In assessing precocious puberty, what is the first step in management for girls under 8 or boys under 9 years old?

In the evaluation of precocious puberty, the first step in management for girls under 8 years old and boys under 9 years old is to perform a bone age evaluation. This assessment is crucial because it helps in determining whether the child's growth and development are advancing at an abnormal rate.

Bone age is assessed through an X-ray of the left hand and wrist, which allows comparison with standardized growth charts for skeletal maturity. If the bone age significantly exceeds the chronological age, it indicates that the child is entering puberty earlier than expected and may be at risk for complications such as growth acceleration and potential short adult height.

This evaluation is foundational, as it provides essential information regarding the cause of precocious puberty—whether it is central (gonadotropin-dependent) or peripheral (gonadotropin-independent)—and can guide further investigations and treatment strategies. Understanding the extent to which puberty has progressed helps clinicians to decide on the appropriate interventions and to differentiate between normal variants and pathological conditions.