I. Stage: Tanner 1 (Prepubertal)

  1. Height increases at basal rate: 5-6 cm/year
  2. Breast
    1. Papilla elevation only
  3. Pubic Hair
    1. Villus hair only
    2. No coarse, pigmented hair

II. Stage: Tanner 2

  1. Height increases at accelerated rate: 7-8 cm/year
  2. Breast
    1. Breast buds palpable and areolae enlarge
    2. Age 10.9 years (8.9-12.9 years)
  3. Pubic Hair
    1. Minimal coarse, pigmented hair mainly on labia
    2. Age 11.2 years (9.0-13.4 years)
  4. Modifications based on increasingly earlier Puberty
    1. White: Stage 2 changes may appear one year earlier
    2. Black: Stage 2 changes may appear two years earlier

III. Stage: Tanner 3

  1. Height increases at peak rate: 8 cm/year (age 12.5)
  2. Breast
    1. Elevation of Breast contour; areolae enlarge
    2. Age 11.9 years (9.9-13.9 years)
  3. Pubic Hair
    1. Dark, coarse, curly hair spreads over mons pubis
    2. Age 11.9 years (9.6-14.1 years)
  4. Other changes
    1. Axillary hair develops (13.1 years)
    2. Acne Vulgaris develops (13.2 years)

IV. Stage: Tanner 4

  1. Height increases at 7 cm/year
  2. Breast
    1. Areolae forms secondary mound on the Breast
    2. Age: 12.9 years (10.5-15.3 years)
  3. Pubic Hair
    1. Hair of adult quality
    2. No spread to junction of medial thigh with perineum
    3. Age: 12.6 years (10.4-14.8 years)

V. Stage: Tanner 5

  1. No further height increases after age 16 years
  2. Breast
    1. Adult Breast contour
    2. Areola recesses to general contour of Breast
  3. Pubic hair
    1. Adult distribution of hair
    2. Pubic hair spreads to medial thigh
    3. Pubic hair does not extend up linea alba

VI. Exam: Other Milestones

  1. Adrenarche: Age 6 to 8 years
  2. Menarche: Age 12.7 years (10.8-14.5 years)
    1. Delayed >1 year if low body fat (e.g. athlete)

VII. Exam: Growth in Girls

  1. Peak height velocity: 11.5 years (9.7-13.3 years)
  2. Basal growth occurs up until Tanner Stage 2
    1. Basal Growth rate: 5.0 to 6.0 cm per year
  3. Pubertal Growth
    1. Girls who mature average time: 8.3 (6.1-10.4) cm/yr
    2. Girls who mature early: 9.0 (7.0-11.0) cm/yr
    3. Girls who mature late: 7.5 (5.4-9.6) cm/yr

VIII. References

  1. Tanner (1985) J Pediatr 107(3):317
  2. Tanner (1966) Growth at Adolescence, Appleton

Images: Related links to external sites (from Google)

Ontology: Tanner girls breast development stage (C0429602)

Concepts Finding (T033)
SnomedCT 251811005
English Tanner girl breast development, breast development Tanner stage, Tanner girls breast development (physical finding), girls development breast, breast development girls, girl breast development, tanner girls breast development stage, B - Breast stage, Girls breast development, Tanner girls breast development, Tanner girls breast development stage (observable entity), Tanner girls breast development stage
Spanish estadio de desarrollo mamario en las niñas según escala de Tanner (entidad observable), estadio de desarrollo mamario en las niñas según escala de Tanner

Ontology: Tanner girls pubic hair (C2197575)

Concepts Finding (T033)
English female pubic hair Tanner stage, Tanner girls pubic hair (physical finding), Tanner girls pubic hair