Alt text on BCH Logo

Family guide to middle childhood

Your companion for ages 5 - 12

Middle childhood is a time of growth, exploration, and discovery.  Children’s personalities blossom, and they develop hobbies and friendships.

It can also be a fraught time when a child has a CHD.  Parents often wonder how to help their child do well at school and with friends.

This guide will accompany through the challenges and opportunities of these special years.  When you know what you need, you can feel confident that you are making the best decisions for your child and your family.

Starting with the basics

What to do right now

Do you want to support your child, but aren’t sure where to start? Don’t worry: we’re here to help. We’ve highlighted the most important things you can do right now to support your child's healthy development. 

domains of child development

Understanding domains of development

As children grow up, they develop in multiple skill area at the same time. We call these skill areas “domains of development.”   

Some children develop pretty evenly across domains. Other children develop quickly in some domains, and more slowly in others.   

When you think about your child’s development, you may find it helpful to think about how they are doing in each domain.  Then, you can use this knowledge to build on their strengths, and support their weaknesses.

Think includes understanding, recognizing patterns, solving problems, learning. It is also called “cognitive development.”

Move includes using arms and legs, using hands, balance, coordination, strength. It is also called “motor development.”  

Talk includes speaking or signing, listening, understanding, communicating.  It is also called “language development.” 

Connect includes understanding other people, social skills, relationships.  It is also called “social development.” 

Feel includes self-regulation, understanding emotions, managing feelings.  It is also called “emotional development.”  

Exploring your child’s development

Cognition is how a child learns, thinks, solves problems, and understands. During middle childhood, children typically develop new ways of thinking, and develop a increasingly complex understanding of the world. 

School-age children (ages 5-12) often learn and remember a lot of information about topics that interest them. They discover new ways to solve problems, and can solve problems using multiple steps.  They can think about multiple aspects of an object at the same time, and they like inventing and playing games with rules.   

Children at this age are usually still pretty concrete in their thinking.  This means they have trouble thinking about ideas that they cannot see or touch.  They are often fairly rigid, and have trouble imagining how things could be done in a different way. 

Typical cognitive skills in middle childhood

During middle childhood (ages 5-12), children usually learn to: 

  • Put things in order 

  • Sort objects in multiple ways 

  • Learn and follow rules 

  • Tell the difference between what is real and what is pretend 

  • Learn and organize a lot of facts  

  • Make a plan and follow it 

  • Understand basic math 

  • Solve problems using logic 

  • Answer questions about what they do and think 

  • Explain why something makes sense 

  • Understand that people have different ideas and beliefs 

  • Make up games and teach them to others 

  • Play pretend with other people 

  • Pay attention for longer periods of time 

Cognitive challenges, delays, and differences

As children with CHDs enter their school years, their worlds expand.  They learn many new skills, and discover new ideas. 

Even as they grow and learn, sometimes children with CHDs gain cognitive skills later than other children, or differently from other children. 

Children may have a hard time gaining cognitive skills if they: 

  • Are often sick or in pain 

  • Spend a lot of time in the hospital 

  • Do not have a wide range of experiences 

  • Cannot go to school regularly 

  • Do not have an appropriate education program  

  • Have a brain injury 

  • Have an intellectual disability (ID) 

  • Have a genetic syndrome that affects brain development  

Sometimes, school-age children with CHDs develop cognitive skills later than children, or differently from other cognitive.   

With intervention, many children with CHDs can catch up with their peers. Other children do not catch up, but intervention can help them to learn skills, meet goals, and feel successful.    

When a child (ages 5-12) has a cognitive difference or delay, they might:  

  • Act like a younger child 

  • Have trouble understanding how ideas are connected 

  • Have difficulty recognizing patterns 

  • Not understand why things happen 

  • Easily forget what they learn 

  • Not use logic to solve problems 

  • Struggle to respond to questions 

  • Not connect what they know to new situations 

  • Confuse fantasy and reality 

  • Need extra time to think or respond 

If you notice that your child is struggling in any of these ways, tell their doctor and teacher. Remember: every child can learn, and help is always available.   

Significant Differences in Thinking and Learning

If your child thinks, understands, and solves problems very differently from other children, they might receive a diagnosis from a doctor or psychologist.  The diagnosis describes what your child is experiencing, and can help them to be matched with appropriate services.

When you understand the diagnosis, you can feel more confident helping your child.  Keep reading to understand diagnoses that might be given to a school-age child.


How you can support thinking and learning

The brains of school-age children (ages 5-12) are still growing, and they are learning new ways to think and understand.  As a parent, you can provide them with experiences and activities that support new types of learning.  

Here are some ideas to get you started. 


Services to support thinking and learning

Do you have a school-age child who has trouble with thinking and understanding? If so, then your child probably qualifies for free services through your public-school district.  

By the time kids reach school-age, public schools are often the best resource for free and comprehensive interventions.   

Keep reading to learn some of the ways your school district may be able to help your family. 

The Power Of Intervention

Interventions for development

Children' brains are still developing, and are astonishingly "plastic," meaning they can change, grow, and heal. Developmental interventions can literally build and rewire a child's brain.

Early, appropriate intervention can help children to learn new skills and concepts, and meet developmental milestones.

Explore the selected interventions below, explore our resources, or visit our Power of Intervention page. Help is always available.

Heart Stories

Aidan: a heart story

How evaluation can guide intervention

When Aidan was a young child, he was often frustrated and dysregulated. His parents struggled to understand the cause of his behavior, and they were unsure how to help him.

Before he entered middle school, Aidan had a comprehensive neurodevelopmental evaluation. Through this evaluation, Aidan and his family finally understood the nature of his difficulties. They were able to set up interventions that met his needs, and Aidan started thriving both at school and at home.

© 2025 All rights reserved