Genes and environment safeguard middle childhood, as the years from about 6 to 11 are called (Konner, 2010). Fatal diseases and accidents are rare; both nature and nurture make these years the healthiest of the entire life span. In the United States in 2012, the death rate for 5- to 14-year-olds was half the rate for 1- to 4-year-olds and one-fifth the rate for 15- to 24-year-olds.

The reasons are (1) genetic diseases are more threatening in early infancy or old age than in middle childhood, (2) infectious diseases are kept away via immunization, and (3) fatal accidents—although the most common cause of death in early childhood—are rare until adolescence.

The already low death rate has been further reduced recently. For example, in the United States in 1950, the death rate per 100,000 children aged 5 to 14 was 60; in 2010, it was 13. Even the incidence of minor illnesses, such as ear infections, infected tonsils, and flu, has been reduced, in part because of better medicine and immunization (National Center for Health Statistics, 2013).

Unlike infants or adolescents, school-age children grow slowly and steadily. Self-care is easy—from dressing to bathing, from making lunch to getting to school. Brain maturation allows children to sit and learn in class without breaking their pencils, tearing their papers, or elbowing their classmates. In these middle years, children are much more self-sufficient than younger children and not yet troubled by adolescent body changes.

Important to the individual child is the loss of baby teeth, with the entire set replaced by permanent teeth beginning at about age 6 (with girls a few months ahead of boys) and complete by puberty.

Important to society is oral health overall. Worldwide sixty years ago, many children neither brushed their teeth nor saw a dentist, and fluoride was almost never added to water. That’s why many of the oldest-old have missing teeth, as do some younger adults because of disease (especially diabetes) or trauma. In developed nations, teeth are replaced with implants or dentures; in poor nations, many of the elderly have gaps in their mouths or visible gold teeth—a sign of wealth in nations where good dentists were scarce.

Currently, most school-age children brush their teeth, and many communities—including all the larger U.S. cities—add fluoride to drinking water. According to a national survey, about 75 percent of U.S. children saw a dentist for preventive care in the past year, and for 70 percent of them, the condition of their teeth was very good (Iida & Rozier, 2013).

Good childhood habits protect later adult health. The health that most school-age children naturally enjoy may either continue or be disrupted, depending on daily actions, including eating a balanced diet, getting enough exercise and sleep, and breathing clean air. Unfortunately, children who have poor health for economic or social reasons (such as no regular medical care) are vulnerable lifelong, even if their socioeconomic status improves later on, because of epigenetic factors in childhood (Miller & Chen, 2010; Blair & Raver, 2012).

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Children’s habits during these years are strongly affected by peers and parents. When children see others routinely care for their health, social learning pushes them to do the same. Camps for children with asthma, cancer, diabetes, sickle cell anemia, and other chronic illnesses are particularly beneficial because the example of other children and the guidance of knowledgeable adults help children learn self-care. Such care needs to become routine—not a matter of parental insistence—in childhood, lest teenage rebellion leads to ignoring special diets, pills, warning signs, and doctors (Dean et al., 2010; Naughton et al., 2014).

Beyond the sheer fun of playing, the benefits of physical activity—especially games with rules, which school-age children are now able to follow—can last a lifetime. Exercise not only improves physical health and reduces depression, it may also improve academic achievement (Efrat, 2011; Carlson et al., 2008).

How could body movement improve brain functioning? A review of the research suggests several possible mechanisms, including direct benefits of better cerebral blood flow and increased neurotransmitters, as well as the indirect results of better mood (Singh et al., 2012).

A new concept in psychology is embodied cognition, that human thoughts are affected by body health, comfort, position and so on. If this is true, then a well-functioning body helps thinking. In addition, playing games with other children teaches cooperation, problem-solving, and respect for teammates and opponents, who may be of many backgrounds. Where can children reap these benefits?

Neighborhood play is flexible. Rules and boundaries are adapted to the context (out of bounds is “past the tree” or “behind the parked truck”). Stickball, touch football, tag, hide-and-seek, and dozens of other running and catching games go on forever—or at least until dark. The play is active, interactive, and inclusive—ideal for children. It also teaches ethics. As one scholar notes:

Children play tag, hide and seek, or pickup basketball. They compete with one another but always according to rules, and rules that they enforce themselves without recourse to an impartial judge. The penalty for not playing by the rules is not playing, that is, social exclusion.

[Gillespie, 2010, p. 298]

For school-age children, “social exclusion” is a steep price to pay for insisting on their own way. Instead, most cooperate.

Unfortunately, modern life has undercut informal neighborhood games. Vacant lots and empty fields have largely disappeared, and parents fear “stranger danger”—thinking that a stranger will somehow hurt their child (which is exceedingly rare) and ignoring the many benefits of outside play, which are universal. As one advocate of more unsupervised, creative childhood play sadly notes:

Actions that would have been considered paranoid in the ’70s—walking third-graders to school, forbidding your kid to play ball in the street, going down the slide with your child in your lap—are now routine.

[Rosin, 2014]

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Indoor activities such as homework, television, and video games crowd out outdoor play, partly because parents always want to see where their children are and what they are doing.

Many parents enroll their children in organizations that offer—depending on the culture—tennis, karate, cricket, rugby, baseball, or soccer. Unfortunately, in every nation, childhood sports leagues are less likely to include children of low SES or children with disabilities. As a result, the children most likely to benefit are least likely to participate, even when enrollment is free. The reasons are many, the consequences sad (Dearing et al., 2009). Another group unlikely to participate are older girls, again a group particularly likely to benefit from athletic activity (Kremer et al., 2014).

When opportunities for neighborhood play are scarce, physical education in school is a logical alternative. However, because schools are pressured to focus on test scores in academic subjects, time for physical education and recess has declined. A study of Texas elementary schools found that 24 percent had no recess at all and only 1 percent had recess several times a day (W. Zhu et al., 2010).

Texas, unfortunately, is no exception. A survey asking teachers of more than 10,000 third-graders nationwide found that about one-third of the children had less than 15 minutes of recess each day. Children deprived of recess were more often lower SES, in classes that were “hard to manage,” in public schools, and in cities. They also had fewer scheduled gym periods (Barros et al., 2009).

These researchers write that “many children from disadvantaged backgrounds are not free to roam their neighborhoods or even their own yards unless they are accompanied by adults. For many of these children, recess periods may be the only opportunity for them to practice their social skills with other children” (Barros et al., 2009, p. 434). Thus, school exercise is least likely for children who most need it—city-dwellers who live in crowded urban neighborhoods, with fearful parents who don’t let them go out to play.

Even when gym is required, classes may be too crowded to allow extensive active play, or the school may implement gym on paper but not in practice. For instance, although Alabama requires elementary schools to have daily physical education for at least 30 minutes, a study of all primary schools in one district found that only 22 minutes a day was actually devoted to gym. None of the schools had recess or after-school sports (Robinson et al., 2014). One reason for the lack of after-school sports is that schools fear liability if children are hurt.

Several organizations have developed guidelines to prevent concussions among 7- and 8-year-olds in football practice, as well as to halt full-body impact among children under age 12 playing ice hockey. The fact that regulations need to protect children from brain damage is sobering (Toporek, 2012). Of course, games for young children could be designed to prevent injury, but the usual reaction from adults is to provide protective equipment, such as better helmets for young players.

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Ironically, schools in Japan, where many children score well on international tests, usually have several recess breaks totaling more than an hour each day. Japanese public schools typically have good equipment for physical activity, including an indoor gym and a pool.