Middle childhood is the stage of growth and development that occurs from ages 5 to 10 years. During this stage, children continue to grow and develop physically, intellectually, socially and emotionally.

Significant differences in physical appearance, including height, weight and build, in children of these ages is common. Heredity, normal human variation, nutrition and physical activity can all affect the rate at which children grow and develop.

Muscular strength, hand-eye coordination and stamina continue to increase rapidly during middle childhood, allowing older children to perform complex tasks such as riding a bicycle, dancing and playing sports (e.g., basketball, baseball) or musical instruments (e.g., piano).

Starting school is a major milestone during middle childhood. At school, children continue to develop their cognitive, language and social skills. Fundamental skills that are acquired during this developmental stage include reading, writing and basic mathematics.

School requirements continue to increase to accommodate more complex subject matters as children age. An older child’s intellectual activities also extend beyond the classroom. For instance, by age 10 many children develop favorite subjects, such as sports trivia, whereas others become avid readers.

In addition to academic challenges, the school setting offers the opportunity for children to interact socially with people outside of the family. In the process, children learn about both themselves and others, including strengths, weaknesses and personal interests. However, children also start to compare themselves to others, especially their peers.

As a result, self-esteem becomes an important issue during these years. Older children continue to develop a sense of self and how they are perceived by others. Children also recognize that they are being judged on the ability to obtain socially valued goals such as excelling in school and sports.

Not only do older children have to deal with peer pressure, they also face pressure to conform to expectations from family, teachers and other adults. This can create a lot of stress for children. In some cases, stress, peer pressure and physical or intellectual differences may result in children being at risk for anxiety or depression.

For some children, these stressors can be aggravated by problems at home including a dysfunctional family, divorce, parental substance abuse or dependence and living in poverty and/or high-crime neighborhoods. These factors can put children at increased risk for having difficulty in school, developing conduct disorders or demonstrating other negative behaviors.

Various studies suggest that positive family relationships are a strong protective factor against these risks. Family support and guidance can be an effective way to promote values, academic success and good self-esteem in children. Among the most important things parents and other caring adults can do during middle childhood development is to provide children with unconditional support as they venture into unfamiliar territory.

Another important step in promoting healthy childhood development is ensuring that children get regular checkups with a physician, most likely a pediatrician. During middle childhood, the American Academy of Pediatrics (AAP) recommends well-child visits at ages 5, 6, 8 and 10 years. A pediatrician will continue to monitor a child’s growth in weight and height, and check for any abnormalities or growth delays during well-child visits.