Physical Growth and Sexual Maturation of Adolescents
During adolescence (usually considered age 10 to the late teens or early 20s), boys and girls reach adult height and weight and undergo puberty. For boys, see Sexual Differentiation, Adrenarche, and Puberty; for girls, see Puberty. The timing and speed with which these changes occur vary and are affected by both heredity and environment.
1. Grummer-Strawn LM, Reinold C, Krebs NF, Centers for Disease Control and Prevention (CDC): Use of World Health Organization and CDC growth charts for children aged 0–59 months in the United States. MMWR Recomm Rep 10(RR-9):1–15, 2010. Clarification and additional information. MMWR Recomm Rep 59(36): 1184, 2010.
A growth spurt in boys occurs sometime between ages 12 and 17, with the peak typically between ages 13 and 15; a gain of > 10 cm can be expected in the year of peak velocity. A growth spurt in girls occurs sometime between ages 9½ and 13½, with the peak typically between ages 11 and 12½; the gain may reach 9 cm in the year of peak velocity (1).
If puberty is delayed, growth in height may slow considerably. If the delay is not pathologic, the adolescent growth spurt occurs later and growth catches up, with height crossing percentile lines until the child reaches a genetically determined stature. At age 18, almost 2.5 cm of growth remains for boys and slightly less for girls, for whom growth is 99% complete. In girls with true precocious puberty (breast development before age 8), an early growth spurt occurs along with menarche at a young age and, ultimately, short stature results because of early closure of growth plates. Although precocious puberty is defined as development starting before age 8, some girls who develop before age 8 may be normal.
All organ systems and the body as a whole undergo major growth during adolescence; breasts in girls and genitals and body hair in both sexes undergo the most obvious changes. Even when this process goes normally, substantial emotional adjustments are required. If the timing is atypical, particularly in a boy whose physical development is delayed or in a girl whose development occurs early, additional emotional stress is likely. Most children who grow slowly have a constitutional delay and catch up eventually. Evaluation to exclude pathologic causes and reassurance are needed.
Guidance concerning nutrition, fitness, and lifestyle should be given to all adolescents, with special attention paid to the role of activities such as sports, the arts, social activities, and community service in the adolescent’s life. Relative requirements for protein and energy (g or kcal/kg body weight) decline progressively from the end of infancy through adolescence (see Table: Recommended Dietary Reference Intakes* for Some Macronutrients, Food and Nutrition Board, Institute of Medicine of the National Academies), although absolute requirements increase. Protein requirements for boys age 15 to 18 years are 0.9 g/kg/day and for girls of the same age are 0.8 g/kg/day; mean relative energy requirements for boys age 15 to 18 years are 45.5 kcal/kg and for girls of the same age are 40 kcal/kg.
Sexual maturation generally proceeds in an established sequence in both sexes. The age at onset and rapidity of sexual development vary and are influenced by genetic and environmental factors. Sexual maturity begins earlier today than a century ago, probably because of improvements in nutrition, general health, and living conditions—eg, the average age of menarche has decreased by about 3 years over the past 100 years. The physiologic changes that underlie sexual maturation are discussed in Male Reproductive Endocrinology and in Female Reproductive Endocrinology.
In boys, sexual changes begin with enlargement of the scrotum and testes, followed by lengthening of the penis (Diagrammatic representation of Tanner stages I to V of penis maturation in boys) and enlargement of the seminal vesicles and prostate. Next, pubic hair appears (Diagrammatic representation of Tanner stages I to IV for development of pubic hair in boys). Axillary and facial hair appears about 2 years after pubic hair. The growth spurt usually begins a year after the testes start enlarging (see Figure: Puberty—when male sexual characteristics develop). The median age for first ejaculation (between 12½ years and 14 years in the US) is affected by psychologic, cultural, and biologic factors. First ejaculation takes place about 1 year after penis growth accelerates. Gynecomastia, usually in the form of breast buds, is common among young adolescent boys and usually resolves within several years.
In most girls, breast budding is the first visible sign of sexual maturation, followed closely by the initiation of the growth spurt. Shortly thereafter, pubic and axillary hair appears. Menarche generally occurs about 2 years after onset of breast development and when growth in height slows after reaching its peak. Menarche occurs within a wide range, with most girls in the US starting their periods at 12 or 13 years (see Figure: Puberty—when female characteristics develop). The stages of breast growth (see Figure: Diagrammatic representation of Tanner stages I to V of breast maturation in girls) and pubic hair development (see Figure: Diagrammatic representation of Tanner stages I to V for development of pubic hair in girls) can be detailed using the Tanner method.
If the order of sexual changes is disturbed, growth may be abnormal, and the physician should consider pathologic reasons.