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Assessment of Skeletal Age

By Kathleen M. Haywood, PhD, and Nancy Getchell, PhD

The growth status of the bones can be used as a maturation assessment system by comparing an individual’s state of development with those depicted in an atlas or standard—that is, a publication picturing skeletal development at many levels, each of which is assigned a skeletal age. The most common bones used for this purpose are the hand and wrist bones (figure 5.4). Thus, from an X ray of a person’s hand and wrist, we could determine a skeletal age by finding the picture in the atlas closest to the individual’s X ray. For example, a boy might have a skeletal age of 8.5 years because his hand and wrist X ray is most similar to the extent of ossification in the standard for 8.5 years. If his chronological age is under 8.5, we would know that he is an early maturer; if it is over 8.5, we would know that he is a late maturer. Skeletal age can easily be a year ahead of or behind chronological age, emphasizing how much variation is possible in maturation status even among those born on the same day.

This is an excerpt from Life Span Motor Development, Fifth Edition.


Figure 5.4 Hand and wrist X rays are often used for assessment of skeletal age. The numerous hand and wrist bones provide multiple sites for comparison of a child’s X ray with the numerous standard X rays found in an assessment atlas. Here are two X rays from an atlas: (a) the standard for boys 48 months old and girls 37 months old, and (b) the standard for boys 156 months old and girls 128 months old. Note, in the later image, how much more ossification (hardening) has occurred in the small wrist bones and the larger ossified area at the epiphyseal plates of the hand bones and the forearm bones.

Reprinted, by permission, from S.I. Pyle, 1971, A radiographic standard of reference for the growing hand and wrist (Chicago: Year Book Medical), 53, 73. Copyright Bolton—Brush Growth Study—B.H. Broadbent D.D.S.


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