The slow gains in body growth that took place during the preschool years continue in middle childhood. Bones of the body lengthen and broaden, and primary teeth are replaced with permanent teeth. Although many school-age children are at their healthiest, health problems do occur. While they can learn a wide range of health information, school-age children do not find it relevant enough to impact their daily behavior. Improvements in gross motor skills occur as a result of gains in flexibility, balance, agility, force, and reaction time, and fine motor coordination increases. Rule-oriented games become common, and physical education helps ensure that all children have access to regular exercise and play.

Thought becomes more logical, flexible, and organized during Piaget’s concrete operational stage, but children cannot yet think abstractly. Research findings raise questions about whether mastery of Piagetian tasks emerges spontaneously, about his assumption of an abrupt, stagewise transition to logical thought, and about the impact of specific cultural and school practices.

During middle childhood, attention becomes more adaptable and planful, and memory strategies improve. Metacognition moves from a passive to an active view of the mind. Still, school-age children have difficulty regulating their progress toward goals. Reading and mathematics instruction that combine conceptual understanding with basic skills training may be most effective.

Intelligence tests for children measure overall IQ and several separate intellectual factors. Sternberg’s triarchic theory extends our understanding of the determinants of intelligence, and both genetic and environmental factors contribute to individual differences in IQ. The IQ scores of low-SES minority children often underestimate their true abilities. Gardner's theory of multiple intelligences provides yet another view of how information-processing skills underlie intelligent behavior.

Although less dramatic, language development continues during the school years. Vocabulary increases rapidly, and pragmatic skills are refined. Bilingual children are advanced in cognitive and language development, although controversy has arisen over the best way to approach bilingual education.

Class size, teacher’s educational philosophy and interaction with pupils, and grouping practices have an important impact on learning. Teaching children with learning disabilities or special intellectual strengths introduces unique challenges. American pupils have not fared well in international comparisons of academic achievement. Efforts are underway to improve American education.