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By ages 9 to 10 years, puberty may have begun in some children. Pubertal onset is marked by breast development at about ages 7 and 8 years for girls, and by testicular enlargement at about age 9 and 10 for boys. These changes are accompanied by a growth spurt. Individual differences are noted with pubertal onset. This is an opportunity for the health care professional to learn about family and cultural beliefs about puberty and about how the family’s cultural and religious values will guide the discussion of sexuality and the physical changes of puberty.

By this age, the child...

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