Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Dr. Shaoleen Daly is an internist and pediatrician, and she's here to discuss developmental signposts for kids six to eight years old. Dr. Daly, welcome to the podcast.

Shaoleen Daly, MD: Thank you so much for having me today. I'm very excited to talk about our topic today.

Host: Me too. So many questions. Let's start with this. What are some of the most common physical and behavioral changes parents can expect to see in kids six to eight years old?

Shaoleen Daly, MD: Yes. So in regards to physical development, at this age, they're a lot more agile, a lot more coordinated. They can run and zigzags, jump down the steps, do cartwheels, catch small balls with more ease. Strength and endurance is also improving, which is why they end up engaging in a lot more complex sports, such as soccer and basketball, climbing. Their coordination begins to improve as well. And so, they can start riding two-wheel bicycles.

And the other fun part is that now they're also starting to get some baby teeth that are now going to turn into adult teeth. So, you'll start noticing the baby teeth are falling off. So, this time is a lot of various differences. But behaviorally, now they're starting to become more self-aware. They're attempting to gain more independence. Their parental influence is no longer as much of a factor, and now it's more of their peer-to-peer relationship and their friendships. So, those are just some of the few physical and behavioral changes, I would say, at this age.

Host: Yeah. And you were mentioning sort of the emotional side too, the independence and sort of exploring further away from parents. How can parents tell the difference between normal emotional ups and downs versus something that might need more attention, like anxiety or ADHD?

Shaoleen Daly, MD: Yes. So, I always say the rule of thumb is if this, whether it's anxiety or ADHD, it's become excessive. It's persisting for weeks to months. It's causing significant distress. It's impairing their functioning at home school or with their peers. They're not wanting to go to school. They're avoiding things that they used to previously like doing such as going to the park, playing with friends, or they're constantly complaining about stomachaches or headaches without any medical cause. So when we are starting to see more of these symptoms, which is when we start worrying that there's an underlying anxiety involved, or they're unable to complete tasks in multiple different realms of their life, school, home, then we get concerned about ADHD. But ADHD is a whole topic in itself where there's so many other underlying factors that actually could manifest as ADHD. But overall, I say, if it's a short term and it's just transient, then there's nothing to worry about. And they're still doing well in every realm of their life. But if they're very much becoming socially withdrawn, not wanting to engage in their previous activities, then I say that's worrisome.

Host: Another thing that can change our food habits and there's more picky eating or really strong food preferences or comments at this age. When should a parent worry that this is affecting a child's nutrition or even their growth?

Shaoleen Daly, MD: Yes. And I say for kids who have developmental disorders such as autism or any developmental delay, I really try to emphasize that we ensure that they are getting a full balance, but sometimes they're so picky. So, we really want to make sure they're getting additional resources for those, whether it's with the nutritionist, whether they're getting insurer or some sort of additional nutrition.

But for our more healthy kids, I say one solid meal that has at least proteins, fruits, veggies, is all we need. One solid meal is all right. And then, trying to always offer everything on the table and what you're eating. I always say whatever the parents is eating is what the kids are eating. So parents, if you're not eating veggies, your kids aren't going to eat veggies. So, always making sure that we're offering everything we can and just hoping. And we always check their weight at every well-child check. So as long as they're gaining weight beautifully, that's great. And they're not only having cake at every meal, then that's good.

Host: Yeah, which can affect your digestion, which can affect bathroom habits, which is also a common thing for parents to be concerned about at this age. What is normal when it comes to things like bedwetting or constipation in early elementary school?

Shaoleen Daly, MD: Yeah. So, typically, bedwetting, by six years old, they should no longer be having bedwetting behaviors, but often they're very intertwined. So, many of our kids who have some constipation issues where they're having pain when going to the bathroom or they're having pellet-like stools or they're straining and screaming going to the bathroom, that's concerning for constipation. And that in turn can often sometimes cause some incontinence. So if there is incontinence past six years old, then I do get a little worried and I do evaluate for constipation. But often, bedwetting at night up until five to six years old is normal. But after six to eight especially, that's when we need to start looking at other underlying causes.

Host: We've talked about how school is now more demanding and there's more challenges and there's more investigating and independence. So, all this is happening. What should parents watch for with school related challenges like focus, relationships with peers or academic pressure?

Shaoleen Daly, MD: Yeah. So, school-related pressures at this age, as I had mentioned earlier, they are becoming a little bit more driven and becoming more goal-oriented. So, I say that when school-related challenges are occurring is when, if they're having difficulties with focus, attendance such as easily being distracted, unable to complete tasks, losing materials or losing their home or their backpack, their pencils. That's one thing to be definitely concerned about. And we should evaluate for attention deficits. And then, if they're having peer relationships such as they're having social withdrawal, conflicts with their friends, constantly, having low self-esteem, not wanting to do schoolwork, or being rejected by their peers, or not wanting to attend school because of bullying and other poor peer-to-peer relationships, that's where we also, I would say, we need to intervene and to further investigate. And then, other things that I would say is it should be distressing and it should be consistent as opposed to just transient here and there.

Host: Another really important factor really for adults as well as children is sleep, but kids definitely need their chunks of sleep. How much sleep do six to eight-year-olds really need? And what if bedtime becomes a point of contention or even a nightly struggle?

Shaoleen Daly, MD: Yes. I think this is the biggest issue that I'm seeing with my six to, eight-year-olds especially now with so much screen time. So, six to eight-year-olds should be getting about nine to 12 hours of sleep per night. And they should be going to bed at an early bedtime, around like 8:00 to 9:00 PM at latest. And so, I say, this sleep is so important because it decreases your risk of obesity, high blood pressure, depression, diabetes and academic difficulties.

And some of the barriers I'm seeing with children having poor sleep is that they're having bedtime resistance, they want to stay up later, they're having some insomnia at night. Sometimes some kids are drinking caffeine early at this age. They have a irregular bedtime routines where during the week that they go to bed early, but then on the weekends they're allowed to sleep later. So, that becomes infrequent as a schedule.

And then, another one is they have their screens in their room. They have their tablets and other electronics in the room, which become a barrier. And I say like how fitting that I advise for my parents is always creating a consistent bedtime routine. I say the four Bs: bathe, brush your teeth, read a book and bedtime that's very important to get rid of technology at least an hour or two hours before bedtime, so it's not consuming in their head. And sometimes the kids want to go to sleep late, and so I say, then you need to do a reward system such as a bedtime pass. "You are allowed five passes a year to stay up and past a certain point, and that is it." So, sleep has been quite a challenge, I feel, especially in this age as they're also testing their limits and testing their parental control.

Host: And then, like a lot of us, kids don't always think they're tired, but if they relax and lay down, gosh, they really are.

Shaoleen Daly, MD: Yes, yes.

Host: Are there any health screenings or doctor visits that are especially important during these early school years?

Shaoleen Daly, MD: Yes. So, we really evaluate, during this time, we look at the weight, that's how we make sure. Weight, BMI, blood pressure screenings, we're doing at this age, just to ensure that they're getting their appropriate nutrition. We talk about screen time. I do see how much screen time they're having, how much sleep they're having. So, a lot of our just general questionnaires really gives us a good gauge on how they're doing.

Other things I do try to screen for is any types of depression, if there's any issues. Oh, another thing, it's a little bit more for the nine to 11-year-old is where I check for cholesterol levels. But sometimes, if there's significant family history or concern for weight, I will check it earlier.

Host: I like the way our discussion has really addressed the whole child, the physical side, the emotional side, screen time, which is such a big factor, you know, those outside factors, school and health screenings and doctor visits. As we wrap up, I would love to know how this topic became a passion of yours. What drew you to focus on Pediatrics and Internal Medicine?

Shaoleen Daly, MD: Yeah. So for me, it's always been about connection across the lifespan. I was drawn to Med-Peds because I love seeing the full story from a child's early development to the behaviors and habits that shape their adulthood, the six to 8-year-old stage is very fascinating. They're gaining independence, but still deeply influenced by family, environment, friends, community, and just understanding those intertwining dynamics helps me support kids in that moment, but also guide families, how we can build foundations for both healthy lifestyles for them as children, as we're trying to create good habits and also good habits for the adults who I also often see, I see their parents as patients. So, this blend of curiosity impact is what keeps me passionate about my work.

Host: Well, Dr. Daly, thank you so much for all this great information. I think you probably put some minds at ease and alerted others by sharing your expertise.

Shaoleen Daly, MD: Awesome. Well, thank you so much for having me. I really enjoyed being on this podcast.

Host: And it was great having you. For more information or to find a physician, visit novanthealth.org/services/pediatrics. And for more health and wellness information from our experts, visit healthyheadlines.org. Meaningful Medicine is a Novant Health Podcast.