Peak Height Velocity in Girls Occurs During Tanner Stage 2-3 (Mid-Puberty)
The most significant height increase in girls occurs during mid-puberty at Tanner stages 2-3, with the peak growth spurt happening approximately 2-3 years after the onset of breast development (thelarche). 1, 2
Timing of Maximum Growth Velocity
- Girls experience their peak height velocity during Tanner stages 2-3, which represents mid-puberty when growth hormone and sex steroid effects are maximally synergistic 1
- The highest growth rates are observed specifically in mid-puberty (Tanner stage 2-3) in girls more than in boys, with mean GH nadir levels reflecting this heightened growth phase 1
- Breast development (thelarche) is the first sign of puberty in females, not pubic hair, and marks the beginning of the pubertal growth acceleration 2
Duration and Magnitude of Pubertal Growth
- Girls with early puberty onset (age 8 years) demonstrate a mean pubertal growth of 31.1 ± 3.5 cm over 5.4 ± 0.7 years, with compensatory mechanisms ensuring similar adult height regardless of onset timing 3
- In girls with growth hormone deficiency treated with GH, the total height gained during puberty averages 17.4 ± 6.3 cm, representing 11.3% ± 4.0% of adult height 4
- Pubertal growth in girls with spontaneous puberty averages 15.4 ± 4.6 cm, significantly more than in those with induced puberty 5
Clinical Implications for Assessment
- Insulin resistance peaks during mid-puberty (Tanner Stages 2-4), making this the critical window for both maximum growth velocity and metabolic changes 2, 6
- There is a significant negative correlation between age at onset of Tanner stage 2 and total height gained during puberty—earlier onset allows for more total pubertal growth 4
- Assessment of pubertal stage should be performed according to Tanner stages in patients older than 10 years of age to monitor growth progression 1
Important Caveats
- The age at onset of puberty does not affect final adult height due to compensatory mechanisms in pubertal duration and growth velocity 3
- Girls who begin puberty at age 8 years show all compensatory phenomena related to height at onset, pubertal duration, and height increase, resulting in similar adult heights to girls with later onset 3
- Growth velocity assessment requires a minimum 6-month observation period to accurately determine if a child is experiencing appropriate pubertal growth 1