Tanner staging - Investigation protocol

Tanner staging of pubertal development


Tanner stage


Pubic hair



Stage 1

Prepubertal - elevation of papilla only.

Prepubertal villus hair only.

Basal level - 5 cm to 6 cm per year.

Adrenarche Ovaries grow and enlarge.

Stage 2

Breast bud appears under an enlarged areola (mean age 11.2 years).

Sparse hair along labia (mean age 11.9 years).

Accelerated growth - about 7 cm to 8 cm per year.

Clitoral enlargement with labial pigmentation Uterine enlargement..

Stage 3

Breast tissue grows beyond areola but without contour separation (mean age 12.4 years).

Hair coarser and pigmented - spreads across pubes (mean age 12.7 years).

Peak velocity - about 8 cm per year (mean age 12.5 years).

Axillary hair (mean age 13.2 years). Acne (mean age 13.2 years).

Stage 4

Projection of areola - papilla forms a secondary mound (mean age 13.1 years).

Adult pattern but without spread to medial thigh (mean age 13.4 years).

Deceleration- less than 7 cm per year.

Menarche (mean age 13.3 years). Regular periods (mean age 13.9 years).

Stage 5

Adult breast contour with projection of papilla only (mean age 14.5 years).

Adult with spread to medial thigh but not up linea alba (mean age 14.6 years).

Cessation of growth at around 16 years.

Adult genitalia.