8
Puberty
WILLIAM A. MARSHALL and JAMES M. TANNER
1. Definition
In this chapter the word "puberty" refers collec-
tively to the morphological and physiological
changes that occur in the growing boy or girl as the
gonads change from the infantile to the adult state.
These changes involve nearly all the organs and
structures of the body but they do not begin at the
same age nor take the same length of time to reach
completion in all individuals. Puberty is not com-
plete until the individual has the physical capacity
to conceive and successfully rear children.
In the past the word "adolescence" was used syn-
onymously with "puberty." More recently it has
become common practice to use "adolescence" to
refer to the psychological changes associated with
puberty. However, the acceleration of somatic
growth which is part of the physical change of pu-
berty is still usually referred to as the adolescent
spurt. As this chapter is not concerned with psy-
chology, the synonymous use of the two words
need not be ambiguous.
The principal manifestations of puberty are as
follows:
l. The adolescent growth spurt; i.e., an acceler-
WILLIAM A. MARSHALL • Department of Human Sci-
ences, University of Technology, Lough borough, Leices-
tershire LEI! 3TU, England. JAMES M. TANNER •
Department of Growth and Development, Institute of
Child Health, University of London, London WCIN
I EH, England.
171
F. Falkner et al. (eds.), Postnatal Growth Neurobiology
© Springer Science+Business Media New York 1986
ation followed by a deceleration of growth in
most skeletal dimensions and in many inter-
nal organs.
2. The development of the gonads.
3. The development of the secondary reproduc-
tive organs and the secondary sex characters.
4. Changes in body composition, i.e., in the
quantity and distribution offat in association
with growth of the skeleton and musculature.
5. Development of the circulatory and respira-
tory systems leading, particularly in boys, to
an increase in strength and endurance.
These and other minor changes that accompany
them will be the subject of this chapter. Puberty is,
of course, the result of developmental processes in
the neuroendocrine system, but these are discussed
elsewhere (see Chapter 10, this volume).
2. The Adolescent Growth Spurt
If serial measurements of the statures of a typical
West European boy and girl are plotted against age,
curves similar to those shown in Figure 1 are ob-
tained. The girl's curve begins to rise more steeply
at about the age of 10.5 and the boy's at about 12.5.
This inflection represents the adolescent spurt in
stature which occurs, on average, about 2 years ear-
lier in girls than in boys. As we shall see, the spurt
occurs at different ages among children in any pop-
ulation, whereas the mean age may vary consider-
ably from one population to another.
172 WILLIAM A. MARSHALL and JAMES M. TANNER

190

180
Boys
170
Girls
160

150

140

130

120
v
E
:i110
Cl
' Qj
J:lOO

Fig. I. Height at different ages of

a hypothetical boy and girl of mean
birth length, who grew at the mean
rate and experienced the adolescent
50 growth spurt at the mean age for
their sex. Each finally reached the
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 mean adult stature. (Reproduced
Age, years from Tanner eta/., 1966.)

Velocity curves, in which the speed of growth (in
centimeters per year) is plotted against age, show
the adolescent spurt more clearly. It appears as a
sharp increase in velocity, which rises to a maxi-
mum and then immediately begins to decrease
again (Figure 2). The maximum velocity is referred
to as peak height velocity (PHV).
The absolute value of peak height velocity varies
from one child to another. Marshall and Tanner
(1969, 1970) found a mean value of 10.3 cmjyear
with a standard deviation of 1.54 em/year in 49
healthy boys who were measured every 3 months
by a single skilled observer, R. H. Whitehouse. The
average peak velocity for 41 girls in the same study
was 9.0 cmjyear with a standard deviation of 1.03
em/year. The value for each subject was estimated
by drawing a smooth curve through a plot of veloc-
ities. It is only by fitting a curve in some way that
the moment of peak height velocity can be identi-
fied with reasonable confidence. The velocity mea-
sured over 3 months, 6 months, or a year does not
represent the actual peak velocity because the
growth rate passes through the final stages of its ac-
celeration and begins to decelerate within a very
short period of time. When the velocity is calcu-
lated over a whole year centered on the peak, i.e.,
including 6 months before and 6 months after it,
the average is in the region of 9.5 em/year for boys
and 8.4 em/year for girls. Thus, for about 1 year
during adolescence the velocity of growth is nearly
twice the velocity in either sex just before the ado-
lescent spurt begins (about 5 cmjyear). During the
year in which a boy attains his PHV he usually
gains between 7 and 12 em in stature, while a girl
in the corresponding year gains between 6 and 11
em.
During the past few years, the longitudinal stud-
ies of growth initiated in a number of countries
under the auspices of the International Children's
Centre (see description in Tanner, 1981) have been
completed on subjects followed from birth to ma-
turity. Major studies of growth at adolescence have