A 7-year-old female came to clinic for her health supervision visit. The mother had no concerns but noted that the school had started her working with a speech therapist once a week. “They noticed that she still seemed to talk wrong with some sounds like L’s and S’s. They did that late last year and she seems to be improving over time. The speech teacher is happy with her progress too,” the mother said.
The pertinent physical exam showed a smiling girl with normal vital signs and growth in the 50-90%. Her speech was intelligible and appropriate but certain sounds were noticeable as indistinct. Her physical examination was normal.
The diagnosis of a healthy female with an articulation problem was noted. “Sometimes I talk wrong but I like seeing Mrs. Michaels. She helps me and we play fun games. Sometimes Matthew makes fun of me and how I talk, but I just walk away,” the girl explained.
Discussion
7 year olds (7YOs) should have gained refinement in earlier tasks and skills and are starting to develop higher level skills. As the range of skill mastery is broad during this early school age time, parents and adults often become concerned around 7YO if their child does not seem to have gained certain skills and “matured” like the other kids.
7YOs can:
- Gross motor
- Rides a 2-wheel bike well
- Can perform most activities of daily living almost independently but may need occasional help with difficult clothing, etc.
- Most, but not all, are toilet trained at night
- Fine motor
- Able to write including name, may start more cursive or more difficult writing as well
- Can use tools better such as safety scissors well
- Can copy complex shapes i.e. diamond
- Language
- Has full language ability
- Pronounces words correctly without articulation problems
- Can understand and follow 3 step commands
- Can read age-appropriate books
- Can have some problems with spelling
- Cognitive/Social
- Becoming more independent
- Thinking about the future and their place in the world
- Likes to copy adults
- Can and likes to play alone, but likes friends as well particularly of same gender
- Becoming more aware and modest about their body
- Developing empathy for others
- Younger fears are abating, but still scared of the unknown
- Understands basic concepts of numbers and can repeat 3 numbers backwards
- Can tell time
- Can cooperate and share but also can be jealous
Learning Point
This is the third in a short case series of key developmental milestones in younger childhood and how understating 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 5 year olds, a review can be here
7 is a magic number as, in general, if it is a skill that one would expect most children to have in the early school age years, then if they do not have that skill by around 7YO then more evaluation and intervention should be considered. Children do come to school with a very broad range of skills and experiences but by 7YO most children should have “gotten school stuff” such as reading, writing, and basic social skills.
Common problems that parents and teachers become concerned about around 7YO include:
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Language
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Usually true language problems have already been identified before age 7YO, but parents are worried because the child still makes articulation errors. These can be normal before age 7, but after should be referred to a speech therapist.
Reading/Spelling
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Reading has a very broad range of when children gain these skills, but most children will have the basics of reading by 7YO.
Before age 7 it is said that children are learning to read, but after age 7 they are reading to learn, so those who may be behind in some reading skills may need evaluation and/or intervention.
Note that spelling also has a very wide range of skill development but in general, basic writing should be understandable. Phonetic spelling for more difficult words or grammar mistakes are still very common.
More formal evaluation by an educational specialist can be considered.
Writing
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Fine motor problems may be most evident with writing with poorly formed letters/numbers that may not be comprehensible. But issues with dressing, eating etc. may also be noticed if there are fine motor problems.
Evaluation by an occupational therapist can be considered.
Attention/Cognition/Executive Functioning
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Children who are more active and/or inattentive generally are given much leeway to “mature.” By 7YO though they are usually expected to be able to follow norms for a situation such as not being disruptive in a quiet classroom for a reasonable amount of time.
Children do need breaks and the ability to move their bodies frequently and should be allowed to do so. This is also the time when teachers and parents often become more concerned about possible attention deficit/hyperactivity disorder or other cognitive or executive functioning issues.
Children who are more behaviorally aggressive or disruptive both physically and/or verbally may also need further evaluation for behavior problems or mental illness and/or help to directly learn appropriate social cues in the school or other settings.
Evaluation by a general pediatrician or family medicine physician, developmental specialist, psychologist, social worker or therapist may be appropriate.
Toileting
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Children are usually toilet trained during the day but many still have nocturnal enuresis at 7YO. However many parents want the “diaper stage” to be over with. Nocturnal enuresis is highly genetic and children usually gain this skill at the same age as the parents.
Bedwetting alarms can be used by children starting around 7YO and are effective in helping improve enuresis. Constipation is also very common in this age group and contributes to enuresis, so it should be treated also as appropriate.
Evaluation by a general pediatrician or family medicine physician who can assist with behavioral interventions and alarms is usually the first step. Evaluation by a urologist may also be appropriate in many circumstances.
Questions for Further Discussion
1. What other common concerns do you see in 7YOs?
2. How is special education accessed in your local area?
3. How do you evaluate and treat nocturnal enuresis?
Related Cases
- Disease: Seven Year Old Development | Child Development
- Symptom/Presentation: Developmental Delay | Health Maintenance and Disease Prevention
- Specialty: Developmental Disabilities | General Pediatrics
- Age: School Ager
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.
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.
Information prescriptions for patients can be found at MedlinePlus for this topic: Child Development
Milestones for 7-Year-Olds | Kaiser Permanente. Accessed October 2, 2023. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.milestones-for-7-year-olds.ue5719
Centers for Disease Control. Child Development: Middle Childhood (6-8 years old) | CDC. Centers for Disease Control and Prevention. Published February 4, 2021. Accessed October 2, 2023. https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.html
The Growing Child: School-Age (6 to 12 Years). Stanford Medicine Children’s Health. Accessed October 2, 2023. https://www.stanfordchildrens.org/en/topic/default?id=the-growing-child-school-age-6-to-12-years-90-P02278
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa
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