Guidepost 1 What are normal patterns during middle childhood, and how can abnormal growth be treated?

• Physical development is less rapid in middle childhood than in earlier years. Wide differences in height and weight exist.
• Children with retarded growth due to growth hormone deficiency may be given synthetic growth hormone. Although the hormone is sometimes prescribed for short children who do not have hormone deficiency, extreme caution is advised in such cases.

Guidepost 2 What are some nutritional and oral health concerns for school-aged children?

• Proper nutrition is essential for normal growth and heath.
• The permanent teeth arrive in middle childhood. Dental health has improved, in part because of the use of sealants on chewing surfaces.
• Malnutrition can affect all aspects of development.
• Obesity, which is increasingly common among U.S. children, entails health risks. It is influenced by genetic and environmental factors and can be treated.
• Concern with body image, especially among girls, may lead to eating disorders.

Guidepost 3 What gains in motor skill typically occur at this age. And what kinds of play do boys and girls engage in?

• Because of improved motor development, boys and girls in middle childhood can engage in a wide range of motor activities.
• About 10 percent of schoolchildren's play, especially among boys, is rough and tumble play.
• Many children, mostly boys, go on to organized, competitive sports, which are geared to the mot athletic children. A sound physical education program should aim at skill development for all children.

Guidpost 4 What are the principle health and fitness concerns in middle childhood, and what can adults do to make the school years healthier and safer?

• Middle childhood is a relatively healthy period; most children are immunized against major illnesses, and the death rate is the lowest in the life span. However, many children, especially girls, do not meet fitness standards.
• Respiratory infections and other acute medical conditions are common. Chronic conditions such as asthma are the most prevalent among poor and minority children.
• Children's understanding of health and illness is related to the cognitive level. Cultural beliefs affect expectations regarding health care.
• Vision becomes keen during middle childhood, but a minority of children have defective vision or hearing. Stuttering is fairly common.
• Most children who are HIV-positive function normally in school and should not be excluded from any activities of which they are physically capable.
• Accidents are the leading cause of death in middle childhood. Use of helmets and other protective devices and avoidance of trampolines, snowmobiling, and other dangerous sports can greatly reduce injuries.