Middle childhood, also known as the school-age period, is a crucial stage of development when children undergo significant physical changes. During this time, children begin to develop lifelong habits that can impact their health and wellness. As a parent, caregiver, or educator, it is essential to provide children with the necessary tools and resources to develop healthy habits that promote optimal growth and development. This health and wellness section will explore various topics related to middle childhood, including nutrition, physical activity, and safety, to help support children in leading healthy and happy lives.

Sleep Needs in Middle Childhood

Throughout childhood, sleep is an important part of thriving development. It is recommended that children between the ages of 6 and 12 get 9–12 hours of sleep per night. Middle childhood is a vibrant time of physical, cognitive, and social-emotional development. The physical changes in middle childhood require adequate rest to help children achieve and maintain healthy levels of physical activity. It’s no surprise that well-rested children have more consistent academic performance and are more likely to reach grade-level academic benchmarks on time (Wheatman et al., 2016). After all, it would be hard to learn fractions if you couldn’t stay awake.

Sleep patterns impact middle childhood development, but they also indicate later life health and wellness outcomes. Childhood sleep health may contribute to areas of adult wellness, such as mental health, maintaining healthy physical activities, and even weight management (Watson et al., 2017). Because sleep is so important to our overall health, it is also important to think about what may interfere with good sleep patterns. Periods of sleep disruption are normal, even among older children. Stressful situations, such as challenges in school or social relationships, and changes to family life, such as separation or divorce, may result in disrupted sleep. Physical growth spurts may cause some discomfort that interrupts sleep cycles.

While we sleep, our brains continue to work to make sense of information and ideas we have heard or thought about throughout the day. So you could say we literally get smarter while we sleep. Sometimes, our brains have trouble multitasking the work of learning and maintaining sleep rhythms. If we are really struggling to make sense of something, it may interrupt our sleep. All of these examples are normal experiences of sleep disruption and should not cause concern as they will typically resolve on their own. However, persistent sleep issues, or sleep issues that escalate in frequency and intensity, such as night terrors, could mean the underlying cause is more persistent and serious. In this case, it is best to consult a pediatrician.

The tapering off of cortisol levels in the latter part of the day allows other hormones, such as melatonin, to become more prominent. Melatonin is often referred to as the “sleep hormone” because it helps regulate the sleep-wake cycle and promotes sleep onset. The decrease in cortisol and increase in melatonin work together to facilitate the onset of sleep and promote restful, rejuvenating rest during the night.

The physical, mental, and emotional growth of people of all ages requires good sleep. Therefore, access to safe places to sleep is an essential part of addressing issues of equity. Children who are unhoused or housing unstable are at greater risk of sleep deprivation. Children navigating poverty are more housing-vulnerable. For many, sleep is a routine-dependent process that is made harder without a consistent place to live. Good sleep patterns benefit from reliable and safe places to rest. For each child to thrive, it is critical to consider factors such as affordable housing, poverty, and neighborhood safety, all of which influence how safe and secure we feel when we lie down to sleep.

Bedwetting

Jesse has been struggling with bedwetting for several months. They are embarrassed to talk about it with friends and family, and afraid they’ll be made fun of if others find out. Jesse, who is otherwise social with peers, often avoids sleepovers or camping trips because they worry about wetting the bed and being humiliated in front of others. They feel ashamed and alone and wish they could stop bedwetting. Jesse is also growing in their awareness that they don’t feel like they fit into the gender binary of boy and girl, and their parents wonder if Jesse’s experience of navigating gender may be contributing to this issue.

Bedwetting, also known as nocturnal enuresis, is a common condition among children in middle childhood, with about 10 percent of children experiencing it (Walker, 2019). While bedwetting can affect any child, there are some factors that may increase the likelihood of a child experiencing it. The causes of bedwetting can be both physical and psychological. Here are some possible factors that increase the likelihood of a child experiencing bedwetting:

• Delayed development: Sometimes, the bladder control mechanism of a child may not have fully developed, leading to bedwetting.
• Genetics: Bedwetting tends to run in families, so genetics may play a role in some cases.
• Urinary tract infections can cause bedwetting by increasing the frequency of urination and reducing the child’s bladder capacity.
• Sleep disorders: Certain sleep disorders, such as sleep apnea, can cause bedwetting by disrupting the child’s sleep.
• Constipation: When a child is constipated, it can put pressure on the bladder, causing bedwetting.
• Psychological issues: Bedwetting can also be caused by psychological issues, such as anxiety, stress, or trauma.
• Hormonal imbalances: In some cases, bedwetting can be caused by hormonal imbalances that affect the production of a hormone called vasopressin, which regulates the body’s water balance.
• Gender: Bedwetting is more common in boys than in girls.

Bedwetting is a common condition and often resolves on its own. However, if it persists or is causing significant distress to the child or family, it’s important to consult a healthcare provider for further evaluation and treatment options. There are several treatment options available for bedwetting, depending on the underlying cause and severity of the condition. Here are some possible treatment options:

• Bedwetting alarms: These are devices that sound an alarm when the child wets the bed, waking them up so they can go to the bathroom. Over time, this can help the child learn to recognize the sensation of a full bladder and wake up to use the bathroom.
• Medications: There are several medications that can help reduce bedwetting, such as desmopressin, which reduces the amount of urine the body produces at night, and imipramine, which helps the bladder hold more urine.
• Bladder training: This involves a structured program of gradually increasing the amount of time between bathroom visits, with the goal of increasing the child’s bladder capacity and reducing the frequency of bedwetting.
• Behavioral therapy: This may involve rewarding the child for dry nights, using positive reinforcement to encourage them to use the bathroom before bed, and addressing any underlying stress or anxiety that may be contributing to the bedwetting.
• Dietary changes: Reducing the amount of fluids the child consumes before bedtime and avoiding caffeine and sugary drinks can help reduce the likelihood of bedwetting.

Returning to Jesse’s story, Jesse has been experiencing some anxiety or embarrassment because of bedwetting, and it may interrupt their social development. Jesse’s parents can take several steps to support them through the struggles with bedwetting. First, they can create a safe and supportive environment by letting them know that bedwetting is a common issue and that they’re there to support them. They can assure Jesse that they won’t judge or criticize them and that they’re committed to helping find a solution. Second, they can encourage open communication by listening to them without judgment and offering empathy and support. Third, they can seek medical advice to explore treatment options that may help reduce or eliminate bedwetting and mental health support to explore if Jesse is experiencing anxiety about the identity development process that is impacting the bedwetting. Fourth, they can use protective bedding, such as waterproof mattress covers and sheets, to help protect the bed and make cleanup easier. Finally, if Jesse is experiencing teasing or bullying related to their bedwetting, their parents can work with the school or other caregivers to address the issue and ensure that they feel safe and supported. With some preparation and support, Jesse can still enjoy social events like slumber parties without feeling embarrassed or ashamed. Overall, by creating a supportive and non-judgmental environment, seeking appropriate medical advice and treatment, and helping Jesse feel understood, accepted, and supported, Jesse’s parents can play a vital role in helping them manage bedwetting and cope with any related challenges.

Nutrition

During middle childhood, a healthy diet facilitates physical and mental development and helps to maintain health and wellness. School-aged children experience steady, consistent growth but at a slower rate than they did in early childhood. This slowed growth rate can have a lasting impact if nutritional, caloric, and activity levels aren’t adjusted in middle childhood. Maintaining levels from early childhood into middle childhood can lead to excessive weight gain early in life and to obesity in adolescence and adulthood. Making sure that children have proper nutrients will allow for optimal growth and development.

Millions of children grow up in food-insecure households with inadequate diets due to both the availability of food and the quality of food. In the United States in 2021, about 13 percent of households with children were food insecure to some degree (USDA, 2022). In half of those, only adults experienced food insecurity, while in the other half, both adults and children were considered to be food insecure. This means that a significant percentage of American children do not have consistent access to adequate, nutritious meals.

Access to food and water is the foundation of Maslow’s hierarchy of needs (see Chapter 2). Without clean water and adequate food, a person cannot survive. When a person has inadequate access to food and water, they may experience a number of negative health consequences. Deficiencies in iron, zinc, protein, and vitamin A can result in stunted growth, illness, and limited development. Federal programs, such as the National School Lunch Program, the School Breakfast Program, and Summer Feeding Programs, work to address the risk of hunger and malnutrition in school-aged children. They help to fill the gaps and provide children living in food-insecure households with greater access to nutritious meals.

Immunization and Disease Prevention

One way to protect a child’s health and the health of those around them is through immunization. Immunization shots, or vaccinations, are essential. The vaccines, if given through injection, may hurt a little, but the diseases they can prevent can hurt a lot more. They protect against a variety of illnesses, including measles, mumps, rubella, hepatitis B, polio, diphtheria, tetanus, and pertussis (whooping cough).

Immunizations are important for adults as well as for children. The immune system helps the human body fight germs by producing antibodies to combat them. Once it does, the immune system remembers the germ and can fight it again. Some vaccines contain germs that have been killed or weakened. When given to a healthy person, the vaccine triggers the immune system to respond and build immunity. Other vaccines use genetic material called messenger RNA (mRNA) to instruct the body to build immunity against a virus and prepare it to fight off future infections. Unlike traditional vaccines, mRNA vaccines do not contain live or weakened viruses, which makes them safer to use. Additionally, mRNA vaccines can be developed more quickly than traditional vaccines since they don’t require growing and culturing the virus.

Before vaccines, people only gained long-term immunity by actually getting a disease and surviving it. Immunizations are an easier and less risky way to become immune. Vaccines are the best defense we have against serious, preventable, and sometimes deadly contagious diseases. Vaccines are some of the safest medical products available, but like any other medical product, there may be risks. Accurate information about the value of vaccines and their possible side effects helps people to make informed decisions about vaccination. For the most accurate, up-to-date information, it is important to consult a healthcare provider.

Vision Development

The most common vision problem in middle childhood is being nearsighted, otherwise known as myopic, with 25 percent of children being 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 and handwriting skill development. Because vision is important in academic success, many public schools partner with county health departments to provide free vision screenings for children. Vision screenings are an opportunity for early detection and intervention.

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) or malposition of their teeth, which can affect their ability to chew food, floss, and brush properly. Dentists may recommend that children with these conditions see an orthodontist to maintain proper dental health. Dental health is exceedingly important as children begin to make their own food choices and take over flossing and brushing. Parents can ease this transition by promoting healthy eating and proper dental hygiene.

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 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 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.

Equity Gaps in Vision, Dental, and Hearing Care

Vision, dental, and hearing are all important for helping children grow in their academic and social skills. Although 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 rely 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 provided through Medicaid, the public health insurance option for low-income families, often severely limits or excludes services such as orthodontia. The current health insurance system contributes to disparities in access to vision, dental, and hearing care for low-income school-aged children.

One effort to address the equity gap in access to vision and dental care involves colocating 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 health care, such as immunizations, are provided at no charge. Because the school serves predominantly low-income families, the location of the health clinic makes health care more accessible for the most economically vulnerable community members. It’s a good example of how communities can promote thriving development by removing barriers to essential services.

Licenses and Attributions for Health and Wellness

“Health and Wellness” by Terese Jones is licensed under CC BY 4.0 international.