The charts below show the age
ranges for each of the five Tanner
stages of breast and pubic hair
development.
Once the Tanner stage has been
determined, make a small dot on
the relevant stage line at the child's
age. The horizontal dotted lines
show the stage centiles for age. If
the point is between the 2nd and
98th centiles then development is
within normal limits. If the point is
above the 98th centile development
is precocious, and if below the 2nd
centile it is delayed. In these cases
further investigation may be
required. Please note that unlike
height and weight centiles, the
stage centile position may change
substantially from one age to the
next.
Breast stage
99.6th
Precocious
98th
91st
5
75th
4
3
25th
2
9th
1
2nd
Delayed
0.4th
8 9 10 11 12 13 14 15 16 17 18 19 20
Pubic hair stage
99.6th
Precocious
98th
91st
5
75th
4
3
2
25th
9th
8 9 10 11 12 13 14 15 16 17 18 19 20
Menarche
Precocious
98th
st
Po
-m
e
e
Hospital No:
46
This chart is mainly intended for use in children and young
people whose growth requires close monitoring, or whose
measurements are outside the usual centile range. It is based
on the UK 1990 growth reference from 4-20 years and at
birth, and the WHO growth standard from 2-4 years (as per
the UK-WHO 0-4 years charts). For children aged under 2
years whose growth needs detailed assessment, the neonatal
and infant close monitoring chart (NICM) is available. This 220 chart has a number of novel features including some
puberty phase specific centile lines. For further information
about the development of this chart and supporting
references see www.growthcharts.rcpch.ac.uk.
Birth centile plotting scale
The chart starts at age 2 years, but there is a scale to the left
of the chart where birth weight, length and head
circumference for term infants can be plotted.
Children with extremes of height or weight
In addition to the usual nine centile lines, the height charts
also show lines -4 and -5 SD below and +4 SD above the
mean. The additional weight lines are -4, -5, and +3 SD
respectively. Children whose growth lies on these outer lines
are likely to have additional clinical problems, and if not
already receiving medical attention should be referred. For
exceptionally heavy or light children BMI should be calculated
and plotted.
Parent height comparator (mid-parental centile)
The mid-parental centile is the average adult height centile to
be expected for all children born of this child’s parents. It
incorporates a regression adjustment to allow for the
tendency of very tall and short parents to have children with
less extreme heights. Comparing the mid-parental centile
with the child’s current height centile can help assess whether
the child’s growth is proceeding as expected. The larger the
discrepancy between the two, the more likely it is that the
child has some sort of disordered growth. Most children’s
height centiles (nine out of ten) are within ± 2 centile spaces
of the mid-parental centile, and only 1 percent will be
discrepant by more than 3 centile spaces.
Mid-parental target height
The mid-parental target height is obtained by plotting the
mid-parental centile on the height chart at age 20 and
reading off the corresponding height. Four girls out of five
will have an adult height within ±7 cm of this target height.
However predicted adult height (above) is usually closer to
the child’s final height.
Adult height predictor
This allows prediction of the child’s adult height based on
their current height, including a regression adjustment to
allow for the tendency of very tall and short children to be
less extreme in height as adults. Four girls out of five will have
an adult height within ±6 cm of this predicted height.
The result should be plotted on the BMI chart provided. To
allow the monitoring of severely obese children, the BMI
chart displays high lines at +3, +3.33, +3.66 and +4 SD, and
-4 and -5 SD for those severely underweight.
Any pubic or axillary
hair
Measurement 1
Recording Date
Measurement 2
Recording Date
Recording Date
m
e
ar
c
he
Delayed
0.4th
8 9 10 11 12 13 14 15 16 17 18 19 20
Van Buuren S. Growth charts of human development;
Statistical Methods in Medical Research.
DOI: 10.1177/0962280212473300
11
12
13
14
Weight
Weight
Length/Height
Length/Height
BMI
BMI
BMI
BMI
Location
Location
Location
Location
Health worker name
Health worker name
Health worker name
Health worker name
Measurement 5
Measurement 6
Measurement 7
Measurement 8
Recording Date
Recording Date
Recording Date
Recording Date
Weight
Weight
Weight
Weight
Length/Height
Length/Height
Length/Height
Length/Height
BMI
BMI
BMI
BMI
Location
Location
Location
Location
Health worker name
Health worker name
Health worker name
Health worker name
19
4
50
20
47
2-20 years
+4 SD
5
46
6
45
45
44
44
43
43
+3.66 SD
42
41
41
40
40
39
39
+3.33 SD
38
38
37
37
36
r
Mo
se
be
ly o
bid
+3 SD
35
34
34
99.6th
ere
Sev
31
e
bes
ly o
30
98th
28 Transit point
29
28
from UK-WHO
to UK90 data.
27
o
ry
Ve
26
ig
we
ver
ht
)
ese
( ob
27
91st
25
26
25
er
Ov
23
+4 SD
22
+3.66 SD
ig
we
ht
75th
50th
19
18
99.6th
25th
98th
9th
18
2nd
75th
16
0.4th
50th
15
Low
25th
BM I
t
Very
9th
14
14
-5 SD
13
12
-4 SD
11
11
-5 SD
10
10
Age in years
2
16
-4 SD
0.4th
12
17
15
hin
2nd
13
20
19
91st
17
22
21
+3 S
D
20
24
23
+3.3
3 SD
21
8
33
32
29
9
36
35
Recording Date
Weight
18
48
30
Measurement 4
Length/Height
17
49
24
Weight
16
Age in years
31
Completing Puberty
(Tanner stage 4-5)
If all of the following:
Starting periods
(menarche) with
breast, pubic and
axillary hair
development
Length/Height
15
32
What does a measurement in a shaded area mean?
The chart provides extra guidance about the lower limit
(0.4th centile) for late-maturing girls in pre-puberty and the
upper limit (99.6th centile) for early-maturing girls
completing puberty. If height and weight falls within a
shaded area on the chart, pubertal assessment will be
required. For girls in pre-puberty, height or weight within the
lower shaded areas are likely to be normal, particularly if
height is not markedly discrepant from the mid-parental
centile and BMI is within normal limits. Similarly, girls
completing puberty who have measurements in the upper
shaded area are usually normal.
Measurement 3
10
33
Pubertal assessment
For most purposes the puberty phase approach will be
sufficient, based on the history and clinical examination as
below. Where more detailed assessment of the progress of
puberty is required see the chart flap for Tanner staging.
The three vertical black lines (puberty lines) on the right hand
side of the chart (8-20 years) indicate the normal age limits
for the phases of puberty described below:
In Puberty
(Tanner stage 2-3)
If any of the following:
Any breast enlargement
so long as nipples also
enlarged
9
42
Body mass index (BMI) centile chart
Where over- or underweight is a concern BMI can be
calculated and plotted on the BMI chart. BMI is calculated by
dividing weight (in kg) by the square of height (in metres e.g.
1.32 m, not centimetres e.g. 132 cm). A simple way to do this
on a calculator or mobile phone is:
1. Enter the weight; 2. Divide by height;
3. Divide the result by height.
Pre-puberty
(Tanner stage 1)
If:
No signs of pubertal
development
8
GIRLS
3
n
2nd
Pre
9th
47
© Copyright RCPCH 2013
rc
h
25th
NHS / CHI No:
na
75th
48
Delayed
0.4th
91st
Name: ________________________________________
Date of Birth:
1
2nd
99.6th
Childhood and puberty
close monitoring (CPCM)
growth chart
49
7
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
9
20
8
May 13
Assessment by clinical examination
should be undertaken only with
parental and child consent and
with adequate privacy.
GIRLS UK 2-20yr
Body mass index
(BMI) chart
Manufacture 1
Tanner stage assessment requires
considerable expertise; so unless
you have been adequately trained
you should use the “puberty phases”
approach (see chart instructions
over). For a detailed description of
each stage consult a standard
paediatric reference book (see
www.growthcharts.rcpch.ac.uk for
further information).
50
Please place sticker (if available) otherwise write in space provided.
Body mass index (kg/m2)
Clinical assessment of
pubertal progress
150cm
31/2
GIRLS
4
41/2
21/2
61/2
6
7
150cm
71/2
SD
+4
Age in years
2-8 years
145
51/2
5
GIRLS
185
8-20 years
145
180
3
140
140
135
130
125
Transit point
from UK-WHO
to UK90 data.
Ch
n
re
ild
n
tti
plo
t
he
110
usu
st
91
iew
rev
h
25t
t
h
ig
le
mp
co
170
155
+4
145
9th
115
2nd
110
140
135
SD
+4
th
.6
99
100
th
98
il
Ch
st
91
95
n
dre
g
ttin
plo
bel
ow
line
this
a
usu
uld
sho
nd
eu
lly b
iew
rev
105
D
-4 S
100cm
120
D
-5 S
115
110
th
50
50
75th
50th
40
5522
SD
-5
70cm
Ch
25th
2nd
4466
0.4th
444cm
4cm
D
+3 Sth
99.6
Weight
98th
91st
5
99.6th
98th
91st
4.5
15
4
50th
25th
9th
2nd
0.4th
3.5
10
3
35
50th
25
40
9th
20
2nd
35
0.4th
-4 SD
15
-5 SD
10
-4 SD
-5 SD
0kg
5
Age in years
2
2 /2
25
20
5
1
30
3
3 /2
1
4
4 /2
1
5
5 /2
1
6
6 /2
1
7
7 /2
1
15
25th
8
8
0kg
10kg
91st
195
5’10”
5’9”
165
5’7”
160
190
185
170
2nd
150
5’3”
0.4th
145
-4 SD
140
135cm
6’1"
5’11”
5’10”
175
160
155
25th
5’7”
5’6”
165
5’5”
5’4”
150
9th
4’10”
5’9”
5’8”
170
5’
4’11”
6’3"
165
5’2”
5’1”
6’5"
6’
5’4”
155
6’6”
6’2"
75th
180
5’5”
6’7”
6’4”
175
50th
9th
160
5’3”
5’2”
145
155
4’8”
5’1”
5’
140
150
4’11”
Father’ s height:____________
100
h
0.4t
erty
pub
e
r
p
9th
d
2n
+3 SD
95
99.6th
90
th
0.4
D
en
ildr
Ch
th
98
e
w
st
91
h
75t
50th
g
tt i n
plo
ve
abo
s
line
this
ld
hou
view
ecialist re
der sp
be un
y
ll
a
u
us
85
98th
80
t
h
g
i
Ch
en
ildr
p
ing
lott
his
wt
belo
line
50th
25th
9th
2nd
ecialist review
e under sp
usually b
should
Adult height predictor
65
5’9”
99.6th
5’8”
98th
5’7”
91st
60
55
50
45
40
-4 SD
35
-5 SD
30
20
Age in years
11
12
13
14
15
16
17
18
19
5’5”
5’3”
5’2”
cm
20
15
10kg
175
170
75th
50th
165
25th
9th
160
2nd
155
5’1”
pre-puberty 0.4th
10
5’6”
5’4”
0.4th
0.4th
9
Mid-parental centile
• Plot the mother’s and father’s
heights on their respective
scales and join the two points
with a line. The mid-parental
centile is where this line
crosses the centile line in the
middle.
• Compare the mid-parental
centile to the child’s current
height centile, plotted on the
adult height predictor centile
scale.
• Nine out of ten children’s
height centiles are within ±2
centile spaces of the midparental centile.
70
25
9th
2nd
Mother’ s height:___________
ft/in
75th
25th
-4 SD
-5 SD
180
105kg
th
.6
99
25th
Mid-parental 200
centile
6’
4’7”
60
45
Father’s
height
cm ft/in
185
5’6”
d usually be under specialist review
line shoul
w this
belo
65
50
75th
Mother’s
height
cm
5’8”
75
30
2.5
2kg
50th
100cm
55
91st
ew
ialist revi
under spec
usually be
ld
ou
sh
e
w this lin
otting belo
Children pl
75th
50th
25th
9th
2nd
0.4th
75th
a
ting
plot
uld
s ho
nd
h
98t
iew
rev
t
h
g
i
we
25kg
20
n
ildre
e
is lin
e th
bov
u
be
ally
usu
t
ialis
pec
er s
ft/in
4’9”
D
Puberty starting before 8 years needs specialist review
9th
175
th
25
105
Parent height comparator
5’11”
75th
th
50
SD
75
5500
4488
Ch
g
ttin
plo
en
r
d
il
180
170
-5 SD
+3
SD
-4
5544
91st
190cm
20
91st
Puberty completing after 16 years is delayed
98th
99.6th
70kg
h
.6t
99
th
0.4
5566
g
tin
Puberty is delayed if no signs are present by 13 years
99.6th
45
19 +4 SD
91st
d
2n
80
Length
SD
+3
18
98th
-5 S
h
9t
85
th
75
S
-4
th
25
Birth
centiles
st
91
17
under specialist review
above this line should usually be
plotting
55kg
th
75
90
125
th
98
16
6th
99.
erty
b
u
p
t
h
g
i
e
h
th
.6
99
120
th
0.4
t
ialis
p ec
er s
SD
150
130
105
ren
Child
160
125
15
185
10
130
th
50
14
6’1”
165
th
75
13
Age in years
175
Puberty starting before 8 years needs specialist review
115
g
e
ov
ab
e
lin
his
uld
sho
n
eu
yb
all
list
cia
pe
rs
e
d
135
12
Puberty is delayed if no signs are present by 13 years
th
98
9
11
Puberty completing after 16 years is delayed
h
.6t
99
120
190cm
0.4th
5’0”
4’11”
150
Predicted adult height
• Plot the most recent height
centile on the relevant centile
line.
• Read off the predicted adult
height for this centile.
• Four out of five children will
be within ±6 cm of this value.
Cole TJ, Wright CM. 2011. A chart to predict adult
height from a child's current height. Ann Hum Biol.
2011;38:662-8.
Wright C, Cheetham T. The strengths and
limitations of parental heights as a predictor of
attained height. Arch Dis Child 1999; 81(2):257-60