Abstract 30 Poster Session III, Monday, 5/3 (poster 277)

Self-assessments of breast and pubic hair development are commonly performed in studies of children and adolescents, and appear valid for those with normal body habitus. Little is known about whether self-assessments are valid in overweight children, who have earlier adrenarche and pubarche, and may have lipomastia.

We studied 56 African American and Caucasian children (32 females and 24 males), 6-11 years of age, selected for body mass index (BMI) > 85th centile for age, gender, and race. Females rated both breast and pubic hair development using a standardized series of drawings accompanied by explanatory text. Males rated only pubic hair development. All subjects were then examined by a pediatric endocrinologist or trained nurse practitioner who were blinded to subjects' self-ratings. Pubic hair self-ratings were highly correlated with Tanner stage determined by physical examination in males (Kendall Tau 0.58, p<0.0001) and females (Kendall Tau 0.43, p=0.0008), and did not differ according to BMI SD or race. 60.0% of pubic hair self-ratings were concordant with physical examination, with 21.8% rated lower and 18.2% rated higher by the subject. However, there was no correlation between self-ratings and physical examination for Tanner breast stage (Kendall Tau 0.20, p = 0.10). Only 31.3% of breast stage self-ratings were concordant with physical examination, with 15.6% rated lower and 53.1% rated higher by the subject. These findings did not differ according to BMI SD or race. The amount by which self ratings deviated from physical examination of breast Tanner stages was significantly different from zero (one-sample nonparametric sign test, p=0.017), with girls overestimating their breast Tanner stage by 0.52 ± 1.02 (SD) Tanner stages. Previous studies of normal weight girls have described systematic underestimation of breast Tanner stage.

We conclude that for overweight African American and Caucasian children, self ratings of pubic hair Tanner stage are largely concordant with pubic hair Tanner stage determined by physical examination. However, self ratings of breast Tanner stage by overweight African American and Caucasian girls are not concordant with physical examination, and thus should not be used to determine the breast Tanner stage of overweight girls.