Growth Milestones – THREE YEARS

“Goodbye Babyhood, Hello Childhood”

While rearing a child at any age is no snap, things should get easier during the third year. Most 3-year-olds can be reasoned with. They will take turns and may even share toys. A child in this age group will help the parents get him or her dressed. Most are toilet trained during the day, although it is common for an occasional “accident” while busy playing. In previous generations, moms and dads learned what to expect of their child from their mother, grandmother or another family member. Today, most families are so scattered that parents do not have this help available. Therefore, do not hesitante to ask any questions you might have about your child’s growth and development during the three year checkup. This is the reason for regular well-child exams.

Parenting and Behavioral
  • The 3-year-old will ask more questions than a district attorney. Nothing is sacred and some questions will throw you for a loop!
  • Continue reading books to your child.
  • Arrange times for safe running and exploring outdoors.
  • Playmates are important. Allow your child to experience interaction with peers. Three-year-olds are usually quite social and enjoy being with other 3-year-olds. This can be accomplished in a preschool, play group or just having another child over for a few hours.
  • It is normal for children this age to have imaginary friends. Parents can sometimes use the youngster’s imaginary “playmate” to their advantage (like getting your 3-year-old to do something you want them to do.)
  • Limit television viewing. Do not use the TV as a baby sitter or as a substitute for interaction with your child. Watch children’s programs with your child when possible.
  • Do not worry if the child becomes curious about body parts. This is normal at this age. Always use the correct terms for genitals.
  • Children this age begin to recognize gender differences and will correctly say “I am a girl” or “I am a boy.”
  • Discipline should be firm and consistent, but loving and understanding. Praise your child for his or her good behavior and accomplishments.
  • Three-year-olds like to do things for themselves.
  • The 3-year-old does not understand “tongue-in-cheek” comments and can not always tell when a parent is joking. For example, never threaten to leave a child at the store when he or she misbehaves.
  • Your child may continue to use a security object (such as a blanket, favorite stuffed toy, etc.). This is normal and the youngster will give up the item when he or she is ready.
  • Keep family outings short and simple. Children have a short attention span at this age and lengthy activities will cause them to become irritable and tired.
  • The question of preschool usually comes up now. Daycare has already been established for a family when both parents work outside the home. Even for moms who stay at home with their child, preschool a few mornings a week can be helpful. It gives mom a welcome break and provides the child an opportunity to meet new friends. The success or failure of preschool will depend upon the child’s maturity and the quality of the preschool. For example, if your child seems anxious and dependent away from home, perhaps he or she is not ready for preschool.
  • If you are expecting another baby, discuss with your child’s physician how to prepare your 3-year-old.
  • Encourage your 3-year-old to make choices whenever possible, but the choices should be limited to those you can live with (“red shirt or green shirt.”) Never ask a toddler an open question (“Do you want to take a bath”) unless you are willing to accept the answer.
  • Use the two “I’s” of discipline (ignore or isolate) rather than the two “S’s” (shouting or spanking). When disciplining, try to separate the child and his or her behavior (“I love you, but I do not like it when you touch the VCR.”).
  • Provide alternatives. “No, you cannot play with the telephone, but you can play with these blocks.”
  • Avoid power struggles. No one wins! The 3-year-old still uses temper tantrums as a weapon. Respond to this behavior with the two I’s of discipline – ignore or isolate (time out!).
  • Discipline should be consistent. Do not make threats that you can not carry out. If you say you are going to do something, do it!
  • Can name pictures in a book.
  • Names at least one color.
  • Knows his or her own name, age and sex.
  • Begins to use pronouns.
  • Able to put on his or her own shirt, but will need help with shoes and buttons.
  • May be able to ride a tricycle.
  • Can jump in place and stand briefly on one foot.
  • Can (unfortunately!) open doors.
  • More than 50 percent of the child’s speech is intelligible. There may be temporary episodes of stuttering during this time.
  • Understands such words as “cold,” “tired,” “hungry.” Comprehends the meaning of “on or under”, and “bigger or smaller.”
Oral Health
  • Supervise brushing twice a day with a small amount of fluoridated toothpaste.
  • Take your 3-year-old to the dentist, if you have not already done so.
  • Limit juice and sweets.
  • Continue giving a fluoride supplement if your drinking water is not fluoridated. Some dentists recommend fluoride be continued through age 8; others recommend continuing through age 12 or 16. Check with your pediatrician and dentist.
  • Stop pacifier use
  • Appetite is perhaps a shade better than it was a few months ago, but it is still not what most parents (or grandparents) think it should be. “My child will not eat,” is a familiar complaint heard at the three year checkup. Remember, feeding problems may arise if parents make their child eat more than the child needs to, or shows too much concern in what the youngster eats.
  • The 3-year-old should pretty much be able to feed himself or herself.
  • During meal time, the 3-year-old is sometimes very demanding of parent’s attention and may also dawdle!
  • Avoid nuts, hard candy, uncut grapes, hot dogs or raw vegetables. Control sweets and avoid junk food.
  • Eat dinner together as a family whenever possible.
  • Begin to teach proper table manners and encourage conversation during family meals.
  • Turn the TV off during meals.
  • Make sure your child’s caregiver is following your feeding instructions.
  • An afternoon nap is usually still needed by the 3-year-old.
  • Fears of the dark, thunder, lightning, etc. are quite common at this age.
  • Maintain a consistent bedtime and bedtime routine. Using a night light, security blanket or toy are all ways to help lessen nighttime fears.
  • Read to your child when possible before “lights out.”
  • Nightmares can wake a child up from sleep. The nightmares can be triggered by changes or stress. Reassure your child and put him or her back to bed.
Toilet Training
  • Many 3-year-olds are trained during the day but still do not stay dry at night. Others are completely trained. Remember, the age a child uses the bathroom by himself or herself varies and it is based only on a child’s readiness to be trained and the positive attitude of the parents.
  • Avoid putting too many demands on the child or shaming him about wearing diapers. Instead, let your child no how proud and happy you are about any potty successes.
  • Some children may postpone having a bowel movement as a way to manipulate their parents or because they are busy doing something else. Try not to make an issue of this.
  • Responsibility for accident prevention will gradually shift to your child as he or she grows older. It is still necessary for parents to keep dangerous and poisonous items out of their 3-year-old’s reach and protect him or her from other indoor and outdoor hazards.
  • Insist that your home and car be smoke free.
  • Begin to teach your child his or her full name, address and phone number
  • If bicycling, teach safety rules and insist on helmet use.
  • Continue to use proper car safety restraints in the back seat of every car trip. A 3- 4 year old child (once 40 lbs. or over) is safest using a belt-positioning booster seat. The greatest risk to your child’s health continues to be motor vehicle accidents. Remember, it is impossible for you to protect your child during an accident by just holding him or her.
  • Always walk behind your car before backing out of the driveway.
  • If your home uses gas appliances, install and maintain carbon monoxide detectors.
  • The purchase of a trampoline is not recommended because of the risk of serious injury.
  • Keep firearms out of the home or in a locked, out of sight container, unloaded
  • Pools must be gated. Knowing how to “swim” does not make a child water- safe at this age. Never leave a child unattended in a bathtub, even for a few seconds. Ensure your child wears a life vest if boating.
  • Be careful of items that can be left a counter level elsewhere, such as knives, scissors, cleaning agents, nail polish remover, household repair items, weed killers, insecticides, gasoline, oil, kerosene, lighter fluid and all medicines. Always keep potentially poisonous things in the original containers. Never put poisons in food containers or bottles.
  • There is no such thing as a “child proof cap.” Ingestion of toxic substances is common at this age. Keep syrup of Ipecac in the home to be used only as directed by your child’s doctor or the poison control center.
  • Never buy toys or other objects that can cut or ingested. Suffocation by plastic bags and balloons still occurs at this age.
  • Always supervise when your child is playing near a street. Remember, a 3-year- old child does not understand danger or remembers “no”; your child cannot be counted on to be aware of outside hazards.
  • Be especially careful when using power lawn mowers and other power tools.
  • Never leave a child unattended in a car or a house.
  • Test smoke detectors to ensure they are working properly.
  • Continue to use a water proof sunscreen on your child before going outside. Avoid the hours between 10 a.m. and 3 p.m. when the sun is the most dangerous.
  • Advise your 3-year-old to be careful around strange dogs, especially ones that are eating.
  • Begin to teach your child not to talk to strangers.
  • Your 3-year-old may continue to experience respiratory infections, such as colds, ear infections and sinus infections. These frequent ailments often become frustrating for parents. Unfortunately, most illnesses are unavoidable, especially if your child is in preschool or has older siblings who bring the colds home from school.
  • When your child is ill, the pediatrician will determine whether antibiotics are needed. Remember, most illnesses at this age are viral, which means antibiotics will not shorten the course of the illness
  • Normally, no immunizations are given at this checkup unless your child is behind in the immunization schedule.
  • Hepatitis A (HepA) may be administered at this visit for children living in selected states.
  • Annual flu vaccines may be recommended for children with chronic illnesses like asthma and heart defects. Check with your doctor.
  • Some physicians at 3years do a hemoglobin or hematocrit determination to check for anemia (“low blood”). This requires a small poke on the finger to obtain a drop of blood. A urinalysis will also be done if the child is toilet trained to check for kidney and bladder problems.
  • By this age, most children have received the following immunizations:
  • By this age, most children have received the following immunizations
  1. 3 doses of Hepatitis B vaccine
  2. 4 doses of DTaP vaccine
  3. 4 doses of HIB vaccine
  4. 1 dose of the MMR vaccine
  5. 1 dose of the Chickenpox vaccine
  6. 4 doses of the Pneumococcal vaccine
  7. 3 doses of the Inactivated Polio Vaccine
  8. 3 doses of the rotavirus vaccine
Immunizations Since immunization schedules vary from doctor to doctor, and new vaccines may have been introduced,it is always best to seek the advice of your child’s health care provider concerning your child’s vaccine schedule.   The information presented in Growth Milestones was obtained with the help of our pediatric experts and with material from The American Academy of Pediatrics’ Guidelines for Health Supervision and Bright Futures’ Guidelines for Health Supervision of Infants, Children, and Adolescents. Bright Futures is supported by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services.. Updated 05-08-07