Puberty phases: an evaluation of a new system for rating puberty in paediatric practice

Gary Butler; Tim Cole; Victoria Dublon; Charlotte Wright; Expert Working Group Charlotte RCPCH

Background and aims: Estimating puberty using Tanner stages is usually done unconfidently by general paediatricians. Self-assessment methods are not reliable. As assessment of growth on the new UK growth charts necessitates establishing pubertal status, we have designed and evaluated a simpler non-invasive approach.

Methods: The new system has three Phases– Pre-Puberty (Tanner stage 1), In-Puberty (stages 2/3) and Completing-Puberty (stages 4/5).


	Pre-puberty All of the following	In puberty Any of the following	Completing puberty All of the following
Girls	No signs of areolar (nipple) or breast development	Any breast enlargement so long as nipples also enlarged	Started periods (menarche)
	No pubic hair	Any pubic or axillary (armpit) hair growth	With breast pubic and axillary hair development
Boys	High voice	Slight deepening of the voice Reddening of the scrotum	Voice fully changed (broken)
	No growth of testes or penis	Any testicular or penile enlargement	Early moustache and facial hair growth
	No pubic hair	Any pubic or axillary hair growth	Adult size of penis and testes with adult pubic and axillary hair growth

The Phase system was tested amongst 28 specialist nurses, 100 general paediatric trainees and 19 consultant general paediatricians after basic training. They evaluated puberty phase and Tanner stage on 10 standard line drawings.

Results: Recognising pubertal development was performed more accurately and fully by each group when using Puberty Phases. Most errors arose due to a failure to recognise the start of puberty.


Mean (range)	Correct %Tanner stage	Correct % phases
General consultants	43 (0–90)	79 (50–100)
General trainees	48 (0–90)	78 (30–100)
Specialist nurses	54 (30–80)	79 (50–100)

Conclusions: The new simpler puberty phase approach was well accepted and allowed a clearer rating of pubertal development, a new requirement for the correct interpretation of the UK growth charts. User education is still required.

Endocrine Abstracts

P52