There are many different symptoms that suggest the possibility of central precocious puberty. Each hospital or clinic has different procedures and each doctor has different practices, but there are specific medical tests that will be performed to confirm the diagnosis. At the initial visit, the doctor will take a detailed medical history and perform a physical examination. It is important to take a history that includes the approximate time when your child’s physical changes began, any behavioral changes, previous illnesses, and family history, as well as details you may not think are important. During the physical exam, you can see the doctor or nurse measure your child’s height and weight and compare them to the normal range. This will give the doctor an idea of your child’s level of maturity. Because of the characteristics of central precocious puberty, the physical examination also includes an examination of the genitalia, which gives the doctor a quantitative measure of the child’s physical maturity. It is important that you ensure that your child is mentally prepared to have his or her genitals examined. For some children, genital examinations may make them feel violated. Children need to understand why they are being observed so closely by medical personnel. At such times, they should be free to ask questions to minimize their internal tension and embarrassment. If there is any discomfort with the examination, they can inform the doctor. There are a number of tests that are needed to evaluate the condition and some of the common tests used for diagnosis are described below. However, please keep in mind that not all of the tests listed below will be necessary for all children. The age, medical history, and physical examination of the child will determine which tests are needed. X-rays of the hand and wrist: X-rays of the left hand or non-dominant hand are performed to determine the age of the bone and to see if it is older than it really is. Your child’s X-rays will be compared to the standard bone age films for children. If the bone age is significantly older than the actual age, this is more supportive of central precocious puberty. Blood tests: During puberty, various hormone levels are elevated and can be checked by taking blood tests. Gonadotropin-releasing hormone (GnRH) stimulation test: A synthetic injection of GnRH, a drug that stimulates the release of sex hormones, can diagnose central precocious puberty when a certain level is reached that suggests precocious puberty is cerebral in origin. This test will last more than 1 hour because it takes time to stimulate the production of the hormone. Blood samples will be collected at different time points during the test to understand the rhythm of the hormones. Usually, a tiny indwelling catheter needle is placed in the vein of the child being tested so that the pain of multiple punctures for blood can be avoided. Ultrasound of the pelvis and adrenal glands: Ultrasound can be used to detect abnormalities of the ovaries, adrenal glands or testes. Using sound waves to reveal images of the inside of the body, this test is not long and not damaging. MRI or CT of the head: Both of these tests use instruments to scan the head and create images of the inside of the brain to identify any abnormalities in the pituitary gland or hypothalamus. Your child will be asked to lie quietly in a very large wrap-around machine, and the test will take about an hour. It is also non-invasive, but the doctor will ask you to accompany him/her during the test. At the end of the test, a diagnosis can be made based on the results. Children who receive treatment usually need to be followed up once every 3-6 months to monitor their condition. Blood tests are taken to see if the current dose of medication is appropriate.