This document provides information on assessing puberty and factors that can affect the timing of puberty. It discusses evaluating puberty through measuring height, weight, sexual maturity ratings, and age of pubertal growth spurt. Genetics influence puberty timing by about 46% while environmental factors like nutrition, urbanization, chemicals like BPA, and stress can also affect the onset and progression of puberty. Chronic illness and mental health issues may delay puberty.

1. Puberty : How to assess??
Guide: Dr. M.V. Patil
-Dr.Hardik Shah

2. Scheme of Presentation
• Assessment of Puberty
• Factor affecting the Puberty
• Delayed Puberty
Dr. Nishant Mittal
• Molecular Physiology
of Puberty

3. Assessment of Puberty
Most visible changes
• Growth in stature
• Development of secondary sexual
characteristics
• Body composition
• Achievement of fertility
• Changes in bone size, and mineralization

4. HEIGHT
Beginning of the increase in growth velocity,
• 11 in boys and 9 in girls,
• Mean age of peak height velocity-
13.5 years in boys and 11.5 years in girls
• The average growth spurt lasts 24-36months.

5. Pubertal Growth accounts for….
• about 20% of final adult height, a total
averaging 23-28 cm in females and 26-28 cm
in males,
• Growth during the year of PHV
Normal Female : 9 cm/yr (5.4 cm to 11.2 cm)
Normal Male : 10.3 cm/yr (5.8 cm to 13.1cm)

6. • Males on average are 12-13 cm taller than
females
• because of…
1) the 2 year delay in bone closure as compared
to females. (10cm difference between the two
sexes)
2) Males also have 2cm more of growth during
their growth spurt

7. WEIGHT
• Weight velocity increases and peaks during the
adolescent growth spurt.
• Pubertal weight gain accounts for about 50%
of an individual's ideal adult body weight

8. Differences in Growth Spurts between
Males and Females
• PHV occurs about 18-24months earlier in the
female than in the male.
• PHV in females averages 2 cm/yr less than in
males.
• PWV coincides with PHV in males, but PWV
occurs 6-9 months after PHV in females.

9. Prediction of Mature Height
Mid parental Height:
For girls:
(father's height - 13cm) + mother's height
2
For boys:
(father's height + 13 cm) + mother's height
2

10. Sexual maturity ratings
Tanner’s Staging
• Physical measurements of development,
based on external primary and secondary sex
characteristics, such as the size of
the breasts, genitals, testicular volume and
development of pubic hair.

11. Genitals (male)
Tanner I
• Testicular volume less than 1.5 ml,
• small penis of 3 cm or less
• (pre pubertal)
• (typically age nine and younger)
Tanner II
• testicular volume between 1.6 and 6 ml;
• skin on scrotum thins, reddens and enlarges; penis
length unchanged
• (9–11)

12. Tanner III
• testicular volume between 6 and 12 ml
• scrotum enlarges further; penis begins to lengthen
to about 6 cm
• (11–12.5)
Tanner IV
• testicular volume between 12 and 20 ml; scrotum
enlarges further and darkens; penis increases in
length to 10 cm (12.5–14)

13. Tanner V
• testicular volume greater than 20 ml;
• adult scrotum and penis of 15 cm in length
(14+)

16. Breasts (female)
Tanner I
• No glandular tissue: areola follows the skin
contours of the chest
• (prepubertal)
• (typically age 10 and younger)
Tanner II
• breast bud forms, with small area of surrounding
glandular tissue; areola begins to widen
• (10–11.5)

17. Tanner III
• breast begins to become more elevated, and extends
beyond the borders of the areola, which continues to
widen but remains in contour with surrounding breast
• (11.5–13) . 1st mound
Tanner IV
• increased breast size and elevation; areola
and papilla form a secondary mound projecting from
the contour of the surrounding breast
• (13–15) 2nd mound

18. • Tanner V
• breast reaches final adult size; areola returns to
contour of the surrounding breast, with a
projecting central papilla.
• (15+)

21. Pubic hair
(both male and female)
Tanner I
• no pubic hair at all (prepubertal)
• (typically age 10 and younger)
Tanner II
• small amount of long, downy hair with slight
pigmentation at the base of
the penis and scrotum (males) or on the labia
majora (females)
• (10–11.5)

22. Tanner III
• hair becomes more coarse and curly, and
begins to extend laterally
• (11.5–13)
Tanner IV
• adult–like hair quality, extending
across pubis but sparing medial thighs
• (13–15)

23. Tanner V
• hair extends to medial surface of the thighs
• (15+)

24. Factor affecting Puberty
Genetic influence and environmental factors
• At least 46% of the variation of timing of puberty in
well-nourished populations
• The specific genes affecting timing are not yet know
-Mustanski BS,(2004). "Genetic and environmental influences on pubertal
development: longitudinal data from Finnish twins at ages 11 and 14.".
Developmental Psychology

25. Early puberty onset may be caused by
• Certain hair care products containing estrogen
,
• By certain chemicals, namely phthalates,
which are used in many cosmetics, toys, and
plastic food containers.

26. • malnutrition plays a major role in inhibiting the
growth process
• Urbanization also has a positive effect on growth
1. sufficient food supply,
2. appropriate health and
3. sanitation services,
4. higher level of education

27. Environmental hormones and chemicals
Metabolized estrogens and progestagens from
pharmaceutical products
Bisphenol A (BPA) : used to make plastics, and
to make baby bottles, water bottles, sports
equipment, medical devices, and as a coating in
food and beverage cans

28. • BPA mimics and interferes with the action of
estrogen-
• an important reproduction and development
regulator. It leaches out of plastic into liquids
and foods,
“,Are Bisphenol A (BPA) Plastic Products Safe for Infants and Children? National centre
for Health researtch

29. • Physical and mental illness
• Chronic diseases can delay puberty in both boys
and girls.
• chronic inflammation
• interfere with nutrition have the strongest effect.
• In the western world, inflammatory bowel
disease and tuberculosis,
• in underdeveloped world,
chronic parasite infections are widespread.

30. • Mental illnesses occur in puberty. The brain
undergoes significant development by hormones
• which can contribute to mood disorders such
as major depressive disorder, bipolar
disorder, dysthymia and schizophrenia.
• Girls aged between 15 and 19 make up 40%
of anorexia nervosa cases.

31. Stress and social factors
• child's psychosocial environment is the family
• features of family structure and function in
relation to earlier or later female puberty
• menarche may occur a few months earlier in
girls in high-stress households