3 Year Old Well Child Check

Three year olds are friendly, talkative and are exuberant about life's experiences!

This is the year your child will show definite signs of coordination, both in large and small movements. By the end of the year, you should be able to watch him run and stop "on a dime," balance on the edge of the curb, hop up and down, and hang from the monkey bars. He'll learn to pedal a tricycle this year, play ball, walk backwards, and climb the stairs by himself. He should be able to control fine movement, too, like picking up and stringing large wooden beads. He'll draw with crayons, and pile blocks in a tower ten high! Don't be disappointed if your child doesn't accomplish everything in his third year. No two children develop at the same rate, and they all have their own timetable.

Behavior

Thinking

This year your three-year-old begins to use thought processes he will rely on for the rest of his life. He will develop size perception, and be able to sort shapes by size and color. He will know the difference between circles, triangles, squares, and rectangles, and be able to match pictures in card games. His memory is getting better, and although he can remember what he did yesterday, he is still just beginning to understand the concept of time - yesterday, today, and tomorrow. He can concentrate for up to twenty minutes on a favorite story, and is beginning to think problems through in his mind. Now he can probably count up to ten, but really only knows "how much" two and three are. Now, just as the thought processes are beginning to develop, your three-year-old gets really interested in TV.

Feelings

Because your child is growing so quickly and making so many changes, he may go through a period of being afraid of everything. In To Listen To a Child, Dr. Brazelton recommends that you help your child express himself and understand his negative feelings for later periods of turbulent change. Because three is a time of rapid change, many children use security blankets and thumb sucking to help them cope with pressure. That's normal, too, and it's better to accept it than to take your child's "crutches" away.

Sadness is another emotion a child can experience at three, when he loses a pet or a friend, or missing grandparent after a visit. Rather than trying to talk your child out of it or cheer him up, just say that you see he's sad. And if it persists, see your pediatrician. At three, children may have bad dreams (fear again), and are interested in the differences between boys and girls. Sibling rivalry may appear too, and is primarily for the benefit of the parents. Don't be surprised if three and a half is the opposite end of three. Rather than conforming, he may rebel… and can be very hard to handle. But in fact when he's worst, he needs the most help from you.

Talking

Threes are talkers, and they just love language. By the end of the year, your child will know about a thousand words and how to use them. Get ready for lots of questions - she can ask as many as 400 a day! Researchers have called children of this age "linguistic geniuses," and it's no wonder. By about three and a half, children are learning the rules of grammar, and using prepositions, helping verbs, and using words for abstract ideas and feelings. As she learns grammar, your child will make up words like "swimmed" that fit her silly rhymes, and although she may know words for opposites like "more" or "less", the meanings are hazy and she mixes them up in her speech. There are two other stages in language that your child may go through this year: stuttering and "toilet" talk. Stuttering is normal, common, and should go away within a few months. Swearing and aggressive threatening language are a passing phase too, as long as you don't overreact. The best way to handle this stage is to tell your child calmly that you don't like those words, and give her a new word to use as a substitute.

Playing

Because this is the year of make-believe, your child will probably spend a lot of time in creative play. Playing house or store, dressing up, and role-playing with dolls are big favorites with three-year-olds, whether they're boys or girls. They like to build with Lincoln logs, big blocks, and Tinkertoys. And make things with clay, finger paints, fat crayons and brushes. To encourage creativity, hang a roll of butcher paper low on the wall, and let your child unroll it as he goes. Because your child can sort and group, stacking and nesting toys are good at this age. It's more important that your child has a few good toys or household things that he can be creative with than a lot of limited toys. And, of course, sharp, breakable toys and toys or games with little pieces should be avoided. Besides, your three-year-old will like mud piles and bubblestuff better. Because three is such a gregarious age, it's a good time to introduce your child to time away from home. Outings can help a child learn to relate to others, play with other children, and realize that she is an individual.

Shyness

Because three-year-olds are more social and self-confident, if you feel your child is consistently afraid and unsure in social situations, she may have a problem with shyness. Although each child is born with a unique temperament, certain parental patterns can create shyness. For example, if you expect too much too soon, are negative, or make decisions for your child, you may be undermining her independence. Be sure to let your child feed, wash, and dress herself, and realize that she won't be good at it until she gets a lot of practice. And the same thing is true of social situations - the more practice she gets, the better she'll be. Encourage socializing, and support her rather than criticize her in front of other people.

Friendship

At three, your child is beginning to learn about friendship, and by the end of the year he may have his own special friends. He is just beginning to learn to take turns, cooperate and share, and can genuinely enjoy other children. If your child doesn't make any real friends this year, don't be alarmed if an imaginary friend becomes part of the family. For the first part of the year at least, Mom is still his favorite person. They will love to be with you most of all. The time your child spends with his grandparents can be rewarding to everyone, because the constraints and responsibility that come with parenting aren't there. Grandparents can give your child a sense of continuity with the past, and help him establish values and learn traditional ways.

Development

Movement
  • Climbs well and runs easily
  • Walks up and down stairs, alternating feet
  • Pedals tricycle
Hand And Finger Skills
  • Holds pencil and makes vertical, horizontal and circular strokes
  • Turns book pages one at a time
  • Build tower of more than 6 blocks
Language
  • Recognizes and identifies almost all common objects and pictures
  • Uses four and five word sentences
  • Strangers can understand most of her words
  • Has 300 words and about 75% of their speech is understandable
Cognitive
  • Makes mechanical toys work
  • Plays make believe with toys and people
  • Sorts objects by shape and color
Social
  • Imitates adults and peers
  • Can take turns in games
  • Shows affection for family and peers
Emotional
  • Expresses a wide range of emotions
  • Separates from parents by age three
  • Objects to changes in routine
Indicators For Concern
  • Poor balance, falls frequently or unable to climb stairs
  • Inability to build a tower of four blocks and cannot handle small objects
  • Unclear speech or unable to communicate in short phrases
  • Inability to copy a circle by age three
  • Little or no interest in other children
  • No pretend play
  • Cannot follow simple instructions

Growth & Nutrition

The average three year old grows about 2 to 3 inches and gains about 3-6 pounds over the third year.

Food problems, common in the second year of life, may be stabilizing in the third year. It's important to feed your child a well balanced diet, and to know how much of each food group she needs at this stage. It's also important to limit the things she doesn't need - sugary foods, junk foods, and chemically treated foods. Some experts believe they can cause overstimulation.

It's also important not to overfeed at this stage, for the total number of fat cells are determined now. Try not to use food as a bribe, a reward, or a punishment. And if the table becomes a testing ground, set a thirty-minute meal limit, or feed the child before your own dinner.

Some helpful guidelines include:

  • Serve your three year old 3 nutritious meals per day. Put her at table height using a booster seat. She should be able to feed herself and use a cup with occasional assistance.
  • Provide 2-3 nutritious snacks per day. Limit sweets and high fat snacks. Add 2 ok meals is a success and parents control what is offered but kids control what they put in their mouth.
  • Your child needs around 500 mg of calcium a day. One cup of whole milk has around 300 mg of calcium. However if your child doesn't drink much milk then cheese and yogurt are rich in calcium. Please review our calcium link to make sure your child is receiving enough calcium
  • Your three year old may be a "picky eater". Offer a variety of foods and continue to offer refused foods on occasion. Don't try to force your child to eat and don't be overly concerned about the sporadic eating habits. This will improve over time and children usually grow at a healthy rate.

Common Issues & Concerns

"The Terrible Two's"

The twos are the breakaway years, and in our culture this stage starts somewhere in the first year and lasts about a year and a half. In other cultures, where conformity is emphasized, this period is shorter. But here, where so many complex demands are placed on a child, this turbulent time is necessary to help the child develop qualities that will encourage individuality.

So at two we find the toddler becoming less dependent on the mother, and literally trying to stand alone. It's the time for them to see everything and do everything independently. When things don't go as expected, they become frustrated and many times angry. Then it's often tantrum time: throwing food on the floor, holding their breath, or refusing to budge. Books written about this period call it the "Declaration of Independence" and it is. But because the child does not now what is safe or appropriate behavior, it's a constant struggle for the parents. And the two-year-old does not have a built-in conscience to tell what's right or wrong - that won't happen until four or five.

Discipline

Discipline is very important at this age, because children can't set their own limits. Without discipline, children can get anxious, provocative, demanding and "spoiled." Three is an age of testing, and often negative behavior is a normal way of seeing how far your child can go.

Watch your child for difficult times of the day - late in the day buildups or during exciting, overstimulating times - and ask him to let you know when he's getting tired. You will need to be firm, and explain to the child what he did wrong. That's the way you help your toddler learn to set limits and learn self-discipline.

A child this age can push too far. Stop the cycle before someone gets hurt. Pick up the toddler and rock him, or if that doesn't work, send him to his room.

Raising a child is a real responsibility and three can be a frustrating age. It's even harder if you're far from your own family, a single parent, or are facing other potential stressful situations. Reading helps, but sometimes you need other people. When it starts to get to you, it's a good idea to use the support system around you. A walk will help; talking with friends and meeting other mothers in play groups also help. You can always call your doctor, a day-care center, or community social services. You are not alone, but you do have to make the first move before you find yourself taking frustrations out on your child.

Safety

Most playground accidents consist of minor cuts, abrasions and bumps, but there is always the chance of something more. Watch out for sharp metal edges and well-anchored equipment, and make sure the sandbox and slide are in the shade. Be sure the sand is clean and clear of objects.

Teach your child never to go swimming without your permission. Home pools should have a child proof fence. Never leave water in a pool or bathtub, and always watch your child while she is in the water. It's never too early to start swimming lessons.

Use sunscreen of at least SPF 30 before your child goes outside. Be careful during the hottest times of the day (11 am to 2 pm). Re-apply sunscreen frequently when swimming. Also protect their lips and scalps from sunburn. Sunglasses are also recommended.

Start having your child wear a safety helmet when riding a tricycle or in a seat on an adult bicycle.

Be very careful with medications. Because your child is small, with a low body weight, she can not tolerate most medicines at full dose. Please clear any medications with your doctor and make sure you are clear about when and what amount should be given.

The most common cause of nonfatal accidents in the home is poison. Aspirin, caustics, lead, and hydrocarbons are the most common serious poisons. Many items you use everyday can be poisonous to a child in large doses - even your vitamins. It's important to take preventative measures and keep cleaning and medical supplies out of reach of small climbers. Painting and work supplies in the workroom or garage should be on high shelves. Always have Poison Control's phone number handy.

For further information on safety, you may also visit Healthychildren.org.

Toilet Training

It is best to begin potty training when your child is ready. Readiness to potty train usually occurs between ages 2 and 4 and involves three aspects:

  • Physical Readiness: involves maturity of the sphincter muscles which give child ability to control "peeing" and pooping"
  • Communication Readiness: child must be able to indicate the urgency to you: even saying "peepee" or pointing to her diaper is sufficient.
  • Emotional Readiness: child must show interest or desire to use the potty.
Sleep

Most two-year-olds will sleep 12-14 hours per day and typically take just one nap a day. Around this time it is best to move them from their crib to a bed

Car Seat

Your child should remain in a forward-facing safety seat, properly installed in the back seat. When she weighs 40 lbs and is 40" tall, she may be moved to a booster seat using the vehicle lap and shoulder belt -always in the back seat.

Dental Care

Routine dental visits should begin at three years. Teach your child to brush her teeth after meals and at bedtime-assistance will still be necessary. A pea-sized dab of fluoridated toothpaste can be used.

Remember you are not alone!

Raising a small child is a real responsibility and two can be a frustrating age. It's even harder if you're far from your own family, a single parent, or facing other potentially stressful situations. Reading helps, but sometimes you need other people. When it starts to get to you, it's a good idea to use the support system around you. A walk will help; talking with friends and meeting other mothers in play groups also help. You can always call your doctor, a day-care center, or community social services. You are not alone, but you do have to make the first move before you find yourself taking frustrations out on your child.

Next Well Child Visit

The next routine physical examination is at four years of life.