Middle childhood is the developmental period that occurs between the ages of 5 and 10 years. During these years, children are more independent and physically active than they were during early childhood (between the ages of 1 and 4 years). 

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

Muscular strength, hand-eye coordination and stamina continue to progress rapidly, allowing older children the ability to perform increasingly complex tasks, such as riding a bicycle, dancing and playing sports or musical instruments.

Starting school is a major milestone during middle childhood. At school, children continue to develop cognitive, language and social skills. School-age children begin to think in more logical terms and gradually learn to consider many parts to a problem or situation. Another important skill children learn in school, if not beforehand, is how to make friends.

Healthy children typically develop at their own pace. Therefore, the developmental time frames should serve as a rough estimate rather than an exact schedule of how middle childhood development will unfold.

However, failure to meet certain developmental milestones may be indicative of possible developmental delays. For example, continuing to have problems understanding reading by age 8 can be a sign of a learning disorder, such as dyslexia.

Regular contact with a child’s school staff, especially teachers, and a pediatrician can help parents or caregivers monitor a child’s development and recognize any problem areas. Children should have regular well-child visits – at ages 5, 6, 8 and 10 years – to ensure healthy middle childhood development.

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.

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.

A child’s cognitive skills and attention span continue to expand throughout middle childhood. By age 5 or 6, most children are able to recall parts of a story, speak sentences consisting of more than five words, use the future tense, tell longer stories and recite their address correctly.

Other developmental milestones typically achieved by this time include the ability to count 10 or more objects and correctly name at least four colors in addition to having a better understanding of the concept of linear time. Children this age also know about items used in the home every day, including money, food and electric appliances.

As children start school, they begin formal academic learning. The first two years of elementary or primary school are structured for acquiring the fundamentals including reading, writing and basic mathematics skills. Most children learn to read by age 6 or 7. However, some children may learn as early as age 4 or 5. They can also perform simple math equations such as addition and subtraction.

During the elementary school years, children build upon the basic skills they have acquired. For instance, by the third or fourth grade, the goal of reading a paragraph is no longer to decipher the words, but also to understand the content. The goal of writing is not just to demonstrate correct spelling and good penmanship, but also to be able to compose a sentence and eventually entire paragraphs.

Middle childhood marks the beginning of concrete operational thinking, occurring at around age 7, in which fantasy or “make-believe” type of thinking gives way to logical thinking and the ability to understand cause-and-effect relationships. However, it is common for children – or for that matter, adults – to occasionally revert to pre-logical thinking patterns under stressful situations. This is normal and results from a healthy, active imagination.

Throughout a child’s school years, the volume of school work will increase along with the complexity. Children can only meet these demands and move on to the next level if they have learned the fundamentals.

Sometimes children can encounter difficulties when they are learning in school. At one time or another, almost all children have difficulty reading, writing or performing mathematics, especially when first acquiring these skills. However, if no improvements are made with age, learning difficulties may be due to a learning disorder, such as dyslexia, in some children.  

Commons signs of a learning disorder in children include, but are not limited to:

• Reversing letters or numbers or seeing them upside down
  
  
• Reading extremely slowly and struggling with every word
  
  
• Continuously misspelling words, including those that other children find simple
  
  
• Confusing math symbols and misreading numbers
  
  
• Mispronouncing words and/or using wrong words that sound similar

Left untreated, learning disorders can impact a patient’s self-esteem, trigger behavioral problems and cause poor academic achievement that tends to compound over time. Therefore, it is crucial that parents, teachers and other caring adults ensure that a child with a learning disorder is taught proper learning techniques.

A specialist in learning disorders can help children with new methods of learning that focus on learning strengths while compensating for areas of weakness. In addition, federal law in the United States guarantees that children in public schools with learning disabilities have the right to receive extra help. The approaches used depend on the extent and cause of the problem – for example, a specific children’s learning disorder (such as reading) or mental retardation.

As they get older, children’s intellectual sophistication often extends well beyond the school setting. Beginning in the third or fourth grade, children enjoy playing strategy games (e.g., board games, checkers) and using word play – puns and insults – to exercise and show off their growing cognitive and language abilities. Although children mostly think in present terms, older children may begin to fantasize or daydream about the future.

Throughout middle childhood, children gradually become more goal-oriented and enjoy planning and organizing tasks. Many older children also become experts on favorite subjects, such as sports trivia or building model airplanes, while others become avid readers.

However, a child’s cognitive reasoning is not fully mature at this time. Nine- and 10-year-olds are generally not good at problem solving because it requires abstract thinking – a skill that is usually acquired during adolescent development.

Preschool children often have complex feelings about their parents, which may include possessiveness toward one parent and/or jealousy or resentment of the other. Control is another issue at this time as children struggle to become more independent and parents face the challenge of dealing with these feelings.

These conflicting emotions – typically hard for a small child to understand or verbalize – may result in frequent talking back and/or regressive behaviors (e.g., temper tantrums) aimed at testing parental authority.

The resolution of common parent-child crises, which can sometimes take years to resolve, often coincides with a child’s unspoken decision to follow the behavior of the parents instead of competing with them. As language abilities increase and play becomes more sophisticated, children have an outlet for such feelings and can play at being grownups, something they cannot do yet in real life.

By age 5 or 6, most children are better able to control their emotions and impulses enough to be able to pay attention and function in school. A child’s success in achieving this relies on healthy emotional development during early childhood.

Similar to early childhood development, emotional and social development in middle childhood includes children learning about social roles and how to interact with others. However, a child’s social arena expands beyond the home and playground to now include the school and neighborhood.

The start of school coincides with a child’s budding independence from the family. Relationships with teachers and peers become increasingly important at this time. During middle childhood, making friends is one of a child’s top concerns. This social skill will endure with varying degrees of intensity throughout a child’s life.

Because children can now think in more sophisticated ways, they begin to compare themselves to others at this time. However, a child’s home life continues to exert the most influence on psychosocial development. A positive parent-child relationship can provide a sense of security as children begin to venture into unfamiliar territory.

School-age children are able to articulate their thoughts and feelings. A child’s self-esteem tends to be strong and resilient during middle childhood. Children are typically confident, adventurous and certain of their capabilities. During adolescence, it is common for the self-esteem of girls and boys to become fragile.

Although they are no less articulate than girls, many boys are not as expressive with their emotions. This is mainly because many boys are socialized from a young age to develop characteristics viewed as masculine. By age 9, most boys have successfully learned to repress their feelings – except anger. As a result, boys tend to be more physically oriented when it comes to self-expression.

During these years, children become less dependent on the family and less self-centered than they were during early childhood. They begin to consider more than one perspective at a time and generally become more understanding and sensitive to the feelings of others. Psychologically, they are ready to form more complex relationships. Throughout middle childhood, most children strive to fit in at home, school and with their friends.

Although children are naturally curious about relationships between the genders, a child’s peer group usually consists of same-sex friendships at this time. By age 10, most children will typically deny that they are interested in members of the opposite sex.

However, they usually show off, tease or act silly as a way of interacting with them. As they progress to adolescence, a child’s group of friends gradually begins to exert more influence and include peers of the opposite sex.

As children grow older, they become more inquisitive and physical and psychological progression allows them to engage in an ever-growing list of behaviors that are necessary for development, but which can also present various risks to their health. Therefore, safety continues to be a concern throughout childhood.

Parents are encouraged to enforce car safety at all times, even when traveling short distances. Children should always be secured by some type of safety restraint, no matter how short the drive. Children ages 12 years and younger should always sit in the back seat, preferably in the middle.

Children may also be prone to accidents or injuries (e.g., fractures) while playing sports or doing other types of physical activity such as riding a bicycle. It is important for children to wear the necessary protective equipment, such as shin pads, mouth guards and helmets, for any sport.

Parents or other caregivers are encouraged to enforce rules about not venturing out into the neighborhood before dawn or after dusk. Keeping a well-stocked first-aid kit as well as a list of important phone numbers (e.g., neighborhood hospitals) handy in case of an emergency is also recommended.

Other ways parents and other caring adults can promote healthy middle childhood development include:

• Involvement in a child’s academic and social life. This can be achieved by maintaining communication with a child’s teachers, other school personnel and parents of friends. Doing so can enable parents to become aware of any problems or difficulties as they arise.
  
  
• Promote reading. As children age, they often enjoy more complex books that can teach them about the world. Introduce a child to various books on many topics, including biographies, science fiction, mysteries and more.
  
  
• Encourage children to be organized and promote proper hygiene. This will help them feel good about themselves as well as develop a sense of independence and accomplishment.
  
  
• Talk with children often and encourage them to express their feelings and thoughts. Connected children are generally happier and do better in school and in life.
  
  
• Enforce disciplinary rules in a consistent manner and establish limits. As children grow, parents will likely need to adjust household rules to encourage and accommodate growing independence (e.g., sleepovers) while continuing to maintain health and safety.
  
  
• Provide children with positive feedback and unconditional support. This will foster the seeds for positive self-esteem.
  
  
• Monitor children’s media. What children view and hear on television, in movie theaters and on the Internet and radio can have an impact on them. Discuss with your child what is and is not appropriate for them. If you think something is inappropriate, redirect your child to more suitable programming and let them know why you are doing so. Various studies indicate that children who are exposed to violent media have a significant long-term increase in aggressive behaviors and thoughts.
  
  
• Discuss important topics by ages 8 to 10 years. It is recommended that topics such as puberty, the names and functions of female and male reproductive organs, sex, masturbation, menstruation, assault, contraception, sexually transmitted diseases, and the dangers of alcohol, tobacco and other recreational drugs should be discussed in a calm, open manner and in a language that children can understand.
  
  
• Be a positive role model. The best way to raise children who are loving, decent and respectful is to demonstrate the values and behavior one hopes they will develop.

Preparing questions in advance can help parents and other caregivers have more meaningful discussions with their physicians regarding their child’s growth and development. Parents may wish to ask their child’s pediatrician the following questions regarding middle childhood development:

1. What kind of changes can I expect in my child from age 5 to 10?
   
   
2. My 6-year-old continues to have temper tantrums. Is this normal at this age?
   
   
3. My 10-year-old is much smaller than his/her same-age peers. Should I be concerned?
   
   
4. My 7-year-old has difficulty speaking and often stutters. Is this a sign of a speech problem?
   
   
5. What kinds of medical exams will my child need during middle childhood?
   
   
6. How can I help my child grow and develop to his/her full potential?
   
   
7. My 8-year-old daughter is showing signs of puberty. Is this normal at her age?
   
   
8. My 9-year-old reads much slower than his same-age friends. Is this a sign of a learning disorder?
   
   
9. At what age should I discuss topics such as sex and the dangers of drugs with my child?
   
   
10. How can I help my child develop good self-esteem?