A mother brings her 12-year-old daughter to your office for consultation. She is concerned because most of the other girls in her daughter’s class have already started their period. She thinks her daughter hasn’t shown any evidence of going into puberty yet.
Knowing the usual first sign of the onset of puberty, you should ask the mother which of the following questions?
A. Has your daughter had any acne?In the United States, the appearance of breast buds (thelarche) is usually the first sign of puberty, generally occurring between the ages of 9 and 11 years. This is subsequently followed by the appearance of pubic and axillary hair (adrenarche or pubarche), the adolescent growth spurt, and finally menarche. On average, the sequence of developmental changes requires a period of 4.5 years to complete, with a range of 1.5 to 6 years. The average ages of adrenarche/pubarche and menarche are 11.0 and 12.8 years, respectively; however, puberty onset is slightly earlier in African-American girls and in overweight girls. These events are considered to be delayed if thelarche has not occurred by the age of 13 years, adrenarche by the age of 14, or menarche by the age of 16. Girls with delayed sexual development should be fully evaluated for delayed puberty, including central, ovarian, systemic, or constitutional causes.