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. 34-2). 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.

FIG 34-2 School-age children are motivated to complete tasks. A, Working alone. B, Working with others.

A sense of accomplishment also involves the ability to cooperate, to compete with others, and to cope effectively with people. Middle childhood is the time when children learn the value of doing things with others and the benefits derived from division of labor in the accomplishment of goals. Peer approval is a strong motivating power.

The danger inherent in this period of development is the occurrence of situations that might result in a sense of inferiority. Children with physical and mental limitations may be at a disadvantage in the acquisition of certain skills. When the reward structure is based on evidence of mastery, children who are incapable of developing these skills risk feeling inadequate and inferior. Even children without chronic disabilities may experience feelings of inadequacy in some areas. No child is able to do everything well, and children must learn that they will not be able to master every skill they attempt. All children, even children who usually have positive attitudes toward work and their own abilities, will feel some degree of inferiority when they encounter specific skills that they cannot master.

Children need and want real achievement. Children achieve a sense of industry when they have access to tasks that need to be done and they are able to complete the tasks well despite individual differences in their innate capacities and emotional development.

Cognitive Development (Piaget)

When children enter the school years, they begin to acquire the ability to relate a series of events to mental representations that can be expressed both verbally and symbolically. This is the stage Piaget describes as concrete operations, when children are able to use thought processes to experience events and actions. The rigid, egocentric view of the preschool years is replaced by mental processes that allow children to see things from another’s point of view.

During this stage, children develop an understanding of relationships between things and ideas. They progress from making judgments based on what they see (perceptual thinking) to making judgments based on what they reason (conceptual thinking). They are able to master symbols and to use their memories of past experiences to evaluate and interpret the present.

One cognitive task of school-age children is mastering the concept of conservation (Fig. 34-3). At an early age (≈5-7 years), children grasp the concept of reversibility of numbers as a basis for simple mathematics problems (e.g., 2 + 4 = 6 and 6 − 4 = 2). They learn that simply altering their arrangement in space does not change certain properties of the environment, and they are able to resist perceptual cues that suggest alterations in the physical state of an object. For example, they recognize that changing the shape of a substance such as a lump of clay does not alter its total mass. They no longer perceive a tall, thin glass of water as containing a greater volume than a short, wide glass; they can distinguish between the weight of items regardless of their size. They recognize that size is not necessarily related to weight or volume. There is a developmental sequence in children’s capacity to conserve matter. Conservation of mass usually is accomplished first, weight some time later, and volume last.

FIG 34-3 Common examples that demonstrate the child’s ability to conserve (ages are only approximate).

School-age children also develop classification skills. They can group and sort objects according to the attributes they share, place things in a sensible and logical order, and hold a concept in mind while making decisions based on that concept. Another characteristic of middle childhood is that children derive enjoyment from classifying and ordering their environment. They become occupied with collections of objects, such as stickers, shells, dolls, cars, cards, and stuffed animals. They may even begin to order friends and relationships (e.g., best friend, second-best friend).

They develop the ability to understand relational terms and concepts, such as bigger and smaller; darker and paler; heavier and lighter; to the right of and to the left of; and more than and less than. They view family relationships in terms of reciprocal roles (e.g., to be a brother, one must have a sibling).

School-age children learn the alphabet and the world of symbols called words, which can be arranged in terms of structure and their relationship to the alphabet. They learn to tell time, to see the relationship of events in time (history) and places in space (geography), and to combine time and space relationships (geology and astronomy).

The ability to read is acquired during the school years and becomes the most significant and valuable tool for independent inquiry. Children’s capacity to explore, imagine, and expand their knowledge is enhanced by reading.

Moral Development (Kohlberg)

As children move from egocentrism to more logical patterns of thought, they also move through stages in the development of conscience and moral standards. Young children do not believe that standards of behavior come from within themselves but, instead, that rules are established and set down by others. During the preschool years, children adopt and internalize the moral values of their parents. They learn standards for acceptable behavior, act according to these standards, and feel guilty when they violate them. Although children 6 or 7 years of age know the rules and behaviors expected of them, they do not understand the reasons behind them. Rewards and punishments guide their judgment; a “bad act” is one that breaks a rule or causes harm. Young children believe that what other people tell them to do is right and that what they themselves think is wrong. Consequently, children 6 or 7 years old may interpret accidents or misfortunes as punishment for “bad” acts.

Older school-age children are able to judge an act by the intentions that prompted it rather than just its consequences. Rules and judgments become less absolute and authoritarian and begin to be founded on the needs and desires of others. For older children, a rule violation is likely to be viewed in relation to the total context in which it appears. The situation, as well as the morality of the rule itself, influences reactions. Although younger children judge an act only according to whether it is right or wrong, older children take into account different points of view. They are able to understand and accept the concept of treating others as they would like to be treated.

Spiritual Development

Children at this age think in concrete terms but are avid learners and have a great desire to learn about their God. They picture God as human and use adjectives such as “loving” and “helping” to describe their deity. They are fascinated by the concepts of hell and heaven, with a developing conscience and concern about rules. They may fear going to hell for misbehavior. School-age children want and expect to be punished for misbehavior and, when given the option, tend to choose a punishment that “fits the crime.” However, they may view illness or injury as a punishment for a real or imagined misdeed. The beliefs and ideals of family and religious persons are more influential than those of their peers in matters of faith.

School-age children begin to learn the difference between the natural and the supernatural but have difficulty understanding symbols. Consequently, religious concepts must be presented to them in concrete terms. Prayer or other religious rituals comfort them, and if these activities are a part of their daily lives, they can help them cope with threatening situations. Their petitions to their God in prayers tend to be for tangible rewards. Although younger children expect their prayers to be answered, as they get older, they begin to recognize that this does not always occur and they become less concerned when their prayers are not answered. They are able to discuss their feelings about their faith and how it relates to their lives (see Cultural Competence box).

Cultural Competence

Religious Orientation

Many schools and communities have a Judeo-Christian orientation toward prayer, holidays, and values. This may result in conflict and discomfort for children of other religious or ethnic groups. Sensitivity must be exercised so as not to offend and confuse children from other religious backgrounds, such as the Buddhist, Hindu, and Muslim faiths, and those with no religious backgrounds.

Social Development

One of the most important socializing agents in the school-age years is the peer group. In addition to parents and schools, the peer group conveys a substantial amount of information to its members. Peer groups have a culture of their own with secrets, traditions, and codes of ethics that promote feelings of solidarity and detachment from adults. Through peer relationships, children learn how to deal with dominance and hostility, how to relate to persons in positions of leadership and authority, and how to explore ideas and the physical environment.

Peer-group identification is an important factor in gaining independence from parents. The aid and support of the group provide children with enough security to risk the moderate parental rejection brought about by small victories in the development of independence.

A child’s concept of the appropriate gender role is also influenced by relationships with peers. During the early school years, few gender differences exist in the play experiences of children. Both girls and boys share games and other activities. However, in the later school years, the differences in the play of boys and girls becomes more marked.

Social Relationships and Cooperation

Daily relationships with peers provide important social interactions for school-age children. For the first time, children join group activities with unrestrained enthusiasm and steady participation. Previous interactions were limited to short periods under considerable adult supervision. With increased skills and wider opportunities, children become involved with one or more peer groups in which they can gain status as respected members.

Valuable lessons are learned from daily interaction with age mates. First, children learn to appreciate the numerous and varied points of view that are represented in the peer group. As children interact with peers who see the world in ways that are somewhat different from their own, they become aware of the limits of their own point of view. Because age mates are peers and are not forced to accept each other’s ideas as they are expected to accept those of adults, other children have a significant influence on decreasing the egocentric outlook of the child. Consequently, children learn to argue, persuade, bargain, cooperate, and compromise to maintain friendships.

Second, children become increasingly sensitive to the social norms and pressures of the peer group. The peer group establishes standards for acceptance and rejection, and children are often willing to modify their behavior to be accepted by the group. The need for peer approval becomes a powerful influence toward conformity. Children learn to dress, talk, and behave in a manner acceptable to the group. A variety of roles, such as class joker or class hero, may be assumed by individual children to gain approval from the group.

Third, the interaction among peers leads to the formation of intimate friendships between same-sex peers. The school-age period is the time when children have “best friends” with whom they share secrets, private jokes, and adventures; they come to one another’s aid in times of trouble. In the course of these friendships, children also fight, threaten each other, break up, and reunite. These relationships, in which the child experiences love and closeness with a peer, may be important as a foundation for relationships in adulthood (Fig. 34-4).

FIG 34-4 School-age children enjoy engaging in activities with a “best friend.” (© 2011 Photos.com, a division of Getty Images. All rights reserved.)

Clubs and Peer Groups.

One of the outstanding characteristics of middle childhood is the formation of formalized groups, or clubs. A prominent feature of these groups is the rigid rules imposed on the members. There is exclusiveness in the selection of persons who have the privilege of joining. Acceptance in the group is often determined on a pass-fail basis according to social or behavioral criteria. Conformity is the core of the group structure. There are often secret codes, shared interests, and special modes of dress, and each child must abide by a standard of behavior established by the members. Conforming to the rules provides children with feelings of security and relieves them of the responsibility of making decisions. By merging their identities with those of their peers, children are able to move from the family group to an outside group as a step toward seeking further independence. Peer groups and clubs allow children to substitute conformity to a peer group for conformity to a family at a time when children are still too insecure to function independently.

During the early school years, groups are usually small and loosely organized, with changing membership and no formal structure. The clubs and groups usually do not display elements of cooperation and order that are seen in groups of older children. In general, girls’ groups are less formalized than boys’ are, and although there may be a mixture of both sexes in the early school years, the groups of later school years are composed predominantly of children of the same sex. Common interests are the basis around which the group is structured.

Peer-group identification and association are essential to a child’s socialization. Poor relationships with peers and a lack of group identification can contribute to bullying. Bullying is any recurring activity that intends to cause harm, distress, or control toward another in which there is a perceived imbalance of power between the aggressor(s) and the victim (Lamb, Pepler, and Craig, 2009). Although bullying can occur in any setting, it most often occurs at school during unstructured times such as recess (Arseneault, Bowes, and Shakoor, 2010). Children who are targeted for bullying often have internalizing characteristics such as withdrawal, anxiety, depression, low self-esteem, and reduced assertiveness that may make them an easy target for bullying (Arseneault, Bowes, and Shakoor, 2010). Bullies are generally defiant toward adults, antisocial, and likely to break school rules. They have dominant personalities, may come from homes where parental involvement and nurturing are lacking, and may experience or witness violence or abuse at home (Bowes, Arseneault, Maughan, et al., 2009). Boys who bully tend to use physical force, referred to as direct bullying, but girls usually use indirect bullying methods, such as exclusion, gossip, or rumors (Arseneault, Bowes, and Shakoor, 2010). Cyberbullying is a new form of bullying and involves the use of cellular telephones, digital cameras, or social networking Internet sites to cause distress on an individual (American Academy of Pediatrics [AAP] Committee on Injury, Violence, and Poison Prevention, 2009).

The long-term consequences of bullying are significant. Chronic bullies seem to continue their behaviors into adulthood, negatively influencing their ability to develop and maintain relationships. Victims of bullying often experience psychologic distress such as worry, sadness, anxiety, depression, and nightmares and can have increased self-harm behaviors, social isolation, suicidal ideation, and violent behaviors (Arseneault, Bowes, and Shakoor, 2010). School personnel play an important role in implementing antibullying interventions in schools; however, research has recognized that involving the whole family in antibullying programs greatly increases success (Arseneault, Bowes, and Shakoor, 2010).

There are also dangers in peer-group attachments that are too strong. Peer pressures force some children to take risks or engage in behaviors that are against their better judgment. A child’s membership in a gang is associated with marked increases in serious delinquent behavior (Fisher, Montgomery, and Gardner, 2008). Peer-group activities that result in unlawful or criminal gang violence are increasing in the United States. An integration of family-centered and school-based programs is needed to reduce the influences for children to become affiliated with gangs.

Relationships with Families

Although the peer group is influential and necessary for normal child development, parents are the primary influence in shaping their children’s personalities, setting standards for behavior, and establishing value systems. Family values usually take precedence over peer value systems. Although children may appear to reject parental values while testing the new values of the peer group, ultimately they retain and incorporate into their own value systems the parental values they have found to be of worth.

In the middle school years, children want to spend more time in the company of peers and they often prefer peer-group activities to family activities. This can be disturbing to parents. Children become intolerant and critical of their parents, especially when their parents’ ways deviate from those of the group. They discover that parents can be wrong, and they begin to question the knowledge and authority of their parents, who were previously considered to be all-knowing and all-powerful.

Although increased independence is the goal of middle childhood, children are not prepared to abandon all parental control. They need and want restrictions placed on their behavior, and they are not prepared to cope with all of the problems of their expanding environment. They feel more secure knowing there is an authority figure to implement controls and restrictions. Children may complain loudly about restrictions and try to break down parental barriers, but they are uneasy if they succeed in doing so. They respect adults who prevent them from acting on every urge. Children view this behavior as an expression of love and concern for their welfare.

Children also need their parents to be adults, not friends. Sometimes parents, hurt by their children’s rejection, attempt to maintain their love and gratitude by assuming the role of “pals.” Children need the stable, secure strength provided by mature adults to whom they can turn during troubled relationships with peers or stressful changes in their world. With a secure base in a loving family, children are able to develop the self-confidence and maturity needed to break loose from the group and stand independently.

Play

Play takes on new dimensions that reflect a new stage of development in the school years. Play involves increased physical skill, intellectual ability, and fantasy. In addition, children develop a sense of belonging to a team or club by forming groups and cliques.

Rules and Rituals.

The need for conformity in middle childhood is strongly manifested in the activities and games of school-age children. In the preschool years, children’s games were either invented for them or played in the company of a friend or an adult. Now children begin to see the need for rules, and their games have fixed and unvarying rules that may be bizarre and extraordinarily rigid. Part of the enjoyment of the game is knowing the rules, because knowing means belonging. Conformity and ritual permeate their play and are also evident in their behavior and language. Childhood is full of chants and taunts, such as: “Eeeny, meeny, miney, mo,” “Last one is a rotten egg,” and “Step on a crack, break your mother’s back.” Children derive a sense of pleasure and power from such sayings, which have been handed down with few changes through generations.

Team Play.

A more complex form of play that evolves from the need for peer interaction is team games and sports. A referee, umpire, or person of authority may be required so that the rules can be followed more accurately. Team play teaches children to modify or exchange personal goals for goals of the group; it also teaches them that division of labor is an effective strategy for attaining a goal. Children learn about competition and the importance of winning—an attribute highly valued in the United States.

Team play can also contribute to children’s social, intellectual, and skill growth. Children work hard to develop the skills needed to become team members, to improve their contribution to the group, and to anticipate the consequences of their behavior for the group. Team play helps stimulate cognitive growth because children are called on to learn many complex rules, make judgments about those rules, plan strategies, and assess the strengths and weaknesses of members of their own team and members of the opposing team.

Quiet Games and Activities.

Although play at this age is highly active, school-age children also enjoy quiet and solitary activities. The middle years are the time for collections, which constitute another ritual. Young school-age children’s collections are an odd assortment of unrelated objects in messy, disorganized piles. Collections of later school years are more orderly, selective, and organized in scrapbooks, on shelves, or in boxes.

School-age children become fascinated with complex board, card, or computer games that they can play alone, with a best friend, or with a group. As in all games, adherence to the rules is fanatic. Disagreements over rules can cause much discussion and argument but are easily resolved by reading the rules of the game.

The newly acquired skill of reading becomes increasingly satisfying as school-age children expand their knowledge of the world through books (Fig. 34-5). School-age children never tire of stories and, as with preschool children, love to have stories read aloud. They also enjoy sewing, cooking, carpentry, gardening, and creative activities such as painting. Many creative skills such as music and art, as well as athletic skills such as swimming, karate, dancing, and skating, are learned during these years and continue to be enjoyed into adolescence and adulthood (Fig. 34-6).

FIG 34-5 Selecting a book with the assistance of an adult. (© 2011 Photos.com, a division of Getty Images. All rights reserved.)

Development of a Self-Concept

The term self-concept refers to a conscious awareness of self-perceptions, such as one’s physical characteristics, abilities, values, self-ideals and expectancy, and idea of self in relation to others. It also includes one’s body image, sexuality, and self-esteem. Although primary caregivers continue to exert influence on children’s self-evaluation, the opinions of peers and teachers provide valuable input during middle childhood. With the emphasis on skill building and broadened social relationships, children are continually engaged in the process of self-evaluation.

Significant adults can often manage to unobtrusively manipulate the environment so that children experience success. Each small success increases a child’s self-image. The more positive children feel about themselves, the more confident they will be in trying for success in the future. All children profit from feeling that they are in some way special to a significant adult. A positive self-concept makes children feel likeable, worthwhile, and capable of significant contributions. These feelings lead to self-respect, self-confidence, and happiness. Negative feelings lead to self-doubt.

Development of a Body Image

School-age children have a relatively accurate and positive perception of their physical selves, but in general, they like their physical selves less as they grow older. The head appears to be the most important part of the school-age child’s perceived image of self, with hair and eye color the characteristics used most frequently to describe the physical self.

Body image is influenced, but not solely determined, by significant others. The number of significant others who influence children’s perception of themselves increases with age. Children are acutely aware of their own bodies, the bodies of their peers, and those of adults. They are also aware of deviations from the norm. Physical impairments, such as hearing or visual defects, ears that “stick out,” or birthmarks, assume great importance. Increasing awareness of these differences, especially when accompanied by unkind comments and taunts from others, may cause a child to feel inferior and less desirable. This is especially true if the defect interferes with the child’s ability to participate in games and activities.

Table 34-1 summarizes the major developmental achievements of the school-age years.

TABLE 34-1

GROWTH AND DEVELOPMENT DURING THE SCHOOL-AGE YEARS

PHYSICAL AND MOTOR	MENTAL	ADAPTIVE	PERSONAL-SOCIAL
Age 6 Years
Height and weight gain continues slowly Weight, 16-26.3 kg (35.5-58 pounds) Height, 106.7-122 cm (42-48 inches) Central mandibular incisors erupt Loses first tooth Gradual increase in dexterity Active age; constant activity Often returns to finger feeding More aware of hand as a tool Likes to draw, print, color Vision reaches maturity	Develops concept of numbers Can count 13 pennies Knows whether it is morning or afternoon Defines common objects such as fork and chair in terms of their use Obeys three commands in succession Knows right and left hands Says which is pretty and which is ugly of a series of drawings of faces Describes the objects in a picture rather than simply enumerating them Attends first grade	At table, uses knife to spread butter or jam on bread At play, cuts, folds, pastes paper; sews crudely if needle is threaded Takes bath without supervision; performs bedtime activities alone Reads from memory; enjoys oral spelling game Likes table games, checkers, simple card games Giggles a lot Sometimes steals money or attractive items Has difficulty owning up to misdeeds Tries out own abilities	Can share and cooperate better Has great need for children of own age Will cheat to win Often engages in rough play Often jealous of younger brother or sister Does what adults are seen doing May have occasional temper tantrums Is a boaster Is more independent, probably an influence of school Has own way of doing things Increases socialization
Age 7 Years
Begins to grow at least 5 cm (2 inches) in height per year Weight, 17.7-30 kg (39-66.5 pounds) Height, 112-130 cm (44-51 inches) Maxillary central incisors and lateral mandibular incisors erupt More cautious in approaches to new performances Repeats performances to master them Jaw begins to expand to accommodate permanent teeth	Notices that certain items are missing from pictures Can copy a diamond Repeats three numbers backward Develops concept of time; reads ordinary clock or watch correctly to nearest quarter hour; uses clock for practical purposes Attends second grade More mechanical in reading; often does not stop at the end of a sentence; skips words such as “it,” “the,” and “he”	Uses table knife for cutting meat; may need help with tough or difficult pieces Brushes and combs hair acceptably without help Likes to help and have a choice Is less resistant and stubborn	Is becoming a real member of the family group Takes part in group play Boys prefer playing with boys; girls prefer playing with girls Spends a lot of time alone; does not require a lot of companionship
Ages 8 to 9 Years
Continues to gain 5 cm (2 inches) in height per year Weight, 19.5-39.5 kg (43-87 pounds) Height, 117-142 cm (46-56 inches) Lateral incisors (maxillary) and mandibular cuspids erupt Movement fluid; often graceful and poised Always on the go; jumps, chases, skips Increased smoothness and speed in fine motor control; uses cursive writing Dresses self completely Likely to overdo; hard to quiet down after recess More limber; bones grow faster than ligaments	Gives similarities and differences between two things from memory Counts backward from 20 to 1; understands concept of reversibility Repeats days of the week and months in order; knows the date Describes common objects in detail, not merely their use Makes change out of a quarter Attends third and fourth grades Reads more; may plan to wake up early just to read Reads classic books but also enjoys comics More aware of time; can be relied on to get to school on time Can grasp concepts of parts and whole (fractions) Understands concepts of space, cause and effect, nesting (puzzles), conservation (permanence of mass and volume) Classifies objects by more than one quality; has collections Produces simple paintings or drawings	Makes use of common tools such as hammer, saw, screwdriver Uses household and sewing utensils Helps with routine household tasks such as dusting, sweeping Assumes responsibility for share of household chores Looks after all of own needs at table Buys useful articles; exercises some choice in making purchases Runs useful errands Likes pictorial magazines Likes school; wants to answer all the questions Is afraid of failing a grade; is ashamed of bad grades Is more critical of self Takes music and sport lessons	Is easy to get along with at home Likes the reward system Dramatizes Is more sociable Is better behaved Is interested in boy-girl relationships but will not admit it Goes about home and community freely, alone or with friends Likes to compete and play games Shows preference in friends and groups Plays mostly with groups of own sex but is beginning to mix Develops modesty Compares self with others Enjoys organizations, clubs, and group sports
Ages 10 to 12 Years
Weight, 24.5-58 kg (54-128 pounds) Height, 127-162.5 cm (50-64 inches) Posture is more similar to an adult’s; will overcome lordosis Remainder of teeth will erupt and tend toward full development (except wisdom teeth) Girls—Pubescent changes may begin to appear; body lines soften and round out Boys—Slow growth in height and rapid weight gain; may become obese in this period	Writes brief stories Attends fifth to seventh grades Writes occasional short letters to friends or relatives on own initiative Uses telephone for practical purposes Responds to magazine, radio, or other advertising Reads for practical information or own enjoyment—stories or library books of adventure or romance, animal stories	Makes useful tools or does easy repair work Cooks or sews in small way Raises pets Washes and dries own hair; is responsible for a thorough job of cleaning hair but may need reminding to do so Is sometimes left alone at home for an hour or so Is successful in looking after own needs or those of other children left in his or her care	Loves friends; talks about them constantly Chooses friends more selectively; may have a “best friend” Enjoys conversation Develops beginning interest in opposite sex Is more diplomatic Likes family; family really has meaning Likes mother and wants to please her in many ways Demonstrates affection Likes father, who is admired and may be idolized Respects parents