Growth slows considerably during middle childhood. During this stage, height increases an average of 2″ (5 cm) per year, and weight increases an average of 6 lb (2.5 kg) per year. However, during this time, the typical school-age child slims down and becomes more agile and graceful.

By age 7, the brain has nearly completed its growth (at approximately 90%) and basic neuromuscular mechanisms are in place.

The pubertal growth spurt begins in girls at about age 10 and in boys at about age 12.

In girls, the first menstruation, called menarche, usually starts around age 12 but can occur as early as age 9 and still be considered normal. The menstrual cycle may be irregular at first.

Secondary sexual characteristics may start to develop— including breasts, hips, and pubic hair—and girls may experience a sudden increase in height. Nurses may find that this provides an excellent opportunity to educate school-age girls about breast self-examination and sexual responsibility.

Loss of primary teeth and eruption of the first secondary teeth occur during the school-age years. Because of their size, secondary teeth may, for a while, appear disproportionately large in relation to the child’s other, smaller facial features.

The school-age child enters Erikson’s stage of industry versus inferiority. In this stage, the child wants to work and produce, accomplishing and achieving tasks. However, if too much is expected of him, or if he feels unable to measure up to set standards, the negative attributes of inadequacy and inferiority may prevail.

The school-age child has an efficient vocabulary and begins to correct previous mistakes in usage. He begins to understand the double meanings of words and becomes proficient at giving others directions without using physical signals.

The child’s personality has become structured, and he’s ready to be a partner in play with his friends. The child in this age-group typically has two to three best friends, who may change frequently. Most of his energies are devoted to school and his friends.

School and learning are viewed by the school-age child as an exciting experience. The major developmental tasks at this time are achievement in school and acceptance by peers. Expectations in the classroom have intensified, and require concentration, attendance, and complex auditory and visual processing.

The school-age child is in Piaget’s concrete-operational period, a time in which the child uses thought processes to experience and understand events and actions. Children at this age are less egocentric and can see things from another’s point of view.

In general, the first level of moral thinking is put into practice at the elementary school level, and the school-age child is in Kohlberg’s conventional level. The child behaves according to socially acceptable norms because an authority figure tells him to do so. This obedience is compelled by the threat of punishment (external factors).

Children should be encouraged to eat a variety of healthy foods, such as lean meats, fruits, vegetables, and grains, to ensure proper nutritional intake.

Requirements for sleep and rest are unique and relate to the child’s activity level and physical health. School-age children generally don’t require an afternoon nap, and compliance at bedtime becomes easier. Children should develop healthy sleep habits by not having a television in their bedrooms.

Exercise and other forms of physical activity should be encouraged to help the child begin healthy habits for a lifetime. Doing so may also prevent childhood obesity.

Children who are interested in sports should be encouraged to join sport teams or participate in sporting events. Sport teams and events are usually same-sex events at this age level, making them less intimidating. Those who aren’t interested in team sports and whose family are unable to meet the time or financial demands should be encouraged to participate in regular family play, walks, or bike rides. Children should learn the importance of daily activity, and parents should limit sedentary activities such as playing video games.

During the school-age years:

School phobias may also be called school refusal or school avoidance. A child’s refusal to go to school may be a sign of a separation anxiety, which occurs in families that are particularly close and caring or in a child who relies heavily on the support of his family. It may also occur after a particular trauma, such as the death of a pet, illness within the family, or a move to a new school.

In these cases, the child may be more fearful of leaving home than he is of going to school. He may, for example, be afraid that something bad will happen to a parent, sibling, or pet if he isn’t there to protect them.

Stealing is attractive to the younger school-age child who simply wants items for himself. The child has a limited sense of what belongs to someone else and will commonly lie to cover up the offense.

Many adults view the changes that occur during adolescence with great fear and trepidation. Although not always the case, it may be a turbulent time for the adolescent and his parents.

During this time, a teenager’s weight almost doubles and his height increases by 15% to 20%. Girls may grow 3″ to 6″ (7.5 to 15 cm) per year until age 16. Boys may grow 3″ to 6″ per year until age 18. Major organs double in size; the exception is the lymphoid tissue, which decreases in mass.

Boys attain greater strength and muscle mass, but motor coordination lags behind growth in stature and musculature. Motor coordination catches up as strength improves.

The pituitary gland is stimulated at puberty to produce androgen steroids responsible for secondary sex characteristics. (See Beginning sexual maturity in girls and Beginning sexual maturity in boys, page 133.)

The secondary (permanent) teeth are all present during the early adolescent years. The four third molars (also called wisdom teeth) may need to be extracted if impaction occurs.

Adolescence is the period of identity development, according to Erikson, as the child enters the stage of identity versus role confusion. Changes in the adolescent’s body are taking place rapidly, and he’s preoccupied with how he looks and with how others
view him. While trying to meet the expectations of his peers, he’s also trying to establish his own identity.

During adolescence, the teen moves from the concrete thinking of childhood into Piaget’s stage of formal operational thought. The teen can now reason logically about abstract concepts and derive conclusions from hypothetical premises.

Kohlberg’s conventional level of moral development continues into early adolescence. At this level, the child does what’s right because it’s the socially acceptable action. At this level, the child continues to advance in moral reasoning as his cognition develops.