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Growth Patterns and Puberty RECS Learning Module


  1. Recognize the stages of sexual development and the range of onset of each
  2. Know that most boys achieve a genital sexual maturity rating (Tanner) of stage 4 prior to attainment of peak height velocity
  3. Understand factors that influence the timing of puberty
  4. Understand the relationship between the timing of onset of puberty and final adult height
  5. Understand the sequence of development of secondary sexual characteristics in boys and girls
  6. Understand the timing, duration and normal range of peak height velocity in male and female adolescents
  7. Understand the impact of relatively early or late puberty on final adult height
  8. Understand that an individual adolescent’s bone age (skeletal maturity) and chronological age may be disparate by as much as two years and still be within normal limits
  9. Know the average prepubertal height velocity (5-6cm/yr) and the accelerated rate (9-10cm/year) in the peak adolescent growth spurt and that completion of the pubertal growth spurt takes two to four years
  10. Know that girls’ heights will typically increase 6-8cm after menarche has occurred
  11. Recognize that physiologic leucorrhea commonly precedes menses by three to six months
  12. Know that a testicular volume of <4ml is prepubertal


  1. Describe Tanner staging.
  2. When is the normal onset of puberty for both males and females?  What is the first sign for a male?  Female?
  3. How does puberty progress in females?  In males?
  4. Approximately how much later does a boy’s growth spurt start after a girl’s?
  5. How do you estimate a predicted target height?
  6. On average how long does it take to complete puberty? What impact does late or early puberty have on final adult height?
  7. How long before menses can physiologic leucorrhea occur?
  8. How much will girl’s height increase after menarche?
  9. What defines “precocious” puberty for girls?  Boys?
  10. What work-up do you do to investigate precocious puberty?
  11. Describe how a bone age is evaluated.  What is considered normal standard deviation?

Reviewed 11/2017

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