MIDDLE CHILDHOOD

Counseling

General

• Children should be physically active every day or nearly every day, as part of play, games, physical education, planned physical activities, recreation, and sports, in the context of family, school, and community activities.
• Physical activity is recommended on most, if not all, days of the week. Explain that children can achieve this level of activity through moderate physical activities (e.g., brisk walking for 30 minutes) or through shorter, more intense activities (e.g., skating or playing basketball for 15 to 20 minutes).
• It is critical for children to understand the importance of physical activity. This may encourage them to stay active during adolescence, when their level of physical activity tends to decline.
• Encourage children to find physical activities they enjoy and can continue into adulthood.
• Discuss with parents how children can incorporate physical activity into their daily lives (e.g., by using the stairs instead of taking the elevator or escalator; by walking or riding a bike instead of riding in a car).
• Many elementary schools include physical education in their curricula. Schools that participate in the President's Council on Physical Fitness and Sports program usually conduct testing when children are in middle childhood. Encourage parents to take the results of their child's fitness test to the health professional to discuss positive results as well as suggestions for improvement.
• Encourage parents to participate in physical activity with their children and to be positive role models by participating in physical activity themselves.

Physical Development

• Discuss physical development with children and their parents, and tell them the approximate time they should expect accelerated growth. For girls, this may occur at ages 9 to 11, typically 1 to 2 years before the onset of menarche; for boys, this may not occur until about age 12 or older.
• Help girls entering puberty to understand and accept the physical changes of puberty that may alter their appearance and physical activity performance.
• Explain to older children that some of their peers may start puberty earlier than they do, reassuring them that their development is normal.
• Explain the growth chart to children and their parents and discuss how the children compare to others their age. Emphasize that a healthy body weight is based on a genetically determined size and shape rather than on an ideal, socially defined weight.
• Tell parents and their children that, before puberty, cardiorespiratory conditioning such as intensive endurance training (e.g., swimming thousands of yards) is of limited value for future performance.

Injury Prevention

• Encourage parents to make sure that children drink plenty of fluids when they are physically active. Before puberty, children are at increased risk for heat-related illness because their sweat glands are not fully developed and they cannot cool themselves as well as adolescents can. (See the Heat-Related Illness chapter.)
• Emphasize the importance of using appropriate safety equipment (e.g., helmets, wrist guards, elbow and knee pads) when participating in physical activity. (See the Injury chapter.)
• Inform parents and their children that the risk of injury is higher during periods of rapid growth.
• For children interested in weight or strength training, recommend doing several sets of multiple repetitions and using weights that provide low resistance. Emphasize the importance of appropriate safety equipment and supervision by a qualified adult. Children should not participate in maximal weightlifting, powerlifting, or bodybuilding until their growth and physical maturation are complete.
• Emphasize the importance of reducing children's exposure to sunlight while playing outdoors and thus their risk of developing skin cancer. Recommend that parents practice preventive strategies such as (1) applying a broad-spectrum sunscreen with a sun protection factor (SPF) rating of 15 or greater to children's exposed skin 30 minutes before they go outdoors, (2) reapplying sunscreen every 2 hours, and (3) ensuring that children wear broad-spectrum child-size sunglasses and brimmed hats and clothing that protect the skin as much as possible.

Safety

• If the safety of the environment or neighborhood is a concern, help parents and children find other settings for physical activity (e.g., Boys and Girls Clubs of America, recreation centers, churches and other places of worship).
• Remind parents that children can do many activities indoors with soft equipment that can be used in tight spaces (e.g., modified versions of bowling, basketball, darts, or golf).

Substance Use

• Warn parents and children about the dangers of using alcohol, tobacco, and other drugs.
• Warn parents and children about the risks of using performance-enhancing products (e.g., protein supplements, anabolic steroids). (See the Ergogenic Aids chapter.)

Special Issues

• Emphasize that achieving and maintaining a healthy weight is best accomplished through healthy eating behaviors and regular physical activity. (See the Nutrition chapter.)
• Encourage children, especially those who are overweight, to limit sedentary behaviors (e.g., watching television and videotapes, playing computer games) to 1 to 2 hours a day.
• Explain that weight loss should not occur during middle childhood, with the possible exception of the child whose BMI is between the 85th and 95th percentiles for age and sex and who has complications, or the child whose BMI is at or above the 95th percentile for age and sex. (See the Obesity chapter.)
• Encourage parents of children with special health care needs to allow their children to participate in physical activity for cardiovascular fitness within the limits of their medical or physical conditions. Explain that adaptive physical education is often helpful and that a physical therapist can help identify appropriate activities for children with special health care needs. (See the Children and Adolescents with Special Health Care Needs chapter.)

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