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Early and Middle Childhood

Early and Middle Childhood


Document and track population-based measures of health and well-being for early and middle childhood populations over time in the United States.


There is increasing recognition in policy, research, and clinical practice communities that early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong health, learning, and well-being. Early childhood, middle childhood, and adolescence represent the 3 stages of child development. Each stage is organized around the primary tasks of development for that period.

  • Early childhood (usually defined as birth to year 8) is a time of tremendous physical, cognitive, socio-emotional, and language development.1
  • Middle childhood (usually defined as ages 6 to 12) is a time when children develop foundational skills for building healthy social relationships and learn roles that will prepare them for adolescence and adulthood.1

Healthy People 2010 addressed the earliest stages of childhood through goals for Maternal, Infant, and Child Health, but the early and middle childhood stages of development were not highlighted in this initiative. To address this gap, the Early and Middle Childhood topic area was included in Healthy People 2020.

Why Is Early and Middle Childhood Important?

Evidence shows that experiences in early and middle childhood are extremely important for a child’s healthy development and lifelong learning. How a child develops during this time affects future cognitive, social, emotional, language, and physical development, which in turn influences school readiness and later success in life.2,3,4 Research on a number of adult health and medical conditions points to pre-disease pathways that have their beginnings in early and middle childhood.3,5

During early childhood, the human brain grows to 90 percent of its adult size by age 3.6,7 Early childhood represents the period when young children reach developmental milestones that include:

  • Emotional regulation and attachment
  • Language development
  • Cognitive development
  • Motor skills

All of these milestones can be significantly delayed when young children experience inadequate caregiving, environmental stressors, and other negative risk factors. These stressors and factors can affect the brain and may seriously compromise a child’s physical, social-emotional, and cognitive growth and development.8,9,10

More than any other developmental periods, early and middle childhood sets the stage for:

  • School success 11
  • Health literacy
  • Self-discipline
  • The ability to make good decisions about risky situations
  • Eating habits
  • Conflict negotiation and healthy relationships with family and friends12

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Understanding Early and Middle Childhood

Although in early and middle childhood, children are typically healthy, it is during this time that children are at risk for conditions such as:

  • Developmental and behavioral disorders
  • Child maltreatment
  • Asthma and other chronic conditions
  • Obesity
  • Dental caries
  • Unintentional injuries

While typically nonfatal, these conditions affect children, their education, their relationships with others, and the health and well-being of the adolescents and adults they will become.

Emerging Issues in Early and Middle Childhood

The keys to understanding early and middle childhood health are recognizing the important roles these periods play in adult health and well-being and focusing on conditions and illnesses that can seriously limit children’s abilities to learn, grow, play, and become healthy adults.

Prevention efforts in early and middle childhood can have lasting benefits.13,14 Emerging issues in early and middle childhood include implementing and evaluating multidisciplinary public health interventions that address social determinants of health by:

  • Fostering knowledgeable and nurturing families, parents, and caregivers
  • Creating supportive and safe environments in home, schools, and communities
  • Increasing access to high-quality health care

A stronger and more robust surveillance system is needed to provide the data to understand and plan for the health and well-being of children.


1Education Encyclopedia. Stages of growth in child development. Available from:

2Halfon N. Life course health development: A new approach for addressing upstream determinants of health and spending. Washington: Expert Voices, National Institute for Health Care Management Foundation: 2009. Available from: [PDF - 91 KB]

3Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA 2009; 301(21), 2252-2259.

4Liew, J. Effortful control, executive functions, and education: Bringing self‐regulatory and social‐emotional competencies to the table. Child development perspectives. 2012;6(2), 105-111.

5Schore AN. Affect regulation and the origin of the self: The neurobiology of emotional development. Florence KY: Psychology Press; 1999. 

6Purves D. Neural activity and the growth of the brain. New York: Cambridge University Press; 1994.

7Brown TT, Jernigan TL. Brain development during the preschool years. Neuropsychol Rev. 2012;22(4), 313–333. doi:10.1007/s11065-012-9214-1

8Shonkoff JP, Phillips DA(Eds.). From neurons to neighborhood: The science of early childhood development. 2002. Washington, DC: National Academy Press.

9Luby J, Belden A, Botteron K, et al. The effects of poverty on childhood brain development: the mediating effect of caregiving and stressful life events. JAMA Pediatr. 2013;167(12), 1135-1142.

10Duncan GJ, Ziol‐Guest KM, Kalil A. Early‐childhood poverty and adult attainment, behavior, and health. Child Dev. 2010;81(1):306-325.

11Duncan G, Dowsett C, Claessensa A. et al. School readiness and later achievement. Dev Psychol. 2007; 43(6):1428 –1446.

12Eccles JS. The development of children ages 6 to 14. Future Child. 1999 Fall;9(2):30-44.

13National Research Council and Institute of Medicine. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities.  Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors, 2009. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

14Shonkoff J. Building a New biodevelopmental framework to guide the future of early childhood policy. Child Dev. 2010;81(1):357-367.

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