SCieNTiFiC REPORTS | 7: 16705 | DOI:10.1038/s41598-017-16996-w
The Uniform Pattern of Growth
and Skeletal Maturation during the
Human Adolescent Growth Spurt
James O. Sanders
, Xing Qiu
, Xiang Lu
, Dana L. Duren
, Raymond W. Liu
, Mariano E. Menendez
, Sarah D. Hans
, David R. Weber
& Daniel R. Cooperman
Humans are one of the few species undergoing an adolescent growth spurt. Because children enter
the spurt at dierent ages making age a poor maturity measure, longitudinal studies are necessary to
identify the growth patterns and identify commonalities in adolescent growth. The standard maturity
determinant, peak height velocity (PHV) timing, is dicult to estimate in individuals due to diurnal,
postural, and measurement variation. Using prospective longitudinal populations of healthy children
from two North American populations, we compared the timing of the adolescent growth spurt’s peak
height velocity to normalized heights and hand skeletal maturity radiographs. We found that in healthy
children, the adolescent growth spurt is standardized at 90% of nal height with similar patterns for
children of both sexes beginning at the initiation of the growth spurt. Once children enter the growth
spurt, their growth pattern is consistent between children with peak growth at 90% of nal height and
skeletal maturity closely reecting growth remaining. This ability to use 90% of nal height as easily
identied important maturity standard with its close relationship to skeletal maturity represents a
signicant advance allowing accurate prediction of future growth for individual children and accurate
maturity comparisons for future studies of children’s growth.
Accurately predicting children’s future growth, while important for many specialties, remains challenging. Our
present study’s hypotheses are that timing relative to the growth spurt and skeletal maturity are highly correlated
with growth remaining and can accurately predict future growth. Childhood growth is characterized by three
major phases: a rapid decelerating infantile growth phase lasting until approximately age 3; a longer childhood
phase with a steady height increase; and the adolescent growth spurt marked by an initial period of rapidly accel-
erating height velocity reaching a maximum rate at the peak growth age (PGA) followed by deceleration until nal
mature height. Children tend to remain in a constant percentile relative to same sex peers during the childhood
phase, but cross percentiles by entering the adolescent growth spurt at diering times. is variation in timing
limits the utility of cross sectional studies to predict growth. Because humans are one of few species undergoing
an adolescent growth spurt, animal studies also have limited utility. ese constraints make longitudinal human
studies essential to understanding human growth. Prior studies have not identied markers of growth suciently
reliable for clinically accurate growth predictions. Predicting the timing or magnitude of future growth requires
a model derived from a robust longitudinally evaluated population of children with closely spaced intervals of
height measurement and other predictive details. Several mathematical models have been proposed to model
growth, but are better at description than prediction
Our understanding of human growth patterns derives from studies following children longitudinally
with serial anthropometrics
. ese studies demonstrate that the timing of the adolescent growth spurt is
non-uniform, boys undergo their growth spurt about two years later than girls, children change their age matched
Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York, USA.
of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA.
of Orthopaedic Surgery, University of Missouri, Columbia, USA.
Department of Orthopaedic Surgery, Case
Western Reserve University, Cleveland, Ohio, USA.
Department of Orthopaedic Surgery, University of California
San Francisco, California, USA.
Department of Orthopedics, Tufts University School of Medicine, Boston,
Colon Rectal Specialists, Rochester Hills, Michigan, USA.
Department of Pediatrics, University
of Rochester, Rochester, New York, USA.
Department of Orthopaedics and Rehabilitation, Yale University, New
Haven, Connecticut, USA. Correspondence and requests for materials should be addressed to J.O.S. (email: james_
Received: 12 April 2017
Accepted: 21 November 2017
Published: xx xx xxxx