School-age children development

Well child - ages 6 to 12

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School-age child development describes the expected physical, emotional,

and mental abilities of children ages 6 to 12.

Information

PHYSICAL DEVELOPMENT

School-age children most often have smooth and strong motor skills. However,
their coordination (especially eye-hand), endurance, balance, and physical
abilities vary.

Fine motor skills may also vary widely. These skills can affect a child's ability to
write neatly, dress appropriately, and perform certain chores, such as making
beds or doing dishes.

There will be big differences in height, weight, and build among children of this
age range. It is important to remember that genetic background, as well as
nutrition and exercise, may affect a child's growth.

A sense of body image begins developing around age 6. Sedentary habits in

school-age children are linked to a risk for obesity and heart disease in adults.
Children in this age group should get 1 hour of physical activity per day.

There can also be a big difference in the age at which children begin to
develop secondary sexual characteristics. For girls, secondary sex
characteristics include:

Breast development
Underarm and pubic hair growth
For boys, they include:

Growth of underarm, chest, and pubic hair

Growth of testicles and penis

SCHOOL

By age 5, most children are ready to start learning in a school setting. The first
few years focus on learning the fundamentals.

In third grade, the focus becomes more complex. Reading becomes more
about the content than identifying letters and words.

An ability to pay attention is important for success both at school and at

home. A 6-year-old should be able to focus on a task for at least 15 minutes.
By age 9, a child should be able to focus attention for about an hour.

It is important for the child to learn how to deal with failure or frustration
without losing self-esteem. There are many causes of school failure, including:

Learning disabilities, such a reading disability

Stressors, such as bullying
Mental health issues, such as anxiety or depression

If you suspect any of these in your child, talk to your child's teacher or health
care provider.

LANGUAGE DEVELOPMENT

Early school-age children should be able to use simple, but complete,

sentences that contain an average of 5 to 7 words. As the child goes through
the elementary school years, grammar and pronunciation become normal.
Children use more complex sentences as they grow.

Language delays may be due to hearing or intelligence problems. In addition,

children who are unable to express themselves well may be more likely to have
aggressive behavior or temper tantrums.

A 6-year-old child normally can follow a series of 3 commands in a row. By age

10, most children can follow 5 commands in a row. Children who have a
problem in this area may try to cover it up with backtalk or clowning around.
They will rarely ask for help because they are afraid of being teased.

BEHAVIOR
Frequent physical complaints (such as sore throats, tummy aches, or arm or
leg pain) may simply be due to a child's increased body awareness. Although
there is often no physical evidence for such complaints, the complaints should
be investigated to rule out possible health conditions. This will also assure the
child that the parent is concerned about their well-being.

Peer acceptance becomes more important during the school-age years.

Children may take part in certain behaviors to be part of "the group." Talking
about these behaviors with your child will allow the child to feel accepted in
the group, without crossing the boundaries of the family's behavior standards.

Friendships at this age tend to be mainly with members of the same sex. In
fact, younger school-age children often talk about members of the opposite
sex as being "strange" or "awful." Children become less negative about the
opposite sex as they get closer to adolescence.

Lying, cheating, and stealing are all examples of behaviors that school-age
children may "try on" as they learn how to negotiate the expectations and
rules placed on them by family, friends, school, and society. Parents should
deal with these behaviors in private with their child (so that the child's friends
don't tease them). Parents should show forgiveness, and punish in a way that
is related to the behavior.

It is important for the child to learn how to deal with failure or frustration
without losing self-esteem.

SAFETY

Safety is important for school-age children.

School-age children are highly active. They need physical activity and
peer approval, and want to try more daring and adventurous behaviors.
Children should be taught to play sports in appropriate, safe, supervised
areas, with proper equipment and rules. Bicycles, skateboards, in-line
skates, and other types of recreational sports equipment should fit the
child. They should be used only while following traffic and pedestrian
rules, and while using safety equipment such as knee, elbow, and wrist
pads or braces, and helmets. Sports equipment should not be used at
night or in extreme weather conditions.
Swimming and water safety lessons may help prevent drowning.
Safety instruction regarding matches, lighters, barbecues, stoves, and
open fires can prevent major burns.
Wearing seat belts is the most important way to prevent major injury or
death from a motor vehicle accident.

PARENTING TIPS
 If your child's physical development appears to be outside the norm, talk
to your provider.
If language skills appear to be lagging, request a speech and language
evaluation.
Keep close communication with teachers, other school employees, and
parents of your child's friends so you are aware of possible problems.
Encourage children to express themselves openly and talk about
concerns without fear of punishment.
While encouraging children to participate in a variety of social and
physical experiences, be careful not to over-schedule free time. Free play
or simple, quiet time is important so the child does not always feel
pushed to perform.
Children today are exposed, through the media and their peers, to many
issues dealing with violence, sexuality, and substance abuse (/health-
library/special-topic/substance-use). Discuss these issues openly with
your children to share concerns or correct misconceptions. You may need
to set limits to ensure children will be exposed to certain issues only
when they are ready.
Encourage children to participate in constructive activities such as
sports, clubs, arts, music, and scouts. Being inactive at this age
increases the risk for lifetime obesity. However, it is important not to over-
schedule your child. Try to find a balance between family time, school
work, free play, and structured activities.
School-age children should participate in family chores, such as setting
the table and cleaning up.
Limit screen time (television and other media) to 2 hours a day.

 References

American Academy of Pediatrics website. Recommendations for preventive

pediatric health care. www.aap.org/en-
us/Documents/periodicity_schedule.pdf. Updated March 2020. Accessed
January 14, 2021.

Finkelstein LH, Feigelman S. Middle childhood. In: Kliegman RM, St. Geme JW,
Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics.
21st ed. Philadelphia, PA: Elsevier; 2020:chap 25.

Marcdante KJ, Kliegman RM. Normal development. In: Marcdante KJ, Kliegman
RM, eds. Nelson Essentials of Pediatrics. 8th ed. Philadelphia, PA: Elsevier;
2019:chap 7.

Version Info
 Last reviewed on: 10/2/2020

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics,

University of Washington School of Medicine, Seattle, WA. Also reviewed by
David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director,
and the A.D.A.M. Editorial team.

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