Similar to early childhood, physical growth continues to occur in spurts during middle childhood. Physical growth occurs sporadically at this time, often in about three to six growth spurts a year. Each growth spurt generally lasts about eight weeks.

From ages 5 to 10 years, most children grow about 2 to 2.5 inches (5 to 6.4 centimeters) in height each year. Weight growth averages about 7 pounds (3.5 kilograms) per year.

There can be significant differences in physical appearance, including height, weight and build, in children of these ages. Heredity, nutrition, normal developmental variation and physical activity can all affect the rate at which children grow and develop throughout middle childhood.

By their fifth birthday, most children can stand on one foot for 10 seconds or longer, hop, do somersaults, swing, and maybe even skip. Muscular strength, hand-eye coordination and stamina continue to improve rapidly throughout middle childhood.

Enhanced musculoskeletal development allows older children to perform more complex physical tasks, such as dancing, playing sports (e.g., basketball, baseball) and playing musical instruments (e.g., piano).

The achievement of higher motor skills during middle childhood, however, is not influenced by growth or age alone. The level of practice and time spent performing such tasks in addition to an individual child’s innate abilities influence the ability to perform and excel in particular activities.

By age 5 or 6, most children can copy triangles and other geometric patterns, draw a person with body (e.g., stick figure) as well as print some letters. They can also use a fork, spoon and sometimes even a table knife properly and are often able to take care of their own hygienic needs (e.g., bathing, brushing teeth, using the toilet).

The acquisition of fine motors skills usually varies widely at first, and gradually improves over time, influencing a child’s ability to write neatly and legibly, dress appropriately and perform certain household chores such as making the bed or cleaning the bedroom.

Physical growth during middle childhood may also be accompanied by growing pains. This is a common condition that typically affects 5-year-olds and children ages 8 to 12 years. Pain often affects the leg muscles, concentrating on the front of the thighs, the calves or behind the knees.

The intensity of the pain can vary from child to child, and most children do not experience pain every day. This condition can be alleviated by the use of a heating pad, stretching of the affected muscles or a leg massage.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can also alleviate growing pains. However, children and adolescents under age 21 should never be given aspirin because it can cause a rare but potentially fatal illness called Reye syndrome.

In contrast with early childhood, brain growth slows down during middle childhood, and head size increases about 1 inch (2.5 centimeters) in circumference. Growth of the middle and lower portion of a child's face occurs gradually.

Loss of primary teeth is a major sign of development during these years. The front middle teeth typically fall out at about age 6 or 7. Molars in the back are shed between the ages of 10 and 12 years. Replacement with permanent teeth occurs at a rate of about four per year. By early adolescence, children usually have most of their permanent teeth.

During middle childhood, growth of infection-fighting lymphoid tissues including the tonsils (two oval-shaped masses of tissue located at the back of either side of the throat) and adenoids also occurs. Growth of lymphoid tissues generally subsides after age 10 or sometime during early adolescence.

However, excessive enlargement of the tonsils and adenoids may result in frequent sore throats or difficulty swallowing (dysphagia). Other more severe consequences of enlarged tonsils and/or adenoids include chronic ear infections and throat infections and breathing problems. In such cases, surgical removal of these glands may be necessary, but is considered only after other treatment methods have failed.

A child’s sexual organs usually remain physically immature until puberty. Generally, pubertal growth occurs during adolescence. However, puberty can begin as early as age 8 for girls and age 10 for boys. Masturbation is not uncommon in girls and boys during middle childhood.

To support adequate growth during middle childhood, proper nutrition, adequate rest (at least 10 hours of sleep a day) and regular exercise are essential. Children should eat a well-balanced diet and be exposed to a variety of different healthful foods.

Health and fitness experts generally recommended that preschoolers and school-age children get a minimum of 60 minutes of structured physical activity such as swimming, playing sports (e.g., basketball) or riding a bicycle every day. Lack of physical activity and excessive sedentary habits, such as watching television and playing video games, can put children at risk for becoming overweight and later developing obesity and heart diseases.