Well Child Care, 3-Year-Old

PHYSICAL DEVELOPMENT

At 3, the child can jump, kick a ball, pedal a tricycle, and alternate feet while going up stairs. The child can unbutton and undress, but may need help dressing. They can wash and dry hands. They are able to copy a circle. They can put toys away with help and do simple chores. The child can brush teeth, but the parents are still responsible for brushing the teeth at this age.

EMOTIONAL DEVELOPMENT

Crying and hitting at times are common, as are quick changes in mood. Three year olds may have fear of the unfamiliar. They may want to talk about dreams. They generally separate easily from parents.

SOCIAL DEVELOPMENT

The child often imitates parents and is very interested in family activities. They seek approval from adults and constantly test their limits. They share toys occasionally and learn to take turns. The 3 year old may prefer to play alone and may have imaginary friends. They understand gender differences.

MENTAL DEVELOPMENT

The child at 3 has a better sense of self, knows about 1,000 words and begins to use pronouns like you, me, and he. Speech should be understandable by strangers about 75% of the time. The 3 year old usually wants to read their favorite stories over and over and loves learning rhymes and short songs. They will know some colors but have a brief attention span.

IMMUNIZATIONS

Although not always routine, the caregiver may give some immunizations at this visit if some "catch-up" is needed. Annual influenza or "flu" vaccination is recommended during flu season.

NUTRITION

  • Continue reduced fat milk, either 2%, 1%, or skim (non-fat), at about 16-24 ounces per day.

  • Provide a balanced diet, with healthy meals and snacks. Encourage vegetables and fruits.

  • Limit juice to 4-6 ounces per day of a vitamin C containing juice and encourage the child to drink water.

  • Avoid nuts, hard candies, and chewing gum.

  • Encourage children to feed themselves with utensils.

  • Brush teeth after meals and before bedtime, using a pea-sized amount of fluoride containing toothpaste.

  • Schedule a dental appointment for your child.

  • Continue fluoride supplement as directed by your caregiver.

DEVELOPMENT

  • Encourage reading and playing with simple puzzles.

  • Children at this age are often interested in playing in water and with sand.

  • Speech is developing through direct interaction and conversation. Encourage your child to discuss his or her feelings and daily activities and to tell stories.

ELIMINATION

The majority of 3 year olds are toilet trained during the day. Only a little over half will remain dry during the night. If your child is having wet accidents while sleeping, no treatment is necessary.

SLEEP

  • Your child may no longer take naps and may become irritable when they do get tired. Do something quiet and restful right before bedtime to help your child settle down after a long day of activity. Most children do best when bedtime is consistent. Encourage the child to sleep in their own bed.

  • Nighttime fears are common and the parent may need to reassure the child.

PARENTING TIPS

  • Spend some one-on-one time with each child.

  • Curiosity about the differences between boys and girls, as well as where babies come from, is common and should be answered honestly on the child's level. Try to use the appropriate terms such as "penis" and "vagina".

  • Encourage social activities outside the home in play groups or outings.

  • Allow the child to make choices and try to minimize telling the child "no" to everything.

  • Discipline should be fair and consistent. Time-outs are effective at this age.

  • Discuss plans for new babies with your child and make sure the child still receives plenty of individual attention after a new baby joins the family.

  • Limit television time to one hour per day! Television limits the child's opportunities to engage in conversation, social interaction, and imagination. Supervise all television viewing. Recognize that children may not differentiate between fantasy and reality.

SAFETY

  • Make sure that your home is a safe environment for your child. Keep your home water heater set at 120° F (49° C).

  • Provide a tobacco-free and drug-free environment for your child.

  • Always put a helmet on your child when they are riding a bicycle or tricycle.

  • Avoid purchasing motorized vehicles for your children.

  • Use gates at the top of stairs to help prevent falls. Enclose pools with fences with self-latching safety gates.

  • Continue to use a car seat until your child reaches 40 lbs/ 18.14kgs and a booster seat after that, or as required by the state that you live in.

  • Equip your home with smoke detectors and replace batteries regularly!

  • Keep medications and poisons capped and out of reach.

  • If firearms are kept in the home, both guns and ammunition should be locked separately.

  • Be careful with hot liquids and sharp or heavy objects in the kitchen.

  • Make sure all poisons and cleaning products are out of reach of children.

  • Street and water safety should be discussed with your children. Use close adult supervision at all times when a child is playing near a street or body of water.

  • Discuss not going with strangers and encourage the child to tell you if someone touches them in an inappropriate way or place.

  • Warn your child about walking up to unfamiliar dogs, especially when dogs are eating.

  • Make sure that your child is wearing sunscreen which protects against UV-A and UV-B and is at least sun protection factor of 15 (SPF-15) or higher when out in the sun to minimize early sun burning. This can lead to more serious skin trouble later in life.

  • Know the number for poison control in your area and keep it by the phone.

WHAT'S NEXT?

Your next visit should be when your child is 4 years old.

This is a common time for parents to consider having additional children. Your child should be made aware of any plans concerning a new brother or sister. Special attention and care should be given to the 3 year old child around the time of the new baby's arrival with special time devoted just to the child. Visitors should also be encouraged to focus some attention on the 3 year old when visiting the new baby. Prior to bringing home a new baby, time should be spent defining what the 3 year old's space is and what the newborn's space will be.