Promoting Optimal Growth and Development

The segment of the life span that extends from age 6 to approximately age 12 has a variety of
labels, each of which describes an important characteristic of the period. These middle years are
most often referred to as school-age or the school years. This period begins with entrance into
the school environment, which has a significant impact on development and relationships.
Physiologically the middle years begin with the shedding of the first deciduous tooth and end
at puberty with the acquisition of the final permanent teeth (with the exception of the wisdom
teeth). Before 5 or 6 years of age, children have progressed from helpless infants to sturdy,
complicated individuals with an ability to communicate, conceptualize in a limited way, and
become involved in complex social and motor behaviors. Physical growth is also rapid during
the preschool-age years. In contrast, the period of middle childhood, between the rapid growth of
early childhood and the prepubescent growth spurt, is a time of gradual growth and development
with more even progress in both physical and emotional aspects.

Biologic Development
During middle childhood, growth in height and weight assumes a slower but steady pace as
compared with the earlier years. Between ages 6 and 12 years, children grow an average of 5 cm
(2 inches) per year to gain 30 to 60 cm (1–2 feet) in height and almost double their weight,
increasing 2 to 3 kg (4.5–6.5 pounds) per year. The average 6-year-old child is about 116 cm
(45.7 inches) tall and weighs about 21 kg (46 pounds); the average 12-year-old child is about
150 cm (59 inches) tall and weighs approximately 40 kg (88 pounds). During this period, girls
and boys differ little in size, although boys tend to be slightly taller and somewhat heavier than
girls. Toward the end of the school-age years, both boys and girls begin to increase in size,
although most girls begin to surpass boys in both height and weight, to the acute discomfort of
both girls and boys.

Proportional Changes
School-age children are more graceful than they were as preschoolers, and they are steadier on
their feet. Their body proportions take on a slimmer look, with longer legs, varying body
proportion, and a lower center of gravity. Posture improves over that of the preschool period to
facilitate locomotion and efficiency in using the arms and trunk. These proportions make
climbing, bicycle riding, and other activities easier. Fat gradually diminishes, and its distribution
patterns change, contributing to the thinner appearance of children during the middle years.
Accompanying the skeletal lengthening and fat diminution is an increase in the percentage of
body weight represented by muscle tissue. By the end of this age period, both boys and girls
double their strength and physical capabilities, and their steady and relatively consistent
development of coordination increases their poise and skill. However, this increased strength can
be misleading. Although strength increases, muscles are still functionally immature when
compared with those of adolescents, and they are more readily damaged by muscular injury
caused by overuse.
The most pronounced changes that indicate increasing maturity in children are a decrease in
head circumference in relation to standing height, a decrease in waist circumference in relation to
height, and an increase in leg length in relation to height. These observations often provide a clue
to a child’s degree of physical maturity and have proved useful in predicting readiness for
meeting the demands of school. There appears to be a correlation between physical indications of
maturity and success in school.
Specific physiologic and anatomic characteristics are typical of children in middle childhood.
Facial proportions change as the face grows faster in relation to the remainder of the cranium.
The skull and brain grow very slowly during this period and increase little in size. Because all of
the primary (deciduous) teeth are lost during this age span, middle childhood is sometimes
known as the age of the loose tooth (Fig. 15-1). The early years of middle childhood, when the
new secondary (permanent) teeth appear too large for the face, are known as the ugly duckling
stage.

Maturation of Systems
Maturity of the gastrointestinal system is reflected in fewer stomach upsets; better maintenance
of blood glucose levels; and an increased stomach capacity, which permits retention of food for
longer periods. School-age children do not need to be fed as promptly or as frequently as
preschool-age children. Caloric needs are less than they were in the preschool years.
Physical maturation is evident in other body tissues and organs. Bladder capacity, although
differing widely among individual children, is generally greater in girls than in boys.
The heart grows more slowly during the middle years and is smaller in relation to the rest of the
body than at any other period of life. Heart and respiratory rates steadily decrease, and blood
pressure increases from ages 6 to 12 years (see Appendix E and inside back cover).
The immune system becomes more competent in its ability to localize infections and to
produce an antibody–antigen response. However, children have several infections in the first 1 to
2 years of school because of increased exposure to other children.
Bones continue to ossify throughout childhood but yield to pressure and muscle pulls more
readily than with mature bones. Children need ample opportunity to move around, but they
should observe caution in carrying heavy loads. For example, they should shift books or tote
bags from one arm to the other. Backpacks distribute weight more evenly than tote bags.
Wider differences between children are observed at the end of middle childhood than at the
beginning. These differences become increasingly apparent and, if they are extreme or unique,
may create emotional problems. The associated characteristics of height and weight
relationships, rapid or slow growth, and other important features of development should be
explained to children and their families. Physical maturity is not necessarily correlated with
emotional and social maturity. Seven-year-old children who look like 10-year-old children will,
in fact, think and act like 7-year-old children. To expect behaviors appropriate for the older age
is unrealistic and can be detrimental to their development of competence and self-esteem.
Conversely, to treat 10-year-old children who look young physically as though they were
younger is an equal disservice to them.

Prepubescence
Preadolescence is the period of approximately 2 years that begins at the end of middle
childhood and ends with the thirteenth birthday. Because puberty signals the beginning of the
development of secondary sex characteristics, prepubescence typically occurs during
preadolescence.
Toward the end of middle childhood, the discrepancies in growth and maturation between
boys and girls become apparent. On the average, there is a difference of approximately 2 years
between girls and boys in the age of onset of pubescence. This is a period of rapid growth in
height and weight, especially for girls.
 There is no universal age at which children assume the characteristics of prepubescence. The
first physiologic signs appear at about 9 years of age (particularly in girls) and are usually clearly
evident in 11- to 12-year-old children. Although preadolescent children do not want to be
different, variability in physical growth and physiologic changes among children of the same sex
and between the two sexes is often striking at this time. This variability, especially in relation to
the onset of secondary sexual characteristics, is of great concern to preadolescents. Either early
or late appearance of these characteristics is a source of embarrassment and uneasiness to both
sexes.
Preadolescence is a period of considerable overlapping of developmental characteristics of
both middle childhood and early adolescence. However, several unique characteristics set this
period apart from others. Generally, puberty begins at 10 years in girls and 12 years in boys, but
it can be normal for either sex after the age of 8 years. Boys experience little visible sexual
maturation during preadolescence.

Psychosocial Development: Developing a Sense of Industry (Erikson)

Freud described middle childhood as the latency period, a time of tranquility between the
Oedipal phase of early childhood and the eroticism of adolescence. During this time, children
experience relationships with same-sex peers following the indifference of earlier years and
preceding the heterosexual fascination that occurs for most boys and girls in puberty.
Successful mastery of Erikson’s first three stages of psychosocial development is important in
terms of development of a healthy personality. Successful completion of these stages requires a
loving environment within a stable family unit. These experiences prepare the child to engage in
experiences and relationships beyond the intimate family group.
A sense of industry or a stage of accomplishment is achieved somewhere between age 6
years and adolescence. School-age children are eager to develop skills and participate in
meaningful and socially useful work. They acquire a sense of personal and interpersonal
competence; receive the systematic instruction prescribed by their individual cultures; and
develop the skills needed to become useful, contributing members of their social communities.
Interests expand in the middle years, and with a growing sense of independence, children want
to engage in tasks that can be carried through to completion (Fig. 15-2). They gain satisfaction
from independent behavior in exploring and manipulating their environment and from interaction
with peers. Often the acquisition of skills provides a way to achieve success in social activities.
Reinforcement in the form of grades, material rewards, additional privileges, and recognition
provides encouragement and stimulation.