In this issue of Pediatrics, Huamei et al report on a cross-sectional study of 20654 healthy Chinese girls aged 3 to 19.83 years to identify stages of breast and pubic hair development. The median age for breast Tanner stage 2 was 9.20 years (95% confidence interval: 9.06–9.32) and for pubic hair Tanner stage 2 was 11.16 years (95% confidence interval: 11.03–11.29). The concern we are putting forth here is the possibility of a secular trend in early puberty and its potential link to toxins in the environment.

Increasing recognition of a possible secular trend in early breast development among girls in this country, and possible environmental determinants, resulted in the convening of a multidisciplinary expert panel sponsored jointly by the US Environmental Protection Agency, the National Institute of Environmental Sciences, and Serono Symposia International. The findings from this workshop were published in Pediatrics in 2008.3–...

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