Final answer:
The question does not specify which clinical manifestations to consider, but growth spurts, hormonal changes, and the development of secondary sexual characteristics are normal age-related changes in older children.
Step-by-step explanation:
The nurse recognizes which clinical manifestation is a normal age-related variant in an older child. In an older child, some age-related changes can be normal as part of the development process and aging. It is common for school-aged children and adolescents to experience growth spurts, hormonal changes, and the development of secondary sexual characteristics as part of puberty. However, the question as presented does not provide a list of manifestations to determine what may be considered normal. Health assessments need to consider the wide variations of normal development among different children.