This document summarizes normal physical, cognitive, and psychosocial development for school-aged children between 6-12 years old. Key points include: - Physical growth slows but children gain 5 cm in height and 2-3 kg in weight per year on average. Dental development and motor skills continue improving. - Cognitive abilities like logical thinking, attention, and memory develop. Peer relationships and team activities become important. - Psychosocially, children's self-concept and identity form based on peer and teacher feedback. They strive for competence and achievement.

1. Normal for School Age
Introduction:
 Middle childhood ,ages 6 to 12 years. The school years is probably one of the
healthiest periods of life . Physiologically the middle years begin with the shedding
of the first deciduous tooth and end at puberty
 Physical growth has been equally rapid during the preschool age years. In contrast,
the period of middle childhood, between the rapid growth of early childhood and
the prepubescent growth spurt, is a time of gradual growth and development with
more even progress in both physical and emotional aspects.

2. Physical Growth
During school- age child is between the ages of 6 to 12 years.
 Grow an average of 5 cm per year to gain 30 to 60 cm in height and increasing 2 to
3 kg per year.
 The average 6-year-old child is about 116 cm, tall and weighs about 21 kg
 The average 12-year-old child is about 150 cm, tall and weighs approximately 40
kg
 During this age, girls and boys differ little in size, although boys tend to be slightly
taller and somewhat heavier than girls.
Weight
Average annual weight gain is about 2-3 kg.
Boys tend to gain slightly more weight through 12 years.
Formula for 6 to 12 years : (Age in years x 7) – 5
2

3. Physiological Growth
- Pulse …………………. 70 + 15 b/min (average 70-115 b/min).
- Respiration…………………. 21+3 c/min (average 16-20 c/min).
- Blood pressure …………………. 104/75 +16/10 mmhg.
- Temperature …………………. 36.5-37c.
- The heart grows slowly during the middle years and is smaller in relation to the rest of the body
than at any other period of life.
- Immune system reaches normal adult level .
- Nervous system is mature by 10 years of age.

4. Dentition
• The first permanent (secondary) teeth erupt at about 6 years old, beginning with the 6-year molar,
which erupts posterior to the deciduous molars.
• Other permanent teeth appear in approximately the same order as eruption of the primary teeth and
follow shedding of the deciduous teeth
• At 7 years maxillary central incisors and lateral mandibular incisors erupt. Jaw begins to expand to
accommodate permanent teeth.
• At 8-9 years maxillary lateral incisors and mandibular cuspid erupt.
• From 10-12 years reminder of teeth will erupt and tend toward full development (except wisdom
teeth) the second permanent morals, cuspid, first bicuspid, and second bicuspid (upper & lower).
- Permanent dentition is more advanced in girls than boys

5. Motor Development
Gross Motor Development:
At 6-8 years the child can tie shoes, use scissor, run, jump, swim, ride a bicycle.
- Likes to print, draw and color with some details.
- Vision reaches maturity.
- At 8-10 years the child can, write in cursive, hit & threw ball, begin to participate in organized
sports.
At 10-12 years the child can achieve the strength & speed needed for most sports, enjoy
physical activities. Good coordination
Play at this stage is co-operative and competitive

6. Motor Development cont
Fine Motor Development:
At 6-8 years the child can know left hand from right, `improved eye- hand coordination.
- Print wards and learns writing.
- Draw a person.
- Can brush and comb hair.
- At 8-10 years the child can use both hands independently.
- Increase smoothness and speed in fine motor control.
- Handles eating utensils (spoon- fork- knife) skillfully.
- At 10-12 years the child motor coordination continues to improve.

7. Play
• Play takes on new dimensions that reflect a new stage of development in the
school years.
• Play involves increased physical skill, intellectual ability, and fantasy.
• In addition, children develop a sense of belonging to a team or club by forming
groups. Belonging to a group is of vital importance
• Team play is a more complex form of play that evolves from the need for peer
interaction is team games and sports.
• Team play teaches children to modify or exchange personal goals for goals of the
group; it also teaches them that division of labor is an effective strategy for
attaining a goal.
• School-age children become fascinated with complex board, card, or computer games that they
can play alone or in groups.

8. Developing a Self-Concept
• The term self-concept refers to a conscious awareness of self-
perceptions, such as one's physical characteristics, abilities, values,
self-ideals and expectancy
• Idea of self in relation to others it also includes one's body image,
sexuality, and self-esteem.
• The opinions of peers and teachers provide valuable input during
middle childhood.

9. Sex Education
• An important component of ongoing sex education is effective communication with parents.
• If parents either repress the child's sexual curiosity or avoid dealing with it, the sexual information
that the child receives may be acquired almost entirely from peers.
• When peers are the primary source of sexual information, it is often transmitted and exchanged in
secret conversation and contains misinformation.
• When sex education is presented from a life span perspective and treated as a normal part of
growth and development, the information is less likely to contain overtones of uncertainty, guilt, or
embarrassment that could in turn produce anxiety in children.

10. Stress and Fear
• Stress in childhood comes from a variety of sources, such as conflict
within the family, parental criminality or psychiatric disorder, and low
socioeconomic status
• The school environment and participation in multiple organized
activities can be additional sources of stress.
• The demands from teachers and parents with school work and
standardized proficiency testing
• In addition, children in the middle school years are often
overcommitted with activities such as dance, music, athletics, and
other activities until the cumulative effect is overwhelming.

11. The nurse who observes the following signs of stress in a child
Stomach pains or headache
Sleep problems
Bedwetting
Changes in eating habits
Aggressive or stubborn behavior
 Withdrawal or refused to participate
Regression to earlier behaviors (e.g., thumb sucking)
Trouble concentrating or changes in academic performance

12. Cognitive Development
Concert operations (ages 6 to 12 years)
 During this stage, children develop the ability to begin problem solving in concert,
systematic way they can classify& organize information &begin to understand that
volume changes
 These children an have another point of view and can deal with more than one
aspect of a situation.
 The biggest developments for a school- age child is gain of independence

13. Psychosexual Development
Latency Stage
 The latency stage extends 6 to 12 years – the latency stage is the time of
primary schooling , when the child is preparing for adult life but must await
maturity to exercise initiative in adult living .
 During this period ,development of self seem is closely linked with a
developing sense of industry to produce concept of one value

14. Psychosocial Development
Industry versus Inferiority (ages 6 to 12 years)
Children begin to seek achievement in this phase. They to
interact with others & sometimes to compete with them.

15. Promoting Optimal Health during the School Years
1. Nutrition
• Although caloric needs are diminished in relation to body size during middle
childhood, resources are being laid down at this time for the increased growth needs
of adolescence.
• The quality of the child's diet depends on the family's pattern of eating. Likes and
dislikes established at an early age continue in middle childhood
• However, the easy availability of fast-food restaurants, the influence of the mass
media, and the temptation of “junk food” make it easy for children to fill up on empty
calories.
• Foods that do not promote growth, such as sugars, starches, and excess fats, are
common in school-age children's diets. The easy availability of high-calorie foods,
combined with the tendency to obesity.

16. Sleep and Rest
• The amount of sleep depends on the child's age, activity level,
and other factors, such as health status.
• The growth rate slows in the school-age years
• School-age children usually do not require naps
They do need to sleep approximately 11.5 hours at 5 years old
They do need to sleep approximately 9 hours at 11 years old

17. Exercise and Activity
• Appropriate activities during the school-age years include
running, jumping rope, swimming, roller skating, ice skating,
dancing, and bicycle riding.
• Positive reinforcement achieved by experiencing increasingly
smooth, rhythmic, and efficient use of the body conditions the
child toward regular physical activity.

18. Dental Health
• Dental caries are important parts of health supervision during this
period, as correct brushing
• It is important to be alert to possible malocclusion problems that may
result from irregular eruption of permanent teeth and that may impair
function.
• Regular dental supervision and continued fluoride supplementation are
integral parts of the health maintenance program

19. Injury Prevention
• School-age children's desire for riding bicycles increases the risk of injury on
streets. Other serious injuries include accidents on skateboards, roller skates,
scooters, and other sports equipment.
• The most effective means of prevention is education of the child and family
regarding the hazards of risk taking and the improper use of equipment.

20. Guidance During School Years
Age 6 Years
• Prepare parents to expect strong food preferences and frequent refusal of specific food items.
• Prepare parents to expect an increasingly appetite.
• Prepare parents for emotional reactions and mood changes.
• Help parents anticipate continued susceptibility to illness.
• Teach injury prevention and safety, especially bicycle safety.
• Encourage parents to respect child's need for privacy and to provide a separate bedroom for child,
if possible.
• Prepare parents for child's increasing interests outside the home.
• Help parents understand the need to encourage child's interactions with peers.

21. Guidance During School Years cont
Ages 7 to 10 Years
• Prepare parents to expect an increase in minor injuries. Emphasize caution in
selecting and maintaining sports equipment and reemphasize safety.
• Prepare parents to expect increased involvement with peers and interest in activities
outside the home.
• Emphasize the need to encourage independence while maintaining limit setting
• Prepare mothers to expect more demands at 8 years old.
• Prepare parents for prepubescent changes in girls.
• Parents of the school-age child must share their child's time with the increasingly
important peer group from the same gender.

22. Guidance During School Years cont
Ages 11 to 12 Years
• Help parents prepare child for body changes of pubescence.
• Prepare parents to expect a growth spurt in girls.
• Encourage parents to support child's desire to “grow up” but to allow regressive behavior when
needed.
• Prepare parents to expect an increase in child's masturbation.
• Instruct parents that the child may need more rest.
• Help parents educate child regarding experimentation with potentially harmful activities
• Experiences with the peer group prepare school-age children for the broader world of relationships
and increased independence from their parents