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School-age children development

Well child - ages 6 to 12

School-age child development describes the expected physical, emotional, and mental abilities of children ages 6 to 12 years.

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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 at least 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 should not be played 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.
• Using an appropriate car seat and 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. 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. 2022 Recommendations for preventive pediatric health care. Pediatrics. 2022;150(1):e2022058044. PMID: 35921638 pubmed.ncbi.nlm.nih.gov/35921638/.

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, Schuh AM. Normal development. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 7.

Review Date: 10/31/2022  

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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