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Your 3 to 4 Year Old Preschooler

Diet:

·        Choose the best foods for your child. Offer 3 regular meals and a healthy snack. It is your child’s job to decide how much to eat and even if to eat at all. Eat meals as a family and make mealtime happy.

·        Growth in preschoolers is sporadic and their appetites follow.  Expect appetite slumps and food jags (preference for the same foods at every meal). Do not force your child to eat. Offer healthy choices limiting fatty foods, sweets and juice intake.

·        During an appetite slump, do not play short order cook and prepare another meal in hopes your child will eat it.  If you can, wait until the next scheduled meal to feed him again.

·        Your child should drink 16-24 oz. of 2% milk each day.  Too much milk can lead to picky eating and iron deficiency.

·        Multivitamins may be used if you feel your child’s diet is consistently inadequate.

·        Do not give your child nuts, popcorn, or hard candies. No fruit snacks- these are very difficult to remove from your child’s teeth.

Sleep:

·        A regular bedtime routine is very important to children.  The average 3-year-old child sleeps 12 hours per day, including 1 nap. By age 4, some children stop napping, but sleep about 12 hours at night.

·        If your child refuses to nap, it is still important to have a quiet period of rest at a scheduled time each day.

·        Nighttime fears and resistance to stay in bed are common problems.  Refer to the AAP  book “Guide to Your Child’s Sleep” for suggestions.

Elimination:

·        By age 3;  90% bowel-trained, 85% dry during the day, 60% stay dry at night. By age 4;  95% bowel-trained, 90% dry during the day, 75% stay dry at night.

·        Constipation or stools that are hard can interfere with potty training. Call us!

Development: (3-5 years):

·        Most 3-year-olds can jump, walk up and down stairs, pedal a tricycle, kick a ball, copy a circle, put on some clothing, use 2-3 sentences that are 75% understandable, ask “what’s that?” and “why?”, say some numbers, ABC’s, colors and shapes, play pretend games with more elaborate story schemes

·        Most 4-year-olds can hop and balance on 1 foot, draw a square and person with 3-6 body parts, use full sentences with 6 or more words, have a large vocabulary, use scissors, play games and take turns, dress without help, zip and trying to button. The 4 year old is a delightful conversationalist, able to tell an involved story and relate a new experience. Make believe in the form of imaginative play holds great fascination for the 4 year old.

·        Books are wonderful learning tools at this age. Begin to select books that he/she may be able to begin to recognize some words. The Bob Books series is great for this purpose and for early reading skills. Let him tell part of the story looking at the pictures. Ask questions about the story. Look for ways to practice word recognition wherever you go- grocery store item labels, STOP signs, etc.

Safety:

·        Children under 8 years must be secured in a carseat or booster seat. Always read the manufacturer’s instructions for use.  Note the weight limits, and use an appropriate size for your child. They should always ride in the back seat. A five point harness is always safest for your 3-4 year old child. www.seatcheck.org

·        With new found speed and agility come new safety concerns for your child. Falls are common. Install 2^nd floor window gates. Make sure blind cords are out of reach.

·        If you must keep guns in your house, store them unloaded and locked with ammunition locked and stored separately from the gun.

·        Supervise all play near streets and driveways.

·        Do not expect younger siblings to watch your child.

·        Teach children to be careful around pets, especially when a pet is eating.

·        Use PABA-free sunscreen with SPF >15.

·        This is the earliest age to begin organized swimming lessons.  Knowing “how to swim” does not ensure the child’s safety near water at this age.

·        Use a bicycle helmet whenever your child is on a bike/scooter. Shoes with skates attached (“Heelys”) are not safe without a helmet either.

·        Start discussing stranger safety, privacy, name, address, and phone number. Come up with a song or jingle with your phone and address! Role play about the dangers of strangers.

·        Bubble baths are not recommended- they can be associated with urinary tract infections especially in girls.

Children’s Acetaminophen Dose:

Every 4-6 hours & no more than 4 doses/day

24-35 lb. = 1 tsp.

36-47 lb. = 1 ½ tsp.

Children’s Ibuprofen Dose:

Every 6-8 hours

24-35 lb. = 1 tsp.

36-47 lb. = 1 ½ tsp.

It is not recommended to alternate acetaminophen and ibuprofen.

Other Things to Keep in Mind:

·        Dental Care - Schedule dental visits every 6 months, use a small soft toothbrush and a dab of fluoridated toothpaste to clean your child’s teeth at least twice a day. By age 3, a child has all 20 primary teeth.

·        Have your child’s vision tested. Hearing can be checked at our office if you have concerns.

·        Limit the amount of TV and monitor the types of shows your child watches. Interactive TV is always best if at all. Limit all screen time to 1-2 hours.

·        Spend time with your child everyday - read books, do crafts, pretend play to encourage the active imagination, show love and affection.

·        Answer questions about body parts and babies in a simple honest way.  Use correct terms for body parts. Your child is very curious at this age.

·        Encourage your child’s independence; many activities still require supervision even though he wants to do it “all by himself”.

·        Be consistent. Praise good behavior.  Avoid too many rules. Do not yell or spank.  Be a good role model. A 4 year old will respond well to praise and clearly stated CONSISTENT rules more than a 3 year old will.

·        Handle anger constructively in your family by settling disputes with respectful discussion, exercise and time alone to cool down.

·        Do not allow hitting or biting- stop it immediately and explain how it makes other people feel. Help your child apologize. Praise her when she demonstrates sensitivity to the feelings of others.

·        Use time-outs for disruptive tantrums or unacceptable behavior.  A minute per year of age is a good guideline.

·        A 3-4 year old can be frustrating and challenging at times. Trying to understand new things and why things work is interesting but this may mean… “how many times can I take my sister’s toys before she gets mad”…or “how many times can I touch this forbidden thing before my parents get mad.”

·        If your child is not already involved, now is the time to find a preschool or play group to develop social skills.

At Today’s and the Next Check-up:

·        Your child will have a physical examination. Your questions and concerns will be answered. If your child is already 4 years, immunizations for school may be started. (DTaP, IPV, MMR, Varicella boosters)

·        A Hepatitis A Vaccination Series of 2 may be started if not done already.

·        A routine urinalysis will be done.

·        You will be given a developmental questionnaire to complete at home and mail back to our office.

Additional Reading: AAP Birth to Age 5;Raising Your Spirited Child:A Guide for Parents Whose Child Is More Intense, Sensitive, Perceptive, Persistent,and Energetic  Mary Kurcinka;

How to Say No to Your Toddler: Creating a Safe, Rational, and Effective Discipline Program for Your 9-Month to 3-Year Old
William G. Wilkoff;

Setting Limits With Your Strong-Willed Child: Eliminating Conflict By Establishing Clear, Firm, And Respectful Boundaries
Robert J. Mackenzie, Robert J. MacKenzie;

Parenting the Strong-Willed Child, Revised and Updated Edition: The Clinically Proven Five-Week Program for Parents of Two- to Six-Year-Olds Rex Forehand, Nicholas Long, Nicholas James Long