 ml or long axis 2.5 to 3.2 cm ### Age 11.5 years (age 9.5 to 13.5 years) ## Pubic Hair ### Minimal coarse, pigmented hair at base of penis ### Age 12.0 years (age 9.9 to 14.0 years) ## Penis Stage ### Earliest increased length and width ### Age 11.5 years (age 10.5-14.5 years) # Tanner Stage 3 ## Height increases at accelerated rate: 7-8 cm/year ## Testes ### Size 12 ml or long axis 3.6 cm ### Age 14.0 years (11.5-16.5 years) ## Pubic Hair ### Coarse, dark curly hair spread over the pubis ### Age 13.1 years (11.2-15.0 years) ## Penis Stage ### Increased length and width ### Age 12.4 years (10.1-14.6 years) ## Other Changes ### Gynecomastia may occur (age 13.2 years) ### Voice breaks (age 13.5 years) ### Muscle mass increases # Tanner Stage 4 ## Height increases at peak rate: 10 cm/year (age 13.8) ## Pubic Hair ### Hair of adult quality ### Not spread to junction of medial thigh with perineum ### Age 13.9 years (12.0-15.8 years) ## Penis ### Continued growth in length and width ### Age 13.2 years (11.2-15.3 years) ## Testes ### Length 4.1 to 4.5 cm ## Other Changes ### Axillary hair (age 14.0 years) ### Voice changes (age 14.1 years) ### Acne Vulgaris (age 14.3 years) # Tanner Stage 5 ## No further height increases after age 17 years ## Pubic Hair ### Adult pubic hair distribution (15.3 years) ### Pubic hair spreads to medial thigh ### No hair spread to linea alba ## Penis ### Mature genital size by 16.5 years ## Testes ### Length >4.5 cm ## Secondary sexual characteristics ### Facial hair present on sides ### Mature male physique ### Gynecomastia disappears ## Peak height velocity: Age 13.5 (11.7-15.3 years) ## Basal growth occurs up until Tanner Stage 3 ### Basal Growth rate: 5.0 to 6.0 cm per year ### Boys who mature average time: 9.5 (7.1-11.9) cm/yr ### Boys who mature early: 10.3 (7.9-12.5) cm/yr ### Boys who mature late: 8.5 (6.3-10.7) cm/yr ## Pubertal Growth # Growth in Boys References: # Tanner (1966) Growth at Adolescence, Appleton # Marshall (1970) Arch Dis Child 45:13 # Tanner (1985) J Pediatr 107(3):317