In assessing pubertal development, the FIRST sign of puberty in girls is:

• A Pubic hair appearance (pubarche)
• B Menarche
• C Breast bud development (thelarche) ✓
• D Axillary hair development

Explanation

Thelarche (breast bud development, Tanner stage B2) is the first visible sign of puberty in girls, representing the initial response of breast tissue to rising estrogen levels. Pubarche (pubic hair) typically follows within 6 months but may appear simultaneously or even precede thelarche. Menarche occurs approximately 2–2.5 years after thelarche. In boys, testicular enlargement >4 mL (Tanner G2) is the first sign of puberty.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.