Is the Tanner scale still in use? An update on puberty assessment in modern medicine

Oct 25, 2025 4 min read •

Clinical Assessment Adolescent Health Pediatrics

While developed between the 1940s and 1960s, the Tanner scale remains a widely used tool in pediatric and adolescent medicine today. The question of, "Is the Tanner scale still in use?" can be answered with a qualified yes, but modern practitioners use it with a greater understanding of its nuances and limitations.

Quick Summary

The Tanner scale remains a standard tool for assessing adolescent development, but it is now used with a deeper understanding of its limitations, especially regarding chronological age and ethnic variations. Clinical professionals still use it to monitor puberty and guide patient care, often supplemented by other methods like the Pubertal Development Scale (PDS).

Key Points

Still in use for clinical assessment: The Tanner scale remains a standard tool for pediatric and adolescent healthcare providers to track the physical progression of puberty.
Used with modern context: Healthcare professionals apply the Tanner scale with an understanding of its original limitations, such as its foundation on a non-diverse population.
Primary purpose is to monitor development: The scale is used to ensure a patient's puberty is on a typical timeline and to identify potential issues like precocious or delayed puberty.
Supplements for a holistic view: While valuable, the Tanner scale is often supplemented by other measures, such as the Pubertal Development Scale (PDS), to capture a more complete picture of adolescent development.
Not for chronological age estimation: A critical ethical point is that the scale should never be used to determine an individual's chronological age, as this is an invalid and inaccurate application.

What is the Tanner Scale?

The Tanner Scale, or Sexual Maturity Rating (SMR), is a five-stage system that documents and tracks the development of secondary sexual characteristics during puberty. Developed by James M. Tanner and colleagues in England through longitudinal studies conducted from the 1940s to 1960s, the scale is based on observational data of physical changes in children. It is divided into separate assessments for males and females:

For females: The scale tracks breast development and pubic hair growth.
For males: The scale monitors the development of external genitalia (penis and testes) and pubic hair growth.

Each stage, from Stage 1 (pre-pubertal) to Stage 5 (adult), corresponds to distinct physical milestones. A key principle of the Tanner scale is that while the sequence of development is generally consistent, the timing and rate can vary significantly between individuals.

Why the Tanner scale is still used in clinical practice

The enduring use of the Tanner scale in modern clinical settings can be attributed to several factors. It provides a standardized framework that is easy to understand and implement, offering a common language for healthcare providers to discuss and document a patient's pubertal status.

Key reasons for its continued relevance:

Monitoring development: The scale allows for tracking the progression of puberty over time to ensure it is progressing on a typical timeline.
Identifying concerns: Significant deviations, such as precocious (early) or delayed puberty, can be flagged and investigated further. In these cases, Tanner staging helps pinpoint potential underlying health issues.
Guiding patient care: The scale informs decisions on medication dosages, particularly for adolescents who may require adult-level dosing as they mature. It can also guide anticipatory guidance for parents and patients on upcoming bodily changes.
Standardizing research: In academic studies involving adolescent populations, the Tanner scale provides a reliable, universally understood measure for classifying participants by pubertal status.
Informing safety measures: In sports and physical activity, Tanner staging can help make maturity-based decisions for safety in contact sports, rather than relying solely on chronological age.

Ethical and scientific criticisms

Despite its longevity, the Tanner scale has faced significant criticism and ethical scrutiny over the years. While the scale itself is a valuable clinical tool, some applications and historical context have raised concerns.

Major criticisms include:

Sample bias: The original studies were based on a non-random, mostly white population of children in an English care institution. This has led to questions about its universal applicability across different ethnicities and socioeconomic groups.
Misuse for age estimation: One of the most significant and condemned misuses of the Tanner scale is in forensics to estimate chronological age. Tanner himself has stated this is an illegitimate application, as the scale measures maturity, not age. This misuse has led to large errors and potential false accusations in legal proceedings.
Intrusive assessment: Clinical assessment via physical examination can be intrusive and potentially distressing for adolescents, especially when used for general screening rather than in cases with a medical indication.
Incomplete picture: The scale focuses only on specific external physical signs, ignoring other important aspects of development like hormonal changes, emotional maturity, and the psychosocial factors that can influence growth.

Alternatives to Tanner staging

To address the limitations and ethical concerns, several alternatives and supplemental methods have been developed. These newer approaches often emphasize self-assessment or are designed for specific research contexts.

Comparison of Assessment Methods


Feature	Tanner Staging (SMR)	Pubertal Development Scale (PDS)	Picture-Based Interview (PBIP)
Method	Clinical observation by a trained healthcare professional.	Self- or parent-reported questionnaire based on descriptive changes.	Interview using standardized pictures and a structured script.
Data Collection	Highly reliant on clinician's judgment and physical examination.	Questionnaire covers a wider range of pubertal changes beyond genitalia/breast development.	Involves the patient directly in their own assessment, promoting conversation.
Primary Use Case	Medical standard for individual assessment in clinical practice.	Widely used in large-scale epidemiological studies to increase feasibility.	Clinical tool that encourages open dialogue between patient and clinician.
Reliability	High, when performed by a trained examiner.	Valid for broad pubertal categories (pre, mid, post) but less precise for specific stages.	Depends on the patient's and clinician's comfort and accuracy of self-reporting.
Limitations	Intrusion concerns, reliance on visual observation, ethical issues in certain applications.	Lower absolute agreement with clinical staging; can misinterpret certain signs.	Relies on accurate self-assessment, which can be inconsistent.

The future of the Tanner scale

The Tanner scale is not obsolete but rather has evolved in its application. It is now understood as one of many tools available for assessing pubertal development, used in conjunction with other clinical markers and modern methodologies. The trend is towards a more holistic, respectful, and evidence-based approach to adolescent health, where Tanner staging is reserved for appropriate medical indications rather than blanket screenings. The scale's historical significance and proven utility in specific contexts ensure it will remain a part of the pediatric toolkit, but its limitations are more openly acknowledged and addressed with alternative methods where necessary. Continued research into pubertal timing across diverse populations will further refine how adolescents' physical and psychological development is monitored and understood.

Conclusion

In summary, the Tanner scale is still very much in use today, primarily within pediatric and adolescent medicine for clinical assessment and research. It provides a standardized system for monitoring pubertal progression, identifying significant delays or precocity, and informing patient care decisions. However, it is used with a critical awareness of its limitations, including its historical origins, ethical concerns related to intrusive examinations, and potential for misuse, particularly for age estimation. Clinicians increasingly complement Tanner staging with alternative tools like the Pubertal Development Scale (PDS) and rely on a broader understanding of individual and ethnic variability in pubertal timing. Far from being outdated, the Tanner scale’s continued relevance reflects an adaptation to modern standards of patient-centered, evidence-based care.

Frequently Asked Questions

Yes, for clinical assessment by a trained medical examiner, the Tanner scale is still considered a gold standard by many researchers, although its use is often combined with other methods and interpreted with modern understanding.

During a doctor's visit, the primary purpose of the Tanner scale is to help track and document a patient's physical development during puberty. It serves as an objective measure to monitor growth and identify potential issues with the timing or sequence of pubertal changes.

Yes, there are ethical concerns regarding the potential for intrusive examinations, particularly when used for general screening of well children without a specific medical indication. This highlights the need for sensitive, patient-centered care during assessments.

Alternative methods include the Pubertal Development Scale (PDS), a questionnaire that relies on self-reported changes, and Picture-Based Interviews (PBIP), which involve discussing changes with the patient using visual aids. These are often used in research to increase feasibility or in clinical practice to encourage conversation.

No, the Tanner scale cannot be used to accurately determine a child's chronological age. It was designed to measure physiological maturity, not age, and its use for age estimation in forensic or legal settings is considered unreliable and illegitimate.

The original studies were based on a specific population, and modern medicine acknowledges that there can be variations in the onset and timing of puberty across different ethnicities and races. This requires clinicians to interpret the scale with additional context.

Using Tanner staging is important because the pace of puberty varies greatly among individuals, and basing decisions on a child's actual level of physical maturity is more accurate than relying on chronological age. This is particularly relevant for medication dosing and making sports-related safety recommendations.

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.