Development of Tanner Stage–Age Adjusted CDC Height Curves for Research and Clinical Applications

BACKGROUND AND OBJECTIVE: Variations in normal pubertal development, pubertal disorders, and race/ethnicity can lead to differences in growth patterns and timing that are not captured by the Centers for Disease Control and Prevention (CDC) height-for-chronological age (CA(Height)) charts. Therefore, we sought to develop new Tanner stage–adjusted height-for-age (TSA(Height)) charts accounting for these differences. STUDY DESIGN: Population-based Tanner staging and anthropometric data for 13 358 children age 8 to 18 years from 3 large US national surveys: National Health Examination Surveys (NHES cycle III); the Hispanic Health and Nutrition Examination Surveys (HHANES) and the third National Health and Nutrition Examination Surveys (NHANES III) were analyzed. TSA(Height) semi-parametric models with additive age splines were used to develop smoothed TSA(Height) curves accounting for maturation stage and calendar age. RESULTS: As expected, the TSA(Height) curves did not track along the respective percentile curves for the CDC 2000 CA(Height) curves. We generated race/ethnicity–nonspecific and race/ethnicity–specific TSA(Height) charts stratified by sex and plotted against the CDC 2000 CA(Height) curves to account for the pubertal status differences between these models. An online calculator to adjust height for pubertal status was created. CONCLUSIONS: TSA(Height) charts provide a much-needed tool to assess and manage linear growth for US children over the course of puberty. These tools may be useful in clinical management of children with pubertal timing variations.