5 is a Magic Number?

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Patient Presentation
A 5-year-old male came to clinic for his health supervision visit. His mother had no concerns and he had just started kindergarten. Both agreed that he had transitioned well to the new school setting.

The pertinent physical exam showed a smiling boy with normal vital signs and growth parameters were 75-90%. His examination was normal and the diagnosis of a healthy male was made. His mother said that she had been concerned because he didn’t seem quite as coordinated as his older brother at the same age and he had a summer birthday and was younger than some of the other children. “He really likes it and his teacher says he is kind to the other children and is making friends,” his mother remarked. “Anjun is my new friend. We have lunch and play together,” he interjected. “We like to play with the balls.”

Discussion
5 year olds (5YOs) are growing their independence.
5YOs often are going off to school, and while they may have experience with childcare or preschool settings, it is a time when many people believe they are “launched” into the world with some independence (and of course adult oversight).

5YOs can:

  • Gross motor
    • Skips, hops, jumps with agility
    • Has good balance and improving coordination
    • Sings, dances and acts
    • Can do simple chores
    • Can perform most activities of daily living but may still need help intermittently (e.g. toileting, eating) or some supervision (e.g. teeth brushing)
  • Fine motor
    • Copy a triangle
    • Can use simple tools and writing utensils, i.e. use a knife for soft foods
  • Language
    • Tells a story
    • Say 5 word sentences with all language being understood
    • Understands and uses all parts of speech
    • Understands rhymes (cat-bat)
    • Tells simple jokes
  • Cognitive/Social
    • Knows address, phone number
    • Names most colors, letters
    • Can count to 10 and has improving math skills
    • Says “sorry” and takes more responsibility for actions
    • More accepting of other’s point of view but may not understand it
    • Has an identified group of friends, especially of the same gender
    • Asks lots of questions and understands “why” and “how”
    • Outgrowing childhood fears
    • Less aggressive physically and uses language instead more
    • Can pay attention for 5-10 minutes

Learning Point
This is the second in a short case series of key developmental milestones in younger childhood and how understanding these “magic numbers” can help a clinician understand when a child may be exhibiting atypical development around these ages.

For 3 year olds, a review can be found here
For 7 year olds, a review can be found here

5YO is a magic number. For many families it is a time when 5YOs start to do more independent activities outside the family such as going to school, being involved in community recreation activities, participate in religious instruction, etc. It is a time when families and society seem to have deemed their child is ready to enter the outside world. This is even an important time for public and health policy and research, as 5YO is used as a reference for important health and educational statistics such as death rates and life expectancy. It is often used as a cut-off time frame for different age groups as well in research studies (i.e. 0-4 years, 5-12 years, etc.).

For many families there is lots of activity surrounding the first day of school. Children need to be enrolled, transportation and meals arranged, and supplies identified and obtained. Needed immunizations and other health care should be obtained too. Sometimes there are ‘rituals’ to be a part of such as a school welcoming event, or a special family meal to celebrate the occasion. Parents are often concerned if their child is “ready for school.” There is lots of research about children and school readiness and a review can be found here.

Adults will often recall their “first day of school” stories. These stories can serve as a good basis for parents and other adults to remember what a 5YO can do and how this may be typical or atypical development.

Questions for Further Discussion
1. What do you remember about your first day of school? What developmental skills could you do?
2. What general tips do you offer for going off to school?
3. Why do you like or dislike 5 year olds?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Child Development

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Your Checkup Checklist: 5 Years Old. HealthyChildren.org. Accessed October 2, 2023. https://healthychildren.org/English/ages-stages/Your-Childs-Checkups/Pages/your-checkup-checklist-5-years-old.aspx

Developmental milestones record – 5 years: MedlinePlus Medical Encyclopedia. Accessed October 2, 2023. https://medlineplus.gov/ency/article/002016.htm

Williams PG, Lerner MA, Council on Early Childhood, et al. School Readiness. Pediatrics. 2019;144(2):e20191766. doi:10.1542/peds.2019-1766

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University

Published