School-age children grow at a slow pace until they hit their “growth spurt.” Expected growth is 2 in and 5 to 7 lb per year for both males and females. These parameters are particularly important in the identification of obesity for which today’s school-age children are at high risk. In terms of stature, genetics play a role in normal variations, which may appear below the fifth or above the 95th percentile on standard growth charts. Abnormal etiologies may exist and include chronic illness, endocrine abnormalities, and neglect or abuse. The beginning of rapid adolescent growth for girls can be as early as 9 years of age and as late as 14 years, 6 months. Boys begin their growth spurt between 10 years, 6 months and 16 years. The median age for girls is 12 years; the median age for boys is 14 years (Bickley, Hoekleman, & Bates, 1999).

Previously developed language skills become more fluid, resulting in advanced cognitive functioning in the school-age child. Vocabulary and understanding increase. Grammar and articulation are usually correct. Young school-age children ask many questions, solve simple problems, and use fantasy in their thinking processes. Fantasy thinking generates new fears. Between 6 and 11 years, the child further organizes thought and develops memory. He or she reads and reasons more completely.

For the young school-age child, the family is the primary social group. Grade-school children usually have strong family ties and use their own parents or other adults close to the family as role models (ie, the child dresses up like mom). Relationships with parents and siblings are usually harmonious in younger years, becoming more challenging as
puberty approaches. At this time, conflicts with parents regarding limit setting and expectations often arise. As they get older, school-age children begin to establish their independence, psychologically separate from their parents, and build their own identities. As they separate from parents, peers become increasingly important. Parents must recognize this as normal and allow children to separate.

The peer group provides an arena for older school-age children to establish independence and test out ideas. Friends are especially important during this time, and children begin to conform to a set of group standards. School-age children assume a sex role and engage energetically in group activities. How they view their competencies within these groups determines motivation, perseverance, and resilience. School-age children begin to incorporate values learned at home, in school, and from peers. The older school-age child begins to let go of fears, focusing more on reality. Approval, recognition, and enthusiasm are the hallmarks of the healthy child during this period. Role models shift to other adults outside the home. Normal variants describe personality differences that exist in children who are thought to be “different” but still function acceptably. Normal variants include shy, cautious, or contentious children. Parents need to seek help when a child fails to succeed at the tasks expected for his or her age because these personality differences are interfering with achievement.

School-age children are valuable participants in providing the history. Providers should direct questions to both parent and child and ask both what their concerns are at each visit. In the late school-age years, it may be appropriate to take a history from the child privately as well as a history from the parent.

School-age children should be “old hands” at visits to their providers. They understand the concrete operation of a physical examination and want to cooperate. The provider should praise children for their successful participation and reward them for cooperation. Each visit should be an opportunity to build the child’s self-esteem.