GROWTH AND DEVELOPMENT

Although physical growth is steady throughout the early school years, it is slower than in the previous periods and the adolescent period to follow. During late childhood,

 

MIDDLE CHILDHOOD

>- The middle childhood years (6 to 12 years) are those dur­ing which the child begins school through the beginning of adolescence.

>- Growth during this period averages 3 to 3.5 kg and 6 cm per year, and occurs in approximately three to four bursts per year that last for approximately 8 weeks.

>- Muscular strength, coordination, and stamina increase pro­gressively, as does the ability to perform complex move­ments such as shooting basketballs, playing the piano, and dancing.

>- During this stage, the child develops the cognitive skills that are needed to consider several factors simultane­ously and to evaluate oneself and perceive others' evaluations.

children typically gain approximately 3 to 3.5 kg and grow an average of 6 cm per year.⁵ The average 6-year-old child is 116 cm tall and weighs approximately 21 kg. By 12 years of age, the same child may weigh 40 kg and be 150 cm tall. There is only a slight difference in the body sizes of boys and girls during this period, with boys being only slightly taller and heavier than girls.⁷

During late childhood, a child's legs grow longer, pos­ture improves, and his or her center of gravity descends to a lower point. These changes make children more graceful and help them to be successful at climbing, bike riding, roller skating, and other physical activities. Body fat dis­tribution decreases and, in combination with the length­ening skeleton, gives the child a thinner appearance. As body fat decreases, lean muscle mass increases. By 12 years of age, boys and girls have doubled their body strength and physical capabilities. Although muscular strength in­creases, the muscles are still relatively immature, and in­jury from overstrenuous activities, such as difficult sports, can occur. With the gains in length, the head circumfer­ence decreases in relation to height, waist circumference decreases in relation to height, and leg length increases in relation to height.

Facial proportions change as the face grows faster in relation to the rest of the cranium. The brain and skull grow very little during late childhood. Primary teeth are lost and replaced by permanent teeth. When the perma­nent teeth first appear, they may appear to be too big for the mouth and face. This is a temporary imbalance that is alleviated as the face grows. Caloric requirements usu­ally are lower compared with previous periods and with the adolescent period to follow. Cardiac growth is slow. Heart rate and respiratory rates continue to decrease, and blood pressure gradually rises. Growth of the eye contin­ues, and the normal farsightedness of the preschool child is gradually converted to 20/20 vision by approximately 11 to 12 years. Frequent vision assessment is recom­mended during late childhood as part of normal routine health screenings.⁷

Bone ossification and mineralization continues. Bones cannot resist muscle pressure and pull as well as mature bones. Precautions should be taken to prevent alterations in bone structure, such as providing properly fitting shoes and adequate desks to prevent poor posture. Children should be checked routinely and often for scoliosis (see Chapter 58) during this period.

Toward the end of late childhood, the physical differ­ences between the two sexes become apparent. Females usually enter pubescence approximately 2 years before males, resulting in noticeable differences in height, weight, and development of secondary sex characteristics. There is much individual variation among children of the same sex. These differences can be extremely difficult for chil­dren to cope with.

Entry into the school setting has a major impact on the psychosocial development of the child at this age. The child begins to develop relationships with other chil­dren, forming groups. Peers become more important as the child moves out of the security of the family and into the bigger world. Usually during this period, children begin to form closer bonds with individual "best friends." However, the best-friend relationships may frequently change. The personality of the child begins to appear. Although the personality is still developing, the basic tem­perament and approach to life become apparent. Although changes in personality occur with maturity, the basic ele­ments may not change. The major task of this stage, as identified by Erikson, is the development of industry or ac­complishment.¹⁷ Failure to meet this task results in a sense of inferiority or incompetence, which can impede further progress.