J. M. Tanner

Increase in length of leg relative to trunk in Japanese children and adults from 1957 to 1977: comparison with British and with Japanese Americans

The secular trends in height, sitting height and leg length in Japanese children have been studied by fitting Preece-Baines Model I curves to the annual mean values from ages five to 17 of school data collected in 1957, 1967 and 1977. The method provides estimates of final adult value, and of age of maximum annual increment. Between 1957 and 1977 the maximal increments in height, sitting height and leg length all became earlier, by about a year in boys and a little less in girls. Japanese now mature about a year earlier than North Europeans. Adult height increased by 4.3 cm in boys and 2.7 cm in girls between 1957 and 1977, the increment being less in the second decade than in the first. Sitting height showed practically no increase whatever; almost the whole secular trend was due to change in leg length. Japanese now have trunk/leg proportions much more similar to those of North Europeans than was the case 20 years ago, but their adult height remains about one standard deviation lower.

Prediction of adult height from height, bone age, and occurrence of menarche, at ages 4 to 16 with allowance for midparent height.

Multiple regression equations for predicting the adult height of boys and girls from height and bone age at ages 4 and upwards are presented. There is a separate equation for each half year of chronological age; and for pre- and postmenarcheal girls at ages 11 to 14. These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the International Childrens Centre longitudinal study. The bone age used is the revised version of the Tanner-Whitehouse standards, omitting the score for carpal bones (RUS age, TW 2 system). Boys aged 4 to 12 are predicted in 95% of instances to within plus or minus 7 cm of true height, and at ages 13 and 14 to within plus or minus 6 cm. Girls ages 4 to 11 are predicted to within plus or minus 6 cm; premenarcheal girls aged 12 and 13 to within plus or minus 5 and plus or minus 4 cm, respectively; and postmenarcheal girls aged 12 and 13 to within plus or minus 4 and plus or minus 3 cm, respectively. Prediction can be somewhat imporved by allowing for midparent height. One-third of the amount that midparent height differs from mean midparent height is added or subtracted. An alternative system of equations which are based on initial classification by bone age rather than chronological age is given. These have about the same accuracy as the equations based on initial classification by chronological age, but allowance for bone age retardation is less. It is not clear which system is preferable. The equations probably apply to girls complaining of tall stature and boys or girls complaining of shortness and needing reassurance as to normality. In clearly pathological children, such as those with endocrinopathies, they do not apply.

Prediction of adult height from height and bone age in childhood. A new system of equations (TW Mark II) based on a sample including very tall and very short children.

A new series of equations is presented for predicting the adult height of a child given present height and bone age. These equations (TW height prediction, Mark II) which replace the ones given in 1975 (TW height prediction, Mark I) are based on larger numbers of normal children, and more importantly on a sample that includes, for the first time, numbers of very tall, very short, and very growth-delayed children. In addition, equations are given for use when the increment of height or bone age, or both, over the previous year is known. These variates improve the prediction at most ages over 8 years in girls and 11 years in boys. The previously given parental allowance has been dropped. Typically 95% of the predictions lie within +/- 8 cm of the real value for boys aged 10 years, falling to +/- 6 cm for boys aged 15 years, or +/- 4 cm if their previous height increment is known. For premenarcheal girls the predictions lie within about +/- 6 cm at age 8 years; a figure which diminishes little till 13 years unless height and bone age increments are known, when it reaches +/- 4 cm at 13 years. For postmenarcheal girls the predictions are substantially more accurate.

ECOLOGICAL CONSIDERATIONS IN THE CREATION AND THE USE OF CHILD GROWTH STANDARDS

There is no proper substitute for a country, especially a developing country, having its own child growth standards or norms for clinical use, based on a representative sample of the population. Separate standards may be derived for subgroups of the population, but the application to the whole population of standards based on an economically privileged group is inappropriate, as is the use of an international standard. The screening or clinical use of growth standards should be sharply distinguished from the use of growth measurements to compare disadvantaged with privileged groups or populations. In particular, the use of growth standards to screen individual children should not divert attention from the need to change existing differences between disadvantaged and privileged groups.

Tanner-Whitehouse bone age reference values for North American children

On the basis of 1090 x-ray films from 225 boys and 225 girls ages 8 to 16 years-participants in the Project Heartbeat longitudinal study who were living in a generally above-average income environment near Houston, Tex.-we provide Tanner-Whitehouse Mark 2 RUS (radius, ulna, and selected metacarpals and phalanges) bone age reference values for North American children of European origin. We designate these values as US90 (for the 1990s) reference values, in contrast to the original British bone age standards, called UK60 (for the 1960s). The US90 children matured considerably earlier than those on which the UK60 standards were based, though only about 3 months earlier than contemporary Spanish children. A study of 190 x-ray films from a research longitudinal series of 23 healthy boys in Virginia yielded values very close to the Houston values, confirming that our US90 reference values should be used in North America, pending a more extensive survey.

Human growth hormone.

Human growth hormone is a successful treatment for children who without it would grow up to be midgets. This article describes present knowledge of its physiology, its role in the regulation of growth and its effect in treatment.

Growth as a Target-Seeking Function

A striking and fundamental property of human growth is that it is self-stabilizing or, to take another analogy, target-seeking. Children, no less than rockets, have their trajectories, governed by the control systems of their genetic constitution and powered by the energy absorbed from the environment. Deflect the child from its natural growth trajectory by acute malnutrition or a sudden lack of a hormone, and a restoring force develops, so that as soon as the missing food or the absent hormone is supplied again, the child hastens to catch up toward its original growth curve. When it gets there, the child slows down again, to adjust its path onto the old trajectory once more.

A Computerized Image Analysis System for Estimating Tanner-Whitehouse 2 Bone Age

A method for assigning Tanner-Whitehouse 2 skeletal maturity scores (or bone ages) to hand-wrist X-rays by an image analysis computer system is described. An operator positions the relevant area of the X-ray on a light box beneath a video camera. Correct positioning is assured by computer templates of each bone stage. Thereafter the process is automatic; the computer, not the operator, rates the bones. The system produces continuous stage scores, not discrete ones such as B, C or D. Data are given which show that the computer-assisted skeletal age score is more repeatable than the usual manual (or unassisted) rating. The absolute difference between duplicates averaged 0.25 stages; differences of as much as 1.0 stage occurred in only 3% of duplicates compared with 15% obtained in manual ratings.

Reliability and Validity of Computer-Assisted Estimates of Tanner-Whitehouse Skeletal Maturity (CASAS): Comparison with the Manual Method

Three observers rated 57 X-rays from normal healthy children in Project HeartBeat! twice each by CASAS, the computer-assisted version of the TW2 RUS bone age method. Differences between duplicates of individual bone ratings which reached or exceeded 1.0 unit (or 1 stage) were 5% within observer and 8% between observers for CASAS, and 17 and 33%, respectively, for the unassisted MANUAL method. In children followed longitudinally, CASAS scores increased much more steadily than MANUAL scores, largely because the bones were rated, in the former system, on a continuous rather than a discrete-integer scale. We conclude that CASAS is a more reliable and probably a more valid estimator of skeletal maturity than the MANUAL version of the TW2 RUS method.

Principles and prenatal growth

I Developmental Biology.- 1 Adaptive Mechanisms of Growth Control.- 2 Human Biochemical Development.- 3 Developmental Pharmacology.- 4 Glimpses of Comparative Growth and Development.- II Biometrical Methods in Human Growth.- 5 Statistics of Growth Standards.- 6 Sampling for Growth Studies.- 7 The Mathematical Handling of Long-Term Longitudinal Data.- III Genetics.- 8 Introduction to Genetic Analysis.- 9 The Genetics of Human Fetal Growth.- 10 The Genetics of Birth Weight.- 11 The Genetics of Adult Stature.- 12 The Genetics of Maturational Processes.- IV Prenatal Growth.- 13 Anatomy of the Placenta.- 14 Physiology of the Placenta.- 15 Fetal Measurements.- 16 Implications for Growth in Human Twins.- 17 Association of Fetal Growth with Maternal Nutrition.- 18 Carbohydrate, Fat, and Amino Acid Metabolism in the Pregnant Woman and Fetus.- 19 Pre- and Perinatal Endocrinology.- 20 Development of Immune Responsiveness.- 21 Fetal Growth Obstetric Implications.