Female Tanner Stage

Aka: Female Tanner Stage, Female Sexual Development, Female Tanner Staging, Tanner Girls Pubic Hair, Tanner Girls Breast Development Stage

1. 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
2. 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
3. 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)
4. 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)
5. 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
6. 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)
7. Exam: Growth in Girls
   1. Peak height velocity: 11.5 years (9.7-13.3 years)
      1. Peak growth: 8.3 cm/year
      2. Occurs during Tanner Stage 2 to 3 in girls
   2. Basal growth occurs up until Tanner Stage 2
      1. Basal Growth rate: 5.0 to 6.0 cm per year from age 4 years to Puberty (similar to boys)
   3. Pubertal Linear Growth (typically completed by age 15 years in girls)
      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
8. References
   1. Tanner (1966) Growth at Adolescence, Appleton
   2. Klein (2017) Am Fam Physician 96(9): 590-99 [PubMed]
   3. Tanner (1985) J Pediatr 107(3):317 [PubMed]