Reexamination of the age limit for defining when puberty is precocious in girls in the United States: Implications for evaluation and treatment

In 1997 a study from the Pediatric Research in Office Settings network, bas ed on pubertal staging of >17 000 girls between 3 and 12 years of age, indi cated that breast and pubic hair development are occurring significantly ea rlier than suggested by our current guidelines, especially in African-Ameri can girls. In response to this article, the Lawson Wilkins Pediatric Endocr ine Society undertook a comprehensive review of this topic. The primary con clusions of this review are: 1. The current recommendation that breast development before age 8 is preco cious is based on outdated studies. Until 1997, no data were available on p ubertal staging in US girls that could have documented a trend to earlier m aturation. 2. The 1997 study indicates that stage 2 of breast and pubic hair developme nt is being achieved similar to 1 year earlier in white girls and 2 years e arlier in African-American girls than previous studies have shown. 3. Concerns that girls with moderately precocious puberty will be significa ntly 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 s tarts between 6 and 8 years of age. 5. New guidelines propose that girls with either breast development or pubi c hair should be evaluated if this occurs before age 7 in white girls and b efore 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.