From Vincent Iannelli, M.D.,
Your Guide to Pediatrics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

Having a best friend, playing with other kids on the playground, and going to birthday parties and sleepovers are some of the things that are routine for most kids. In fact, the American Academy of Pediatrics states that "making friends is one of the most important missions of middle childhood -- a social skill that will endure throughout their lives."

Unfortunately, some children struggle with all of these things and have trouble making and keeping friends. That is not to say that your child needs to be a "social butterfly" and be well-liked by every kid at school. In fact, a shy or quiet child may just have one or two good friends and be very happy.

But it can be a problem if your child doesn't have any friends or is never invited over to play with other children -- especially if he seems anxious about this.

Young Kids Making Friends

When do kids begin to make friends?

Even toddlers seem to play together and have friends, but group play doesn't usually evolve until age three. Until then, most infants and younger toddlers simply play by themselves next to each other, in parallel play.

Once they begin playing together regularly as preschoolers, kids are more likely to make regular friends. Keep in mind that who your younger child considers to be a "friend" will likely change very often. Even younger school-age children, until they are 10 to 12 years old, may have a new best friend every few months.

Does Your Child Have Friends?

Unfortunately, it can often be hard to know if a child has any friends.

Does your school-age child ever get invited to sleepovers, birthday parties, or have other kids over to the house? If not, then he may not have a best friend or any friends at all.

If you aren't sure if your child has friends, you might talk to your child's teachers to see how he interacts with other kids at school. Is he always alone in the classroom, at lunch, or during recess?

You can simply ask your child about his friends and if he has a best friend to get a better idea of how well he is making friends, too.

Helping Kids Make Friends

If your child doesn't have friends, it may simply be that he has not had enough opportunities to make them. Getting your child involved in plenty of activities with children of his same age and with similar interests can be a great way to find friends for your child.

Some good examples of places where your child may make friends include:

• youth sports and classes, including team sports (soccer, baseball, etc.) and individual sports (tennis, martial arts, etc.)
• noncompetitive activities, including music and art lessons, a chess club, etc.
• story time at your library or bookstore
• other kids' clubs, including boy scouts and girl scouts
• the park or playground

Bring an ice-breaker, such as a toy, pet, or snacks, to help draw other kids to your child when you go to the park or to other activities if your child is not very outgoing.

Kids Who Have Trouble Making Friends

If your child continues to struggle with making friends, consider inviting a child over for a play date and then closely observing what happens. Is your child too bossy, clingy, aggressive, touchy, or simply too shy to build a friendship with the child? Does he do something that annoys the other kids? If so, see if you can talk to your child and help him do better next time. Role playing a play date, in which you pretend you are a friend who has come over to play with your child, can be a helpful way to teach your child more appropriate ways to act around other children.

Kids who continue to have problems making friends could have a medical condition affecting their social relationships. These medical conditions can include ADHD, autism, Asperger syndrome (a form of autism), anxiety, and selective mutism (in which children don't talk to people outside their immediate family). In fact, not being able to make and keep friends can be an important clue that your child needs help from a medical professional.

In addition to ADHD and the other medical conditions listed above, having trouble with friendships can also be a side effect or sign of depression, a learning disability, stress, or bullying.

What You Need To Know

• Your pediatrician, a child psychologist, or a counselor can be good resources for help when your child continues to have problems making friends. Discussing friendships is also a good topic for your child's yearly well-child checkups with your pediatrician.
  
  
• Be realistic about your expectations for your child and his friendships. If your child is shy and quiet, then he may be very happy with just one or two good friends and may not want or need a whole group of friends.
  
  
• In general, kids usually have friends that are about the same age as they are. However, some prefer to be around older or younger children. For example, children with the hyperactive type of ADHD often end up making friends with much younger kids, since kids their own age don't like playing with them. And gifted children often have problems making friends too, preferring to be around adults instead of kids that are their own age. Keep in mind that these preferences can actually be a sign that your child is having problems making friends.
  
  
• Don't push shy children to make friends or into social situations to make friends if it causes too much anxiety or if they aren't ready.
  
  

_Sources:

Caring for Your School-Age Child: Ages 5 to 12 (Copyright (c) 2003 American Academy of Pediatrics)