Peak height velocity occurs in stage 2 or 3 in girls but in stage 3 or 4 in boys. Thus, the pubertal growth spurt is effectively an premenarcheal event in girls. A short girl who has reached menarche is not likely to attain much greater height, while an early pubertal boy who demonstrates short stature can be expected to grow a consider- able amount before completing his pubertal development. For a normal child, the age of onset of the growth spurt is not a good predictor of adult height; the duration of pubertal growth is of greater importance in determining final height. Precocious puberty, however, causes an advanced bone age, which leads to the paradox of the tall child but the short adult. Similarly, delay in puberty due to constitutionally delayed puberty also has a tendency to decrease final height.
