Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society

Pediatrics. 1999 Oct;104(4 Pt 1):936-41. doi: 10.1542/peds.104.4.936.


In 1997 a study from the Pediatric Research in Office Settings network, based on pubertal staging of >17,000 girls between 3 and 12 years of age, indicated that breast and pubic hair development are occurring significantly earlier than suggested by our current guidelines, especially in African-American girls. In response to this article, the Lawson Wilkins Pediatric Endocrine Society undertook a comprehensive review of this topic. The primary conclusions of this review are: 1. The current recommendation that breast development before age 8 is precocious is based on outdated studies. Until 1997, no data were available on pubertal staging in US girls that could have documented a trend to earlier maturation. 2. The 1997 study indicates that stage 2 of breast and pubic hair development is being achieved ~1 year earlier in white girls and 2 years earlier in African-American girls than previous studies have shown. 3. Concerns that girls with moderately precocious puberty will be significantly short adults are overstated; most have adult height within the normal range. 4. Therapy with gonadotropin-releasing hormone agonists has not been proven to have a substantial effect on adult height in most girls whose puberty starts between 6 and 8 years of age. 5. New guidelines propose that girls with either breast development or pubic hair should be evaluated if this occurs before age 7 in white girls and before age 6 in African-American girls. No changes in the current guidelines for evaluating boys (signs of puberty at younger than 9 years) can be made at this time.normal puberty, breast development, pubic hair.

Publication types

  • Review

MeSH terms

  • Age of Onset
  • Breast / growth & development
  • Child
  • Child, Preschool
  • Female
  • Fertility Agents, Female / therapeutic use
  • Gonadotropin-Releasing Hormone / therapeutic use
  • Growth Disorders / etiology
  • Growth Disorders / prevention & control
  • Humans
  • Practice Guidelines as Topic
  • Puberty / physiology*
  • Puberty, Precocious / complications
  • Puberty, Precocious / diagnosis*
  • Puberty, Precocious / drug therapy
  • Puberty, Precocious / epidemiology
  • Reference Values
  • United States / epidemiology


  • Fertility Agents, Female
  • Gonadotropin-Releasing Hormone