Introduction

Middle Childhood: The middle childhood years are a unique developmental time when children undergo critical physical, cognitive, and social changes. During this time, children enter school, and their social context broadens beyond their families. This is the age of critical development falling between infancy and adolescence.

Middle childhood is a period of continued neurophysiologic changes, particularly synaptogenesis and myelination in the prefrontal cortex (PFC), the brain center responsible for a range of execution of functioning including attention control, working memory, reasoning, behavioral self-regulation and monitoring, inhibition, information processing, and goal-setting.

Socially, this period is characterized by new and defining social structures that involve increasing levels of independence, development and maintenance of peer relationships, increased self-regulation needs, intellectual challenges, and pubertal changes, all of which have implications for health and functioning, and employ some degree of executive functioning.

There is no exact consensus regarding an age range defining middle childhood. Middle childhood has also been differentiated from adolescence cross-culturally, largely by the onset of puberty (Collins, 1984). Middle childhood has been delimited differently by many scholars, as ages 6 to 10 (Eccles, 1999), and ages 6 to 12 (Collins, 1984).

Due to early start of formal schooling nowadays in India and sometimes early onset of puberty (between age 10–12) the middle childhood period may vary. The study propose to undertake 6 - 11 year old children, as most children start primary schooling at about 6 years of age and enter middle or junior high school around 11 years of age, which many also use to mark the beginning of adolescence.

Health and development research has largely focused on early childhood (i.e., 0–5 years old) and adolescence (12–17 years old). Very little is known about health and functioning during middle childhood. This has been due to critical development occurring in the first five years of life and high morbidity and mortality accompanying risky behavior in adolescence. But there are substantial health issues in middle childhood which need increased focus.

By traditional definitions of health, the middle childhood population is often considered healthier than any other age group (Collins, 1984). However, by a broader definition — one that includes health problems that have behavioral and social origins (Guyer, et.al., 2000) — there are a significant number of health problems affecting this age group related to mental health, health risk behaviors, and child victimization. In addition, some unhealthy behaviors of adolescence (e.g., poor nutritional habits, smoking) may have antecedents in middle childhood and some behaviors actually begin in middle childhood. These behaviors are linked to many diseases (e.g., hypertension, cancer and diabetes) that are unlikely to emerge clinically until adolescence and adulthood. Thus, the middle childhood years present an opportunity for early intervention to encourage healthy behaviors and prevent disease among adolescents and adults.

The health and wellbeing of the middle childhood population is part of a continuum that depends on what happens during infancy and early childhood and influences the behaviors and outcomes of adolescents and adults. Promoting the health of the middle childhood population, through research and policy development, would complement progress made in the areas of early childhood and adolescence, leading to a comprehensive approach for ensuring healthy development throughout childhood.

Monitoring of growth and development during middle childhood is important for improving overall health. Further, culturally based interventions are known to have better success rate in improving access and utilization of health services.