Tanner staging

Tanner staging or the Tanner scale is a scale of physical development in children, adolescents, and adults. The scale defines physical measurements of development based on external primary and secondary sex characteristics, such as the size of the breasts, genitalia, development of pubic hair, and, for boys, testicular volume. The stages were first identified by James Mourilyan Tanner, a British pediatrician, and thus the scale takes his name. Tanner staging is a cornerstone in the field of pediatrics, endocrinology, and adolescent medicine, providing a framework for assessing and managing adolescent development.

Stages

The Tanner scale is broken down into five stages:

Girls

• Stage 1 (prepubertal): No pubic hair. The breasts and genitals are in the preadolescent stage.
• Stage 2: Breast buds form with small areas of surrounding glandular tissue; sparse, lightly pigmented pubic hairs appear.
• Stage 3: Breasts become more elevated and rounded, although without separate contour of the areola; pubic hair becomes darker and coarser.
• Stage 4: The areola and nipple form a secondary mound on the breast; pubic hair is coarse, thick, and curly as in adults, but covering a smaller area.
• Stage 5: Breast and genital development are mature; pubic hair extends to the medial thigh and sometimes up the linea alba.

Boys

• Stage 1 (prepubertal): No pubic hair. The testes, scrotum, and penis are in the preadolescent stages.
• Stage 2: Enlargement of the scrotum and testes; the skin of the scrotum reddens and changes in texture; few pubic hairs appear.
• Stage 3: Enlargement of the penis (first in length, then in width); further growth of the testes; pubic hair becomes darker and coarser.
• Stage 4: Penis and testes continue to grow; the pubic hair is coarse, thick, and curly as in adults, but covering a smaller area.
• Stage 5: Genitalia are adult in size and shape; pubic hair extends to the medial thigh and sometimes up the linea alba.

Applications

Tanner staging is used by healthcare professionals to:

• Assess and monitor the physical development of children and adolescents during routine health examinations.
• Diagnose and manage conditions related to early, delayed, or abnormal puberty.
• Guide decisions regarding the need for further evaluation or treatment in cases of suspected endocrine disorders.

Limitations

While Tanner staging is a useful tool, it has its limitations. The assessment is somewhat subjective, and there can be significant variation in the onset and progression of puberty among individuals. Additionally, Tanner staging does not account for the psychological or emotional aspects of puberty and adolescence.

See Also

• Puberty
• Pediatrics
• Endocrinology
• Adolescent medicine