The main aspects of these differences are summarized in Table 1 focused on variability, time of execution, radiation risk, and standardization. In particular, the method of medical age assessment proposed consisted of taking X-rays of wisdom teeth and MRI scans of knee joints, which are then analyzed by dentists and radiologists. doi: 10.2214/ajr.167.6.8956565, 97. Most children with short or tall stature have normal variants of growth. doi: 10.1007/BF02171555, 116. doi: 10.1097/00004032-199811000-00005, 87. doi: 10.1093/bmb/lds014. The emergence of the primary ossification centers of the carpal bones appear in a predictable order that can help in determining bone age. Fortes EM, Malerba MI, Luchini PD, Sugawara EK, Sumodjo L, Ribeiro Neto LM, et al. Although encouraging results have been shown, this method still requires improvements in terms of reproducibility and elimination of confounding factors (135, 136). Int J Legal Med. Introduction: Bone age (BA) is a quantitative determination of skeletal maturation. Most infants with the congenital form are normal size at birth, but may have episodes of hypoglycemia or prolonged jaundice. Bones and growth plates change over time. The Nemours Foundation. He developed a series of standards for the assessment of skeletal age for both males and females. In another study, it was shown that the evaluation of 599 bone age in subjects belonging to different ethnic groups shows a greater variability, especially in African children, in Hispanic women and in Asian and American men (96). doi: 10.1136/adc.81.2.172, 94. Oxford University Press (2011). doi: 10.1002/ajhb.1310010206, 126. This may not be the case if the maternal and paternal heights are discordant, or if the child takes more after 1 parent, Kutney added. X-ray exam: bone age study. Pietka E, McNitt-Gray MF, Kuo ML, Huang HK. Steps in the methodology: a Measurements of the metacarpal lengths and the M2-M5 width.b Linear regression analysis of each measured variable with chronological age.c Equations established for each model along with R 2. d Linear regression analysis of chronological age with each estimated bone age.e Intraclass correlation between the different metacarpal-based estimated bone ages and the two . Among these, three methods are the most representative: GreulichPyle method, TannerWhitehouse method, and Fels method. doi: 10.1590/S0004-27302007000300021, 64. Satoh M. Bone age: assessment methods and clinical applications. Am J Clin Nutr. (1990) 149:3147. . There are different methods to predict adult height, but the most used are the BayleyPinneau method and RocheWainerThissen method. Means and standard deviations of weight, height, chronological age, SA, P-TW3 and P-KR were determined by group 1 and 2 (model and validation groups) and by sex, for all 497 (group 1 = 252; group . [28], For the average person with average puberty, the bone age would match the person's chronological age. Puberty is a time for rapid growth and development for nearly every system in the bodynot just the reproductive system. Acharya SV, Gopal RA, Lila A, Menon PS, Bandgar TR, Shah NS. Front Pediatr. Jung H. The radiation risks from x-ray studies for age assessment in criminal proceedings. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. To do the study, your child will sit on a stool and place their left hand on the table with the fingers spread. doi: 10.1016/j.gcb.2008.09.020, 30. Bone age is measured in years, most often using the Greulich-Pyle scale. doi: 10.1056/NEJMoa064725, 62. 4. Albanese A, Stanhope R. Predictive factors in the determination of final height in boys with constitutional delay of growth and puberty. Underweight in a child with short stature suggests a systemic illness or malnutrition, whereas overweight suggests an endocrine disorder.2,21, Different causes of short stature tend to fall within identifiable growth patterns, and a review of a child's growth curve and bone age should guide further evaluation. Multiple regression equations for predicting the adult height of boys and girls from height and bone age at ages 4 and upwards are presented. Results: At the time of diagnosis, the chronological age was 9.90.6 years, the bone age was 11.61.0 years, and the bone age/chronological age ratio was 1.200.1. Applicability of the Greulich and Pyle skeletal age standards to black and white children of today. IEEE Trans Med Imaging. 106. doi: 10.1016/B978-0-323-04883-5.50052-0, 43. A projected height that differs from the midparental height by more than 10 cm suggests a possible pathologic condition. Next, the scores for all evaluated bones are compiled into a sum, and that sum is correlated to bone age through a lookup table for males or females depending on the sex of the patient. In addition, subjects with long-lasting and untreated growth hormone (GH) deficiency have a delay in bone maturation. Search dates: June and December 2014, and March 2015. doi: 10.1210/jc.82.5.1603, 86. Since bone age measurements are inherently approximations, they are conventionally reported with a standard deviation which serves as an estimate of the associated error. Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain. Harel S, Hursh BE, Chan ES, Avinashi V, Panagiotopoulos C. Adrenal suppression in children treated with oral viscous budesonide for eosinophilic esophagitis. As well, height prediction methods might be affected by ethnicity-related differences, thus either underestimating or overestimating adult height, with wide variations in accuracy. Assessing the skeletal maturity of the hand-wrist: FELS method. doi: 10.3923/pjbs.2009.702.706. Final height in boys with untreated constitutional delay in growth and puberty. Look for a Mllerian anomaly as well. Eur J Endocrinol. These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the . Arch Dis Child. The keywords for the research have been bone age and skeletal maturation.. doi: 10.1136/adc.2005.090134, 121. [5] Other techniques for estimating bone age exist, including x-ray comparisons of the bones of the knee or elbow to a reference atlas and magnetic resonance imaging approaches. doi: 10.1080/03014469700004982, 120. Few pediatric devices were approved after a clinical trial involving children. A longitudinal study. Br J Sports Med. doi: 10.1159/000101336, 25. Figure 1. The following are generally documented (84, 97105): a delay in bone age in Middle-Eastern men and Iranian men and in Southeast Asian children (Indonesian and Indian men and women) and Asian-American men; an advanced age in Afro-American children (more in female than in male) and in Middle Eastern female children (Iranian girls); no variation is documented for Italian, Korean, and Scottish children and in Pakistani girls. Similarly, an excessive intake of foods containing phytoestrogens such as soya, according to some studies, may have an effect on bone age progression (5663). Acta Paediatr Scand. (2010) 7:26674. Crowne EC, Shalet SM, Wallace WH, Eminson DM, Price DA. (1994) 331:62936. Moreover, even when there is a good correlation between predicted and actual adult height, there is a wide individual variation, with almost 30% of adults differing by more than 5.0 cm from the BP predicted height (141). Martin MB, Li CS, Rowland CC, Howard SC, Kaste SC. Am J Hum Biol. (1980) 37:110311. (1996) 167:13958. Any child with bone age more than 2 years advanced or delayed, or whose growth pattern deviates from their genetic potential should bereferred to endocrinology for assessment, she noted. Nebesio TD, Eugster EA. Sustained decrease in bone-age-to-chronological-age (BA:CA) ratio through 5 years 3 Mean BA:CA ratio decreased throughout the study; . The X-ray image is black and white. According to a recent study, the BoneXpert method is affected by obesity to a lesser extent than the GreulichPyle method. Martin DD, Wit JM, Hochberg Z, Savendahl L, van Rijn RR, Fricke O, et al. However, the bone age was significantly different from each other ( p =0001). | Do we take RSV disease seriously enough? Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. If findings from the initial evaluation do not suggest a diagnosis, laboratory testing may be performed (Table 4).1,3,13,14,16,19,20 A retrospective study found that a complete laboratory evaluation of an asymptomatic child with idiopathic short stature is low yield and expensive. (2014) 20:627. Ranjitkar S, Lin NH, Macdonald R, Taylor JA, Townsend GC. (2013) 19:615. Front. A bone age study helps doctors estimate the maturity of a child's skeletal system. (2014) 30:40911. Moreover, weight gain and obesity are one of the most important causes of pediatric advanced bone age; the mechanisms underlying these alterations are not fully clarified, although insulin resistance and hormonal factors produced by adipose tissue might play an important role (50, 51). [24] The Sontag method uses x-rays of all the bones and joints of the upper and lower limbs on the left side of the body. Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V. Skeletal age determinations in children of European and African descent: applicability of the Greulich and Pyle standards. (1993) 21:148. doi: 10.1530/EJE-15-0608, 60. This method has the advantage of being more reproducible, and it is not based on the subject age but on skeletal maturity of several bone elements and population-based references. Hill RJ, Brookes DS, Lewindon PJ, Withers GD, Ee LC, Connor FL, et al. p. 293753. Children with cardiac diseases, or those with chronic kidney or liver disease, may experience a delay in skeletal maturation (3842). Benso L, Vannelli S, Pastorin L, Angius P, Milani S. Main problems associated with bone age and maturity evaluation. Haffner D, Nissel R. Growth and puberty in chronic kidney disease. Dense body parts, such as bones, block the passage of the X-ray beam through the body. Klein KO, Newfield RS, Hassink SG. Separate tables are used for boys and girls because of the sex difference in timing of puberty, and slightly different percentages are used for children with unusually advanced or delayed bone maturation. Most children will have a projected adult height within 10 cm (4 in), or two standard deviations, of their midparental height. Available online at: https://www.rch.org.au/immigranthealth/clinical/Birth_date_issues/. Particularly, in the TW3, the possibility to predict final height has been introduced. 110. Tanner JM. In many European countries, the increase in illegal immigration and above all the immigration of children and adolescents unaccompanied by parents and without identity documents posed important doubts and stressed the need for new procedures aimed at ensuring a better assistance and protection for young people. Regardless of the method used, an appropriate and standardized hand positioning procedure and radiographic image acquisition are required in order to better describe the skeletal maturation. (1993) 68:6779. [Paternal height (cm) 13 cm + maternal height (cm)] 2, [Paternal height (in) 5 in + maternal height (in)] 2, [Paternal height (cm) + 13 cm + maternal height (cm)] 2, [Paternal height (in) + 5 in + maternal height (in)] 2, Constitutional delay of growth and puberty, Normal growth velocity, history of delayed puberty in parents, History and physical examination, bone age, Short parents, projected height consistent with midparental height, normal growth velocity, Midparental height, growth velocity, bone age; consider targeted laboratory evaluation, Height < 2 standard deviations below the mean for age with no identified pathology, normal growth velocity and bone age, Abdominal pain, malabsorption, anemia; short stature may be the only symptom, Tissue transglutaminase and total immunoglobulin A measurements; consider referral for endoscopy and biopsy, History of renal disease, poor weight gain, Abdominal pain, bloody stool, poor weight gain, Erythrocyte sedimentation rate and C-reactive protein measurements, referral for endoscopy and biopsy, Short limbs; long, narrow trunk; large head with prominent forehead, History of head trauma or cranial irradiation, central nervous system infection, IGF-1 and IGFBP-3 measurements, referral for growth hormone stimulation, other pituitary function tests, Hypoglycemia, birth length may be normal, height and bone age progressively delayed; jaundice, microphallus, midline craniofacial abnormalities, IGF-1 and IGFBP-3 measurements; referral for growth hormone stimulation, magnetic resonance imaging, other pituitary function tests, Mental retardation if not identified early, Newborn screening, thyroid-stimulating hormone and free thyroxine (T4) measurements, Born small for gestational age, normal height not achieved by 2 to 4 years of age, Focused laboratory testing to evaluate organic causes, consider referral to pediatric endocrinologist, History of poor nutrition, weight loss precedes height loss, Short stature, webbed neck, characteristic facies, short metacarpals, broad chest with widely spaced nipples, hyperconvex fingernails and toenails; may be normal appearing; decreased growth velocity and delayed puberty, Follicle-stimulating hormone, karyotyping, Erythrocyte sedimentation rate, C-reactive protein, Thyroid-stimulating hormone, free thyroxine (T4), Tissue transglutaminase and total immunoglobulin A, Serum luteinizing hormone, follicle-stimulating hormone, testosterone, Children with intrauterine growth retardation who do not catch up to the growth curve by 2 years of age, Height more than 3 standard deviations below the mean for age, No onset of puberty by 14 years of age for boys or 13 years of age for girls, Projected height more than 2 standard deviations (10 cm [4 in]) below the midparental height, Bone age more than 2 standard deviations below chronologic age, Diagnosis of conditions approved for recombinant growth hormone therapy, Family history of early puberty, bone age greater than chronologic age, Projected height within 5 cm (2 in) of midparental height, bone age greater than chronologic age, normal growth velocity after catch-up growth, Rapid childhood growth, goiter, tachycardia, hypertension, diarrhea, fine tremor, exophthalmos, Thyroid-stimulating hormone and free thyroxine (T4) measurements, Body mass index greater than the 95th percentile, slightly early onset of puberty, modest overgrowth/tall stature, minimally advanced bone age, Pituitary gigantism (excess growth hormone), Coarse facial features, mandibular prominence, broad root of nose, broad hands and feet, excessive sweating, hypertension, glucose intolerance, Measurement of insulinlike growth factor 1 and insulinlike growth factor binding protein 3, brain/pituitary magnetic resonance imaging, glucose suppression test, Girls: breast development before 8 years of age, Measurements of luteinizing hormone, follicle-stimulating hormone, estradiol, and testosterone, Boys: testicular enlargement (> 3 mL) before 9 years of age, Measurement of 17-hydroxyprogesterone, human chorionic gonadotropin, dehydroepiandrosterone, estradiol, and testosterone; bone age, Macrocephaly, macroglossia, ear pits, renal abnormality, omphalocele, umbilical hernia, hepatosplenomegaly, Insulin and glucose measurements, advanced bone age, karyotyping, renal ultrasonography, echocardiography, Marfan-like habitus, developmental delay, inferior subluxation of lens, Homocysteine and methionine measurements, dilated eye examination, Delayed puberty; infertility; small, firm testes; gynecomastia; high-pitched voice; learning disability, Measurements of luteinizing hormone, follicle-stimulating hormone, and testosterone; karyotyping, Increased arm span, thin extremities, superior subluxation of lens, hypotonia, kyphoscoliosis, cardiac valvular deformities, aortic root dilation, Clinical diagnosis using Ghent criteria, testing for, Large, protruding ears; long face; high-arched palate; hyperextensible fingers; pes planus; soft skin; macro-orchidism, Clinical suspicion based on dysmorphic features, testing for, Large head; long, thin face; broad forehead; prominent, narrow jaw; downward slanting palpebral fissures; feeding difficulties from birth; facial flushing; hypotonia, Clinical suspicion based on dysmorphic features, renal ultrasonography, echocardiography, advanced bone age, Small chin, broad forehead, hypertelorism, long philtrum, camptodactyly, Clinical suspicion based on dysmorphic features, renal ultrasonography, brain magnetic resonance imaging, advanced bone age (from birth). There are also exceptions with people who have a delayed bone age (bone age is younger than chronological age) due to being a late bloomer (someone starting puberty and hitting PHV later than average), being a late bloomer with delayed puberty, or having another condition. Cambridge. (1995) 126:54550. Assessment of bone age in prepubertal healthy Korean children: comparison among the Korean standard bone age chart, Greulich-Pyle method, and Tanner-Whitehouse method. (2001). Greulich WW. (1992) doi: 10.1017/CBO9780511661655, 127. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. In this way, a maturity score is obtained for each area of clinical interest, generally categorized as A, B, C, D, E, F, G, H, and I. In terms of height growth and height growth related to bone age, average females stop growing taller two years earlier than average males. Human Rights: Convention on the Rights of the Child. Comparison among dental, skeletal and chronological development in HIV-positive children: a radiographic study. Bone age is the degree of a person's skeletal development. Topor LS, Feldman H. Variation in methods of predicting adult height for children with idiopathic short stature. Hochberg Z. Endocrine Control of SkeletalMaturation. To note, a proper assessment of bone age must always take into account differences between ethnic groups, sex, and any present pathological conditions. The two diseases that were most often identified in the studied cohort were celiac disease and an abnormality of the growth hormone axis.3 If history and physical examination findings do not suggest a cause, a complete blood count, comprehensive metabolic panel, and measurement of bone age, insulinlike growth factor 1, and insulinlike growth factor binding protein 3 might be useful to screen for chronic disease and growth hormone deficiency. But perfectly healthy kids also can have bone ages that differ from their actual ages. doi: 10.1097/NNR.0b013e3181b4b921, 16. doi: 10.1016/S0022-3476(52)80205-7, 138. doi: 10.1007/s00247-011-2302-1. (2010) 2010:298937. doi: 10.1186/1687-9856-2010-298937, 56. A child whose growth is initially normal but then falls progressively further off the growth curve may have growth hormone deficiency. This chart depicts bone age as compared with chronological age in boys. (2016) 8:4751. The GP and TW methods are characterized by a considerable variability. Many of these parameters, and particularly growth spurt and menarche, correlate better with bone age compared to chronological age (4). Adrenal suppression in patients taking inhaled glucocorticoids is highly prevalent and management can be guided by morning cortisol. (2009) 39:5917. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). In particular, bone age is more advanced in female than in male individuals with the same chronological age. This may be inherited. (2008) 122:30914. doi: 10.1002/mpo.2950210104, 40. Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. [1][2][21], The Tanner-Whitehouse (TW) technique of estimating bone is a "single-bone method" based on an x-ray image of a patient's left hand and wrist. 4 For infants and toddlers, weight, length, and head circumference should be plotted on a growth curve at every visit. The bone age (also called the skeletal age) is measured in years. They look darker on the image. Tanner JM. [5] For example, a patient's bone age may be less than their chronological age suggesting a delay in growth as may be caused by a growth hormone deficiency. New technology for bone age determination includes computer-automated readings and assessments obtained from alternative imaging modalities. The GreulichPyle tables can be applied in subjects belonging to Australia and the Middle East (108110) but not to African or Asian populations (106, 111, 112). Bone age should be compared with chronologic age to help narrow the differential diagnosis of short or tall stature. In particular, subjects with severe hypothyroidism may have a delayed bone age. Available online at: www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests. For this reason, pediatricians should evaluate each prediction of future height on the bases of all the available knowledge about the child, particularly their personal growth history. Included criteria were age below 18 years, height more than 2 SD below the mean for age (< 3rd percentile), growth failure (< 4 cm/year), small for mid-parental height, and adequate. 1. Then, the final report is done, making an average of the measurements. Because children grow in spurts, two measurements at least three to six months apart, and preferably six to 12 months apart, are needed to accurately determine growth velocity.4. Tanner JM WR, Cameron N, Marshall WA, Healy MJR, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method). (2017) 37:1925. Berlin; Heidelberg. Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods. Nemours Kids Health. Bone age assessment: automated techniques coming of age? Ann Hum Biol. For males, one takes the maternal height and adds 5 inches or 13 centimeters, and averages this value with the paternal height to obtain the mid-parental height. doi: 10.1016/j.forsciint.2004.08.018, 80. (2014) 238:8390. Although this method is very accurate and allows doctors to estimate children's bone age even when they are <1 year old, the Fels method is too complex, thus minimizing its daily use. We present three pre-pubertal female children with a diagnosis of NC-CAH treated with anastrozole monotherapy after presenting with advanced bone age, early adrenarche, no signs of genital virilization, and normal peak cortisol in response to ACTH stimulation. (127) started a computerization project of reading using phalanxes length compared to atlas. Cameron N. Can maturity indicators be used to estimate chronological age in children? Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. Radiograph Atlas of Skeletal Development of the Hand and Wrist. 114. (2012) 223:372 e14. Acceleration of growth and bone maturation in childhood thyrotoxicosis. In some psychiatric conditions, such as anorexia and in subjects with states of psychosocial stress or abuse, the presence of delayed skeletal maturation is documented (4345). Serinelli S, Panetta V, Pasqualetti P, Marchetti D. Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Because the bone age of a child with endocrine diseases will progressively fall behind chronologic age, calculating bone age every 12 months might be useful to differentiate constitutional delay of growth from endocrine diseases.1, Children with endocrine disorders, such as growth hormone deficiency, hypothyroidism, or glucocorticoid excess, have normal to increased weight, whereas children with systemic disease tend to have decreased height and weight.2,21. When the bone age reaches 16 years in females and 18 years in males, growth in height is over, and they have reached their full adult height. Bone age may be used either in normal variants of delayed growth patterns with delayed puberty and accelerated growth patterns with early puberty, where it may be more consistent with height age and adult height prediction may be more consistent with genetics. However, bone age itself cannot be considered the only absolute and incontrovertible datum to define the chronological age (6879); therefore, limits and accuracy of this examination in predicting chronological age, especially in relation to different ethnic groups and underlying diseases, need to be considered. Idiopathic short stature is defined as a height less than two standard deviations below the mean for age without a known etiology. Growth Horm IGF Res. J Pak Med Assoc. doi: 10.1136/bcr-2015-212216, 58. 92. Mansourvar M, Ismail MA, Raj RG, Kareem SA, Aik S, Gunalan R, et al. Skeletal Development of the Hand and Wrist: A Radiographis Atlas and Digital Bone Age Companion. BoneXpert is the first AI-based bone age assessment solution introduced in 2008. doi: 10.1210/er.2015-1106, 20. [] The other applications of BA include height prediction and estimation of age in children seeking asylum in other countries and in competitive sports where chronological age (CA) may be unknown. Int J Pediatr Endocrinol. This information, associated with the characterization of the shape and changes of bones, represents an important factor of the biological maturation process. Bar-El DS, Reifen R. Soy as an endocrine disruptor: cause for caution? (1978) 93:74955. Computer-assisted phalangeal analysis in skeletal age assessment. 73. Clin Pediatr Endocrinol. Using an atlas-based method gives a great possibility of intra- and interoperator variability (142). (1988) 77:15460. Int Clin Psychopharmacol. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). Endocr Pract. The bone age at onset of puberty was 11.0 1.5 years. A difference between a child's bone age and their chronological age might indicate a growth problem. Taranger J, Karlberg J, Bruning B, Engstrom I. Of these, 5477 participants (2975 female [54.3%]) had bone measurements from at least 1 age after peak height velocity . This system does not take into account the state of carpus bones maturation and allows a bone age assessment between 2.5 and 17 years and 2.0 and 15.0 years for male and female individuals, respectively. Anink J, Nusman CM, van Suijlekom-Smit LW, van Rijn RR, Maas M, van Rossum MA. doi: 10.1055/s-2000-3766, 89. Since then, more than 15 new computerized automatic systems have been developed (128, 129). GreulichPyle distinguished two standard templates: 31 and 27 radiographic images, in male and female individuals, respectively, which illustrate different phases of bone maturation between 0 and 18 or 19 years, respectively. Zafar AM, Nadeem N, Husen Y, Ahmad MN. In particular, estrogens and oral contraceptives or creams containing testosterone or estrogens can cause an early closure of the growth plate. (2007) 68:2315. These tables, the Bayley-Pinneau tables, are included as an appendix in the Greulich and Pyle atlas. (TW 2 method). (2005) 32:31625. *Correspondence: Cosimo Giannini, cosimogiannini@hotmail.it, Debates in Clinical Management in Pediatric Endocrinology, View all
Endocrine effects of inhaled corticosteroids in children. Advanced bone age and hyperinsulinemia in overweight and obese children. Dental age assessment among Tunisian children using the Demirjian method. Among them, the most used is based on the tables developed by Bayley and Pinneau in 1946 and revised in 1959. [39] Liver weight increases with age and is different between males and females. For specific medical advice, diagnoses, and treatment, consult your doctor. Pak J Biol Sci. BMJ Case Rep. (2015) 2015:bcr2015212216. [1 2 3]The two major methods of BA assessment used commonly are i . (2015) 61:1903. Because of this, those who are short with an advanced bone age, need medical attention before their bones fully fuse. Statistics have been compiled to indicate the percentage of height growth remaining at a given bone age. Contemporary Pediatrics Resident Writer Program, Food Insecurity and the Dangers of Infant Formula Dilution, Getting into the Roots of Childhood Atopic Dermatitis, Opt-Out Chlamydia Screening in Adolescent Care, The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, | Obstetrics-Gynecology & Women's Health. doi: 10.1111/j.1365-2605.2005.00575.x, 17. Herman-Giddens ME. The Pediatric Endocrine Society website was searched for consensus statements and clinical guidelines. These methods differ according to the technique of the procedure and particularly to peculiar advantages and disadvantages (Table 1). A number of conditions could contribute to delayed bone age, including5: Any child crossing up or down percentiles in childhoodafter age 3 years and before pubertyshould be referred, Kutney said.