11.1 A Healthy Time

Genes and environment safeguard middle childhood, as the years from about 6 to 11 are called (Konner, 2010). Fatal diseases or accidents are rare; both nature and nurture make these years the healthiest of the entire life span (see Figure 11.1).

Death at an Early Age? Almost Never! Schoolchildren are remarkably hardy, as measured in many ways. These charts show that death rates for 6- to 11-year-olds are lower than those for children younger than 6 or older than 11 and are about 100 times lower than those for adults.

SOURCE: HOYERT AND XU, 2012.

Genetic diseases are more threatening in early infancy or old age than in middle childhood, and serious accidents and fatal illnesses are less common, even compared with a few decades ago. This is true virtually everywhere. For example, in the United States in 1950 the death rate per 100,000 children aged 5 to 14 was 70; 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)

Slower Growth, Greater Strength

Unlike infants or adolescents, school-age children grow slowly and steadily. Self-care is easy—from dressing to hair washing, from making lunch to walking to school. Brain maturation allows schoolchildren to sit and do their work without breaking their pencils, tearing their papers, or elbowing their classmates. In these middle years, children are much more self-sufficient than younger children but not yet buffeted 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. 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 elders have missing teeth. In developed nations, they usually have dentures; in poor nations, they have gaps in their mouths or very visible gold teeth—a sign of wealth in nations where good dentistry is scarce.

Currently in developed nations, school-age children brush their teeth, and most communities—including all the larger cites—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 the condition of their teeth was rated very good (Hiroko & Rozier, 2013). Children with poor oral health are likely to have parents who are low SES do not speak English. In addition, they are likely to live in neighborhoods where adults do not help or trust each other—apparently one thing that good neighbors do for each other is encourage visits to the dentist! (Hiroko & Rozier, 2013)

Good childhood habits protect later adult health. For example, the more regular exercise children get, the less likely they are to suffer a stroke or a heart attack in adulthood (Branca et al., 2007). The health that most school-age children naturally enjoy may either continue or be disrupted, depending on daily practices—such as 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 those with no regular medical care) are vulnerable lifelong, even if their socioeconomic status (SES) improves later on (G. E. Miller et al., 2010).

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, helps children care for themselves. Establishing good health habits is vital before adolescence, because teenage rebellion leads some children with chronic diseases to ignore special diets, pills, warning signs, and doctors unless the children themselves have incorporated such habits into daily life (Dean et al., 2010; Suris et al., 2008).

Physical Activity

Expert Eye-Hand Coordination The specifics of motor-skill development in middle childhood depend on the culture. These flute players are carrying on the European Baroque musical tradition that thrives among the poor, remote Guarayo people of Bolivia.

DAVID MERCADO/REUTERS/CORBIS

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, it may also improve academic achievement (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 and thus improved concentration (Singh et al., 2012). In addition, playing games with other children teaches cooperation, problem solving, and respect for teammates and opponents 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:

For school-age children, “social exclusion” is a steep price to pay for insisting on their own way. Instead, they learn to cooperate. Unfortunately, modern life has undercut informal neighborhood games. Vacant lots and empty fields have largely disappeared.

Idyllic Two 8-year-olds, each with a 6-year-old sister, all four day-dreaming or exploring in a very old tree beside a lake in Denmark—what could be better? Ideally, all the world’s children would be so fortunate, but most are not.

HENRIK WEIS/CULTURA/CORBIS

An additional problem is that parents fear “stranger danger”—although one expert writes that “there is a much greater chance that your child is going to be dangerously overweight from staying inside than that he is going to be abducted” (quoted in Layden, 2004, p. 86). Indoor activities such as homework, television, and video games compete with outdoor play in every nation, perhaps especially in the United States. According to an Australian scholar:

The United States is not the greatest offending nation in terms of using after-school time as study time instead of play time. South Korea in particular is known for the intensity of “shadow education,” which is extra tutoring that parents find for their children, hoping to improve their test grades later on (Lee & Shouse, 2011).

Many parents around the world enroll their children in neighborhood organizations that offer additional opportunities for play. Culture and family affect the specifics: Some children learn golf, others tennis, others boxing. Cricket and rugby are common in England and in former British colonies such as India, Australia, and Jamaica; baseball is common in Japan, the United States, Cuba, Panama, and the Dominican Republic; soccer is central in many European, African, and Latin American nations.

Unfortunately, organized teams 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).

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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 of U. S. teachers of more than 10,000 third-graders nationwide found that about one-third of all 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.

Many researchers note 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 most likely to need it—city-dwellers who live in poor neighborhoods, where fearful parents do not let them go outside to play (Barros et al., 2009).

When school districts require gym, classes may be too crowded to allow active play for all the children. Ironically, schools in Japan, where many children score well on international tests, usually have several recess breaks totaling more than an hour each day. It is common for Japanese public schools to have an indoor gym and a pool.

After-school sports teams affiliated with schools or other organizations are not always ideal for 6- to 11-year-olds. Sometimes they push children to excel at sports that are better suited to adults, such as baseball, basketball, and football.

National organizations are developing 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 are needed to protect children from serious harm is sobering (Toporek, 2012).

Why Helmets? Sports organized by adults, such as this football team of 7- to 8-year-old boys sponsored by the Lyons and Police Athletic League of Detroit, may be harmful to children. The best games are those that require lots of running and teamwork—but no pushing or shoving.

JIM WEST/AGE FOTOSTOCK