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. Three-year-olds 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 his or her favorite stories over and over and loves learning rhymes and short songs. The child will know some colors but have a brief attention span.

RECOMMENDED IMMUNIZATIONS

  • Hepatitis B vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past.)

  • Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Doses only obtained, if needed, to catch up on missed doses in the past.)

  • Haemophilus influenzae type b (Hib) vaccine. (Children who have certain high-risk conditions or have missed doses of Hib vaccine in the past should obtain the vaccine.)

  • Pneumococcal conjugate (PCV13) vaccine. (Children who have certain conditions, missed doses in the past, or obtained the 7-valent pneumococcal vaccine should obtain the vaccine as recommended.)

  • Pneumococcal polysaccharide (PPSV23) vaccine. (Children who have certain high-risk conditions should obtain the vaccine as recommended.)

  • Inactivated poliovirus vaccine. (Doses obtained, if needed, to catch up on missed doses in the past.)

  • Influenza vaccine. (Starting at age 6 months, all children should obtain influenza vaccine every year. Infants and children between the ages of 6 months and 8 years who are receiving influenza vaccine for the first time should receive a second dose at least 4 weeks after the first dose. Thereafter, only a single annual dose is recommended.)

  • Measles, mumps, and rubella (MMR) vaccine. (Doses should be obtained, if needed, to catch up on missed doses in the past. A second dose of a 2-dose series should be obtained at age 4–6 years. The second dose may be obtained before 4 years of age if that second dose is obtained at least 4 weeks after the first dose.)

  • Varicella vaccine. (Doses obtained, if needed, to catch up on missed doses in the past. A second dose of a 2-dose series should be obtained at age 4–6 years. If the second dose is obtained before 4 years of age, it is recommended that the second dose be obtained at least 3 months after the first dose.)

  • Hepatitis A virus vaccine. (Children who obtained 1 dose before age 24 months should obtain a second dose 6–18 months after the first dose. A child who has not obtained the vaccine before 2 years of age should obtain the vaccine if he or she is at risk for infection or if hepatitis A protection is desired.)

  • Meningococcal conjugate vaccine. (Children who have certain high-risk conditions, are present during an outbreak, or are traveling to a country with a high rate of meningitis should obtain the vaccine.)

NUTRITION

  • Continue reduced fat milk, either 2%, 1%, or skim (non-fat), at about 16–24 ounces (500–750 mL) each day.

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

  • Limit juice to 4–6 ounces (120–180 mL) each day of a vitamin C containing juice and encourage your child to drink water.

  • Avoid nuts, hard candies, and chewing gum.

  • Your child should feed himself or herself with utensils.

  • Your child's teeth should be brushed after meals and before bedtime, using a pea-sized amount of fluoride-containing toothpaste.

  • Schedule a dental appointment for your child.

  • Give fluoride supplements as directed by your child's health care provider.

  • Allow fluoride varnish applications to your child's teeth as directed by your child's health care provider.

DEVELOPMENT

  • Read to your child and allow him or her to play with simple puzzles.

  • Children at this age are often interested in playing with water and 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 bed-wetting accidents while sleeping, no treatment is necessary.

SLEEP

  • Your child may no longer take naps and may become irritable when he or she does 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 your child to sleep in his or her own bed.

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

PARENTING TIPS

  • Spend some one-on-one time with your 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 your child to make choices and try to minimize telling your child "no" to everything.

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

  • Limit television time to one hour each day. Television limits a child's opportunity 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 he or she is riding a bicycle or tricycle.

  • Avoid purchasing motorized vehicles for your child.

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

  • All children 2 years or older should ride in a forward-facing safety seat with a harness. Forward-facing safety seats should be placed in the rear seat. At a minimum, a child will need a forward-facing safety seat until the age of 4 years.

  • 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 child. Use close adult supervision at all times when your child is playing near a street or body of water.

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

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

  • Children should be protected from sun exposure. You can protect them by dressing them in clothing, hats, and other coverings. Avoid taking your child outdoors during peak sun hours. Sunburns can lead to more serious skin trouble later in life. Make sure that your child always wears sunscreen which protects against UVA and UVB when out in the sun to minimize early sunburning.

  • 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.