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Childhood is a challenging and exciting time of life in which kids develop autonomy and individuality. This period can be subdivided into three stages: early, middle and late childhood, each with its own set of demands and experiences.

Early Childhood (3 – 4 Years)

The goal of early childhood is to obtain the skills necessary for entrance into school. These include language development, with the ability to put multiple words together and speak in full sentences. By this age, children should have acquired the motor skills to walk up stairs with an alternating gait, pedal a tricycle, cut with scissors and draw simple objects such as a circle and cross. Important adaptive skills include toilet training (majority of children by age four), undressing and dressing themselves with help, brushing teeth and eating with utensils. Social skills necessary for school preparedness include the ability for interactive and pretend play, ability to share, following simple rules and commands and the ability to sit for extended periods such as when playing a board game or listening to a short story.

There are many common problems that parents encounter in this age group. Pre-schoolers may experience sleep-related problems such as bedtime resistance, nightmares or night terrors. Behavior issues may include temper-tantrums, aggressive behavior such as hitting or hurting another child. Other predictable behaviors may include sibling rivalry towards a newborn, thumb sucking and learning about the differences between boys and girls through self-exploration.

Undesirable behaviors can usually be handled with appropriate discipline techniques. Some important points to remember include applying rules and consequences consistently. Children respond more favorably when rules are clear and concrete with acceptable or appropriate behaviors stated (i.e. “don’t hit your sister” and “play with this toy instead.”) Avoid physical punishment as this rarely leads to long-term behavior changes and teaches that hitting is acceptable. Try to use methods such as “time-out” in which your child is instructed to sit quietly away from other distractions (for one minute per year of age) and redirecting your child away from the misbehavior towards a more desirable one.

Middle Childhood (5 – 7 Years)

This time period marks the transition from preschool to school age. As a result, changes in cognitive development and social skills contribute to a child’s understanding and interaction with the world around him/her. They are becoming increasingly independent individuals and lifelong patterns of health behavior (i.e. proper nutrition, regular exercise, appropriate hygiene practices) often begin at this time. Both school success and home life are important for developing and maintaining a positive self-esteem. Participation in group activities (i.e. organized sports, dance classes) helps in the development of both physical coordination as well as one’s self identity.

This is also an important time to review safety practices and injury prevention. Topics may include pedestrian and bicycle safety practices, water safety, fire safety as well as stranger interaction. Children should know their parent(s) full name, home address and home phone number by this time and should be taught how to seek out help should the need arise (such as dialing 911 or going to a trusted neighbor).

Screening at the five year-old visit will include evaluation of visual and hearing acuity as well as urinalysis. This is also the time for immunization boosters such as DTaP, IPV and MMR (Diptheria/Tetanus/Pertussis, Polio, Measles/Mumps/Rubella), which is required for entrance into public school.

Common issues of concern in this age group include school phobia or refusal, bed-wetting, stool soiling secondary to constipation and the emergence of symptoms possibly associated with Attention Deficit Hyperactivity Disorder. While some problems are self-limited, others require further evaluation and concerns should be discussed with your child’s provider.

Late Childhood (8 – 11 Years)

The preadolescent years are a time when children are growing increasingly more complex, with the ability to comprehend abstract concepts. It is a time when they often define themselves in relation to their peers (i.e. the first/second/third fastest person in the class). A child’s role in the family is expanding, often starting to take-on chores and earning allowance. School demands are increasing and often challenges arise in trying to maintain the appropriate balance between school work and extracurricular activities. Children can be given more responsibility and more autonomy and should be given a chance, when appropriate, to learn from mistakes as they mature. Confidence-building activities should be reinforced in preparation for the next stage of development, which presents with the challenges of physical changes and increasing influence by peers.

At this stage, physical exams can be performed every two years if there are no major health concerns requiring regular follow-up. There are no scheduled immunizations, other than what might be required if the standard immunization schedule was not followed. All patients on chronic medications, for which refills are needed , as well as those individuals needing forms completed for school/camp participation will need to be seen on an annual basis. 

 

Helpful links

Below is a list of links that may be useful in the care and parenting of your child: