50 50

BOYS UK
Clinical assessment of 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Body mass index
2-20yr
pubertal progress Please place sticker (if available) otherwise write in space provided.
49 49
Tanner stage assessment requires (BMI) chart Age in years

Childhood and puberty

considerable expertise; so unless Name: ________________________________________ 48 48
you have been adequately trained
you should use the “puberty phases” BOYS 4
approach (see chart instructions
over). For a detailed description of close monitoring (CPCM) NHS / CHI No: 47
2-20 years +4 SD
47

growth chart
each stage consult a standard Hospital No: 46 46
paediatric reference book (see 3 4 5 6
www.growthcharts.rcpch.ac.uk for 45 45
further information). Date of Birth:
Assessment by clinical examination 44 44
should be undertaken only with Adult height predictor
parental and child consent and This allows prediction of the child’s adult height based on 43 43
with adequate privacy. their current height, including a regression adjustment to
This chart is mainly intended for use in children and young allow for the tendency of very tall and short children to be 42 42
The charts below show the age people whose growth requires close monitoring, or whose +3.66 SD
ranges for each of the five Tanner less extreme in height as adults. Four boys out of five will
measurements are outside the usual centile range. It is based have an adult height within ±6 cm of this predicted height. 41 41
stages of genital and pubic hair
development, and mean testicular
on the UK 1990 growth reference from 4-20 years and at
volumes using the Prader birth, and the WHO growth standard from 2-4 years (as per Body mass index (BMI) centile chart 40 40
orchidometer. the UK-WHO 0-4 years charts). For children aged under 2 Where over- or underweight is a concern BMI can be
years whose growth needs detailed assessment, the neonatal calculated and plotted on the BMI chart. BMI is calculated by 39 39
Once the Tanner stage has been

Body mass index (kg/m2)

determined, make a small dot on
and infant close monitoring chart (NICM) is available. This 2- dividing weight (in kg) by the square of height (in metres e.g.
20 chart has a number of novel features including some 1.32 m, not centimetres e.g. 132 cm). A simple way to do this 38 +3.33 SD 38
the relevant stage line at the child's
age. The horizontal dotted lines puberty phase specific centile lines. For further information on a calculator or mobile phone is:
show the stage centiles for age. If about the development of this chart and supporting 1. Enter the weight; 2. Divide by height; 37 37
the point is between the 2nd and references see www.growthcharts.rcpch.ac.uk. 3. Divide the result by height.
98th centiles then development is 36 se 36
within normal limits. If the point is be
Birth centile plotting scale The result should be plotted on the BMI chart provided. To dly
o
above the 98th centile development rbi +3 SD
The chart starts at age 2 years, but there is a scale to the left allow the monitoring of severely obese children, the BMI 35 Mo 35
is precocious, and if below the 2nd chart displays high lines at +3, +3.33, +3.66 and +4 SD, and
centile it is delayed. In these cases of the chart where birth weight, length and head
circumference for term infants can be plotted. -4 and -5 SD for those severely underweight. 34 34
further investigation may be
required. Please note that unlike
height and weight centiles, the Children with extremes of height or weight Pubertal assessment 33 33
th
For most purposes the puberty phase approach will be 99.6
stage centile position may change In addition to the usual nine centile lines, the height charts
substantially from one age to the also show lines -4 and -5 SD below and +4 SD above the sufficient, based on the history and clinical examination as 32 32
next. below. Where more detailed assessment of the progress of
mean. The additional weight lines are -4, -5, and +3 SD
puberty is required see the chart flap for Tanner staging. 31 31
Genital stage respectively. Children whose growth lies on these outer lines
The three vertical black lines (puberty lines) on the right hand
99.6th are likely to have additional clinical problems, and if not
Precocious side of the chart (9-20 years) indicate the normal age limits 30 30
98th already receiving medical attention should be referred. For for the phases of puberty described below: se
91st
5
exceptionally heavy or light children BMI should be calculated o be
ly
29 ere 29
75th and plotted. Pre-puberty In Puberty Completing Puberty Se
v 98th
4

(Tanner stage 1) (Tanner stages 2-3) (Tanner stages 4-5)

3
Parent height comparator (mid-parental centile) 28 28
If both of the If any of the following: If any of the following:
2 The mid-parental centile is the average adult height centile to following: Slight deepening of the Voice full broken
25th
be expected for all children born of this child’s parents. It 27 27
9th
voice Transit point
1 incorporates a regression adjustment to allow for the ese
)
2nd No signs of pubertal Early pubic or armpit Moustache and early 26 from UK-WHO (ob 91st 26
Delayed tendency of very tall and short parents to have children with to UK90 data. eig
ht
0.4th less extreme heights. Comparing the mid-parental centile development hair growth facial hair growth erw
ov
8 9 10 11 12 13 14 15 16 17 18 19 20 25 Ve
ry 25
with the child’s current height centile can help assess whether Enlargement of testes Adult size of penis
Pubic hair stage the child’s growth is proceeding as expected. The larger the or penis with pubic and 24 24
99.6th discrepancy between the two, the more likely it is that the axillary hair 75th
Precocious
98th child has some sort of disordered growth. Most children’s 23 23
91st height centiles (nine out of ten) are within ± 2 centile spaces What does a measurement in a shaded area mean? +4 igh
t
5
SD we
of the mid-parental centile, and only 1 percent will be The chart provides extra guidance about the lower limit ver
75th 22 +3
O
50th
22
discrepant by more than 3 centile spaces. (0.4th centile) for late-maturing boys in pre-puberty and the .66
SD
4

upper limit (99.6th centile) for early-maturing boys +3.

21 33
SD 21
Mid-parental target height completing puberty. If height and weight falls within a
3

+3
SD
25th shaded area on the chart, pubertal assessment will be 25th
The mid-parental target height is obtained by plotting the 20 20
2

99.
9th
1 mid-parental centile on the height chart at age 20 and required. For boys in pre-puberty, height or weight within the 6th
2nd lower shaded areas are likely to be normal, particularly if
Delayed reading off the corresponding height. Four boys out of five 19 9th 19
0.4th height is not markedly discrepant from the mid-parental 98th
8 9 10 11 12 13 14 15 16 17 18 19 20
will have an adult height within ±7 cm of this target height. centile and BMI is within normal limits. Similarly, boys
However predicted adult height (above) is usually closer to 18 2nd 18
completing puberty who have measurements in the upper 91st
Mean testicular volume (ml) the child’s final height. shaded area are usually normal.
99.6th 17 75th 0.4th 17
12

20

Precocious
Measurement 1 Measurement 2 Measurement 3 Measurement 4 16 16
10

98th 50th
6
Recording Date Recording Date Recording Date Recording Date BM
I
91st 25th Low -4 SD
4
Weight Weight Weight Weight 15 15
thin
75th Length/Height Length/Height Length/Height Length/Height 9th Very
3 -5 SD
14 14
BMI BMI BMI BMI 2nd
20 0.4th
Location Location Location Location 13 13
Health worker name Health worker name Health worker name Health worker name
25th
Measurement 5 Measurement 6 Measurement 7 Measurement 8 12 -4 SD 12
-5 SD
© Copyright RCPCH 2013

9th 12 Recording Date Recording Date Recording Date Recording Date

May 13
11 11
Weight Weight Weight Weight
2nd 10

Delayed Length/Height Length/Height Length/Height Length/Height 10 10

Age in years
6

Manufacture 1
0.4th 3
4

BMI BMI BMI BMI

8 9 10 11 12 13 14 15 16 17 18 19 20 9 9
Location Location Location Location
Van Buuren S. Growth charts of human development; 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Statistical Methods in Medical Research.
DOI: 10.1177/0962280212473300
Health worker name Health worker name Health worker name Health worker name 8 8
 160cm 160cm 210cm 210cm
31/2 4 41/2 5 51/2 6 61/2 7 71/2 8 81/2 9 11 12 13 14 15 16 17 18 19 20 Parent height comparator

155
BOYS Age in years
155
205 BOYS Age in years
+4 SD
205
Father’s
Mother’s
height

2-9 years 9-20 years

SD ft/in cm
height
+4 200 200 cm ft/in
6’1” 185
200 6’7”
Mid-parental 6’
Mid-parental
21/2 3 10 er specialist review 99.6th
usually be und 6’6” centile
centile
months 195 e should 195
150 150 ve this lin

Puberty completing after 17 years is delayed

ab o 91st
91st 5’11” 180
tt ing 98th 195 6’5"
dre n plo
h 190 Chil 190 5’10”
.6t 6’4”
99
6th 91st 175
145 145 y 99. 190 6’3" 5’9”
185 ert 185

Puberty is delayed if no signs are present by 14 years

ub
98
th gp 6’2" 5’8”
l etin 75th 75th
75th
p
180 com 180 185 6’1"
5’7” 170
140 st
140 50th 6’
91 5’6”
iew 175 175 180 5’11”
rev 25th 5’5” 165
al ist
ci 75
th 5’10” 50th
50th
135 sp
e 135 170 170
er 5’4”
u nd 9th 175 5’9”
be
lly 5’3” 160
u sua 50
th 165 165 5’8”
uld 2nd
130 ho 130 S D 170
es +4
5’7” 5’2”
lin
his 160 160 25th
25th

t
et 25t
h
pecialist review 0.4th 5’6” 5’1” 155
months ov under s
ab ll y be
ng usua

h
165
tti ould
5’5”
125 plo 125 155 h e sh 155 5’

t
en .6t lin

g
Transit point dr 9th 99 his 5’4”
hil wt 150

Puberty starting before 9 years needs specialist review

4’11”
C el o

h
from UK-WHO b -4 SD 160
150 th ttin
g 150 5’3”

he
to UK90 data. 98 9th
9th
plo 4’10”

g
n
120 2nd 120 dre 5’2”

i
st hil 145
145 91 C 145 155 4’9”

he
-5 SD 5’1”
th th 4’8”
0.4 75 5’
140 140
115 115 150
4’11” 4’7” 140
th
50
135 135cm Father’ s height:____________
th
25
y 0.4th
110 i ew ubert
t rev 110 130 pre-p
120kg Mother’ s height:___________
alis -4 S
D
9th
eci
r sp Mid-parental centile
nde
eu
ally b 125 2n
d 115 • Plot the mother’s and father’s
SD

usu
105 uld 105 heights on their respective
+4

sho th scales and join the two points

line D 0.4
th is -5 S 120 +3 SD 110 with a line. The mid-parental
ow
g bel centile is where this line
th

ttin
.6

100 plo 100cm 115 105 crosses the centile line in the
99

ren D 99.6th
ild -4 S middle.
th Ch review
98 specialist • Compare the mid-parental
e under
110 ually b 100
st uld us centile to the child’s current
91 lin e sho
95 -5 S
D his height centile, plotted on the
55kg b o ve
t
th 105 ga 95 adult height predictor centile
75 ttin
plo 98th scale.
th ren • Nine out of ten children’s
50 h ild
SD 100cm 90
Birth
2
90 +3 50
C height centiles are within ±2
th centile spaces of the mid-
centiles 25
.6t
h parental centile.
h 99 85kg 85
9t 91st
Adult height predictor
85 2n
d 45

Puberty completing after 17 years is delayed

80 80 ft/in cm
th
0.4 75th 99.6th 192
75 75 6’3” 190
80 iew 98
th
40
rev 98th
list 6’2”
Length SD cia
spe

Puberty is delayed if no signs are present by 14 years

-4 r 70 50th 70
de
58 be
un 6’1” 91st 185
99.6th lly
75 D su a 91s
t
35
56 -5
S
o u ld u 65 25th
65 6’0”
98th
n e sh 75th
is li SD 5’11” 180
91st
54 e th +3
bov 60 60
in ga 75th 9th 50th
75th
52 70cm np
lott
30
5’10”
dre
50th Chil .6t
h
50th 55 99 2nd 55 5’9” 25th 175

t
25th 50
Puberty starting before 9 years needs specialist review

h
5’8”

g
0.4th

ei
9th 48 25th
25kg 25 50 ist revi
ew 50 9th

t
pecial 5’7” 170
er s

w
2nd d
46 9th be un

h
th ally
98 u su 5’6” 2nd
0.4th
2nd 45 uld -4 SD 45

eig
44cm sho
ne 5’5”
20 0.4th
20 s li 165
D thi -5 SD 0.4th
+3 S th 40 t elo
w
40
Weight 99.6 t review 91s gb 5’4”

w
r specialis ttin
98th be unde -4 SD plo
uld usually ldre
n
5 is line sho -5 SD Chi 5’3” 160
99.6th 91st plotting b
elow th 35 75th 35
15 75th Children 15
98th 4.5 50th 50th
Predicted adult height
91st 25th 30 30 • Plot the most recent height
75th
4 9th 25th centile on the relevant centile
2nd
10 0.4th 10 9th line.
50th 3.5 25 2nd pre-puberty 0.4th
25 • Read off the predicted adult
25th
-4 SD
-5 SD 0.4th height for this centile.
9th
3 • Four out of five children will
20 -4 SD 20 be within ±6 cm of this value.
2nd 2.5 5 Age in years 5 -5 SD
Age in years
Cole TJ, Wright CM. 2011. A chart to predict adult
0.4th
2kg 2 21/2 3 31/2 4 41/2 5 51/2 6 61/2 7 71/2 8 81/2 9 15 10 11 12 13 14 15 16 17 18 19 20 15 height from a child's current height. Ann Hum Biol.
2011;38:662-8.
9 Wright C, Cheetham T. The strengths and
limitations of parental heights as a predictor of
1 0kg 0kg 10kg 10kg attained height. Arch Dis Child 1999; 81(2):257-60