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Cited by 1,709Hypothalamic control of reproductive hormonesAdolescent Sexual and Reproductive HealthHuman Health and Disease

Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network

Herman-Giddens, Marcia E., Slora, Eric J., Wasserman, Richard C., Bourdony, Carlos J., Bhapkar, Manju V., Koch, Gary G., Hasemeier, Cynthia M.·1997·PEDIATRICS
DOI 10.1542/peds.99.4.505
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Abstract

OBJECTIVE: To determine the current prevalence and mean ages of onset of pubertal characteristics in young girls seen in pediatric practices in the United States. METHODS: A cross-sectional study was conducted by 225 clinicians in pediatric practices belonging to Pediatric Research in Office Settings, a practice-based research network. After standardized training in the assessment of pubertal maturation, practitioners rated the level of sexual maturation on girls 3 through 12 years who were undergoing complete physical examinations. RESULTS: Data were analyzed for 17,077 girls, of whom 9.6% were African-American and 90.4% white. At age 3, 3% of African-American girls and 1% of white girls showed breast and/or pubic hair development, with proportions increasing to 27.2% and 6.7%, respectively, at 7 years of age. At age 8, 48.3% of African-American girls and 14.7% of white girls had begun development. At every age for each characteristic, African-American girls were more advanced than white girls. The mean ages of onset of breast development for African-American and white girls were 8.87 years (SD, 1.93) and 9.96 years (SD, 1.82), respectively; and for pubic hair development, 8.78 years (SD, 2.00) and 10.51 years (SD, 1.67), respectively. Menses occurred at 12.16 years (SD, 1.21) in African-American girls and 12.88 years (SD, 1.20) of age in white girls. CONCLUSIONS: These data suggest that girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms. Practitioners may need to revise their criteria for referral of girls with precocious puberty, with attention to racial differences.

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  • A large cross-sectional study of about 17 000 girls in the USA (the Pediatric Research in Office Settings [PROS] study) used information obtained from mothers and photography, and the results suggested an advancement of pubertal development in the second half of the 20th century.

    “A large cross-sectional study of about 17 000 girls done in an office setting in the USA (the Pediatric Research in Office Settings [PROS] study) used information obtained from mothers and photography, and the results suggested an advancement of pubertal development in the second half of the 20th century.23”

    From Pubertal development and regulation (2016) · cites this paper as [23]

  • Data showing an association between the ages at which a mother and her children attain pubertal milestones and between the timing of puberty within ethnic groups are suggestive of genetic modulation of the reproductive endocrine axis.

    “Data showing an association between the ages at which a mother and her children attain pubertal milestones and between the timing of puberty within ethnic groups are suggestive of genetic modulation of the reproductive endocrine axis.23,41”

    From Pubertal development and regulation (2016) · cites this paper as [23]

  • African American girls tend to show earlier pubertal maturation compared to girls of White European ancestry.

    “African American girls tend to show earlier pubertal maturation compared to girls of White European ancestry42”

    From Thirty new loci for age at menarche identified by a meta-analysis of genome-wide association studies (2010) · cites this paper as [42]

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Authors
Herman-Giddens, M. E., Slora, E. J., Wasserman, R. C., Bourdony, C. J., Bhapkar, M. V., Koch, G. G., & Hasemeier, C. M.
Affiliations
  • From the Department of Maternal and Child Health, School of Public Health and the Office of Chief Medical Examiner, University of North Carolina, Chapel Hill, North Carolina;
  • American Academy of Pediatrics (US)
  • University of Vermont (US)
  • University of Puerto Rico, Medical Sciences Campus (PR)
  • Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina.
  • University of North Carolina at Chapel Hill (US)
ORCID
Wasserman, Richard C.
Venue
PEDIATRICS
Publisher
American Academy of Pediatrics (AAP)
Published
1997-04-01
Volume
99
Issue
4
Pages
505-512
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.99.4.505
OpenAlex
W2115976287
Cited by
1,709
References
43
Citations by year
2026: 13 · 2025: 29 · 2024: 44 · 2023: 29 · 2022: 37 · 2021: 54 · 2020: 118 · 2019: 43 · 2018: 66 · 2017: 60 · 2016: 70 · 2015: 55 · 2014: 56 · 2013: 59 · 2012: 81
FWCI
38.49
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Health Resources and Services Administration
  • U.S. Public Health Service (MCJ-177022)
  • Maternal and Child Health Bureau
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
  • Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Human Health and Disease
Keywords
secondary sexual characteristics, puberty onset, breast development, pubic hair development, menarche, precocious puberty, age of onset, racial differences, African American girls, white girls, pediatric practice
MeSH terms
Black or African American, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Menarche, Pediatrics, Puberty, Sex Characteristics, Sexual Maturation, United States, Reproducibility of Results, Observer Variation, Prevalence, Age Distribution, Black People, White People

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