Skeletal maturity in 750 normal Pakistani children (400 males, 350 females) aged 1–18 y was determined by
the Greulich–Pyle atlas system. Male children during first year and female children during first 2 y of life
matured in conformity with Greulich–Pyle standards. After that period mean bone ages were lower than the
American standards up to 15 y in males and 13 y in females (at or around puberty), which may be due to
malnutrition, ill health or other environmental factors. After puberty bone ages were higher than the
American standards indicating earlier maturity in Pakistani than Western children. Hence for the proper
evaluation of skeletal age in a given region, a longitudinal study on individuals in that region to establish
normal standards is necessary.