Can maturity indicators be used to estimate chronological age in children?

Abstract Context: There is widespread concern over the use of maturity indicators to estimate chronological age in children. Objective: To review the definition of maturity indicators, the criteria governing their identification and use and the problems of their interpretation. Methods: The development of maturity indicators, the criteria for their selection and the relationship of maturity to chronological age is critically reviewed. Results and Conclusions: Maturity indicators are not related to the passage of chronological time, but to the progression of the individual from an immature to a mature state. They are discrete events in a continuous process or a series of processes (e.g. skeletal, sexual, dental, etc.) that highlight uneven maturation within the individual, the independence of maturational processes, sexual dimorphism and the relationship of maturity to size. The use of a timescale of development causes considerable problems in translating biological maturity into a developmental scale. One “year” of maturational time does not equate to 1 year of chronological time and, thus, the passage of time determined by developmental rather than temporal landmarks is both variable and inconsistent. Chronological age determination was not the aim of maturational assessment and, thus, its widespread use as an age determinant poses considerable interpretive challenges.