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Arch Pediatr Adolesc Med. 2001;155:988-989.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

PUBERTY IS the gradual period of transition between childhood and adulthood during which a growth spurt occurs, secondary sexual characteristics appear, fertility begins, and profound psychological changes take place. Substantial changes in the endocrine systems occur during puberty, but these begin subtly. Although they are reflected in the attainment of mature physical features of sexual development and in pronounced growth, it may be difficult to ascertain when the first changes occur. The easiest one to determine is the initial growth of coarse, pigmented sexual hair. However, the appearance of pubic hair may not indicate the onset of gonadal activity but instead reflect adrenal androgen secretion. The criteria that more accurately reflect gonadal activity are breast development in girls and genital growth in boys. Both are difficult to ascertain. Physicians do not consistently agree on what constitutes the first evidence of breast development, particularly in girls who have considerable subcutaneous tissue . . . [Full Text of this Article]

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