9.5.1 Vision Development

The most common vision problem in middle childhood is being nearsighted, otherwise known as myopic, with 25 percent of children diagnosed by the end of middle childhood (Theophanous et al., 2018). Being nearsighted can be corrected by wearing glasses with corrective lenses.

Vision problems can interfere with academic progress for children during elementary school. Poor vision has been linked to delays in reading as well as developing hand-writing skills. Because vision is important in academic success, many public schools partner with county health departments to provide free vision screenings for children. These vision screenings are an opportunity for early detection and intervention.

9.5.2 Dental Development

Children in middle childhood will start or continue to lose teeth. They experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age 6 or 7. It is important for children to continue seeing a dentist twice a year to be sure that these teeth are healthy. Children’s dental health needs continuous monitoring as children lose teeth and new teeth come in. Many children have some malocclusion (when the way upper teeth aren’t correctly positioned slightly over the lower teeth, including under- and overbites) or malposition of their teeth, which can affect their ability to chew food, floss, and brush properly. Dentists may recommend that it’s time to see an orthodontist to maintain proper dental health. Dental health is exceedingly important as children grow more independent by making food choices and as they start to take over flossing and brushing. Parents can ease this transition by promoting healthy eating and proper dental hygiene.

9.5.3 Hearing Development

Hearing development during middle childhood is characterized by improved auditory processing, language development, sound localization, auditory sensitivity, and musical ability. Children in middle childhood have more refined auditory processing abilities than younger children. They are better able to distinguish between different sounds and to filter out background noise, allowing them to focus on relevant auditory information. As children continue to refine their language skills during middle childhood, their ability to process and understand speech also improves. They become more adept at interpreting complex sentences and understanding the nuances of language. Children in middle childhood develop better sound localization skills, which means they can determine the direction and distance of a sound source. This is important for safety and for understanding the environment. Children’s auditory sensitivity continues to develop during middle childhood. They become better at hearing softer sounds and detecting subtle differences in pitch, loudness, and timbre.

9.5.4 Equity Gaps in Vision, Dental, and Hearing Care

Vision, dental, and hearing are all important to help children grow in their academic and social skills. Though schools provide screenings, the ability to access services to treat a vision or hearing impairment may be impacted by a child’s access to health insurance. Children who are relying on programs such as the Children’s Health Insurance Program (CHIP) may have fewer resources available for obtaining glasses or hearing aids. The dental care often provided through Medicaid, the public health insurance option for low-income families, severely limits or excludes services such as orthodontia. The current health insurance system contributes to disparities in the development of vision, dental and hearing for low-income school-aged children.

One effort to address the equity gap in access to vision and dental care is to colocate the county health department with public schools. In Corvallis, Oregon, a recently built elementary school has an office of the county health department adjacent, where vision, dental, and basic healthcare like immunizations are provided at no charge. Because the school serves predominantly low-income families, the location of the health clinic makes access to healthcare more accessible for the most economically vulnerable community members. It’s a good example of best practices to ensure thriving development by creating the path of least resistance to essential services.