Appendix 1. Tanner Stages of Sexual Maturation
Tanner Staging Ranges from 1 (Prepubertal) to 5 (Adult Development)[1]
Stages |
Girls—Breast Development |
Girls and Boys—Pubic hair |
Boys—External Genitalia Development |
Tanner Stage 1 |
Prepubertal Only the papilla is elevated above the level of the chest wall |
Prepubertal (velus hair similar to abdominal hair) |
Prepubertal (velus hair similar to abdominal hair) Testes, scrotal sac, and penis have size similar to early childhood |
Tanner Stage 2 |
Breast budding, elevation of breasts as small mounds, enlargement and widening of areolae. May be tender and not symmetrical bilaterally |
Sparse growth of long, slightly pigmented, downy, straight or curled hair on labia majora or at the base of the penis |
Enlargement of scrotum and testes; scrotum skin will thin and may be redden
|
Tanner Stage 3 |
Breast enlarges, elevating beyond the areolae |
Pubic hair becomes curly, coarser, extends outward over junction of pubes |
Penis lengthening, testicles continue to grow |
Tanner Stage 4 |
Breast enlarges and areolae and papilla form secondary mounds |
Hair adult in type, but covers smaller area, no spread to the medial surface of thighs |
Penis and testicles grow, scrotum darker in color |
Tanner Stage 5 |
Breast achieves adult contour |
Hair adult in type and quantity extends onto medial thigh |
Adult genitalia |
Changes in Girls and Boys at Various Stages of Sexual Maturation
(Original illustration from Johnson, Moore, & Jefferies. (1978). Permission to use obtained from Abbott Laboratories, Nutrition Research and Development.)
[1] The scale was developed with reference to a single ethnic group and a relatively small sample of only 200 children, so using this as a measure may not apply to all ethnic groups (Blackemore, Burnet, & Dahl, 2010). Different ethnic groups may have variations in breast development, pubic hair growth, distribution, or growth patterns. Care should be taken to assess children for pubertal development based on a knowledge of local ethnic variations and common characteristics.