School Age 5 to 12 Years

PHYSICAL ASPECTS The school years represent the slowest period of growth in childhood, and the body habitus is typically slender. The primary teeth are loosening and the secondary teeth erupt. The lymphatics reach maximal dimensions relative to body size by 6 years of age. There is increased physical activity, including organized sports, during this period, and injuries become common.

NEUROLOGIC ASPECTS School-age children experience rapid language growth and maturing motor ability. Concrete reasoning ability emerges with an ability to understand cause and effect. The child is increasingly aware of his or her body and develops a sense of modesty. Task-oriented behavior is common, and school and sports activity are typically the central events of the child's life. School-age children are eager to please and often reluctant to express their fears of pain and death.

AGE-SPECIFIC APPROACH The direct examination approach is typically successful for school-age children. Parental accompaniment and respect for modesty should be maintained. Historical information should be elicited from child as well as parent. An effort to inquire about school or extracurricular interests will enhance rapport. Change in school performance is a helpful indicator of chronic disease. Painful procedures are best preceded by explanations to both parent and child, given well in advance with honesty regarding discomfort. The child should be given some degree of choice in the manner in which the procedure is completed, such as a comfortable position, in order to minimize the sense of loss of control.

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