The Preschool Years – Ages 3-4

As you have probably already experienced, the preschool years are a fun, exhausting and unpredictable.  Generally, preschoolers love to explore, gain independence and learn more about the people and things around them in their own way. The parent’s job is to guide them through this tremendous time by providing stability, choices when appropriate, lots of positive reinforcement and consistency in discipline when necessary.

You will notice that we will be starting to go over BMI at their annual visits in addition to their growth charts. BMI is a measure of weight adjusted for height and helps us  asses whether your child’s weight is in a healthy range for their height. The list below helps to understand the percentiles and will help guide discussion during your child’s visit:

  • < 5th percentile = underweight
  • 5th percentile – 84th percentile = healthy weight
  • > 95th percentile = obese
  • > 99th percentile = morbidly obese

It is often uncomfortable to think of a child’s weight as unhealthy because “they are just kids” but unfortunately, there are very real long term consequences to unhealthy weight in childhood. According to Strong 4 life, 1 million children in Georgia are overweight or obese.  These children are at a higher risk for developing adult diseases like type 2 diabetes, sleep apnea, joint pains,  high blood pressure, liver problems and high cholesterol levels.

This is the perfect age to help form healthy habits that will last into adulthood. Here are some great ideas to set the path towards long term health.

The link below gives some great basic guidelines preschoolers:

The link below contains information about healthy eating at home and on the go:

This link provides some great information on the importance of everyday physical activity:

One of the biggest “jobs” of a toddler is to master toilet training. There are some basics that will make this transition more positive:

  • Toilet training has to be their idea – toddlers are at a place in development where there ego far outweighs other realms of their subconscious – they are not selfish – they just do not have the ability to fully understand why they are not able to control everything; therefore, any parental force to master toilet training will usually lead to power struggles and delayed training
  • Most children are ready to train between 15 months to 2 years. Some signs that they are ready include understanding of what the potty is and what “pee” and “poop” are, understanding the urge to have a bowel movement (jumping up and down, pulling at pants) or urinate (running around) and having the ability to briefly postpone the urine or stool
  • start by getting a potty, having “practice runs” and rewarding any attempts to go on the potty – they all progress at their own speed and rate and they will have periods of time when they will regress but most will be trained by 3
  • Do not use punishment, pressure or force – you will always lose.

Temper tantrums are an immature way of expressing anger – a 2 – 3 year old cannot usually reason out why they are angry (i.e. why they are not supposed to be screaming in the middle of the mall) or how they should have handled it so a lengthy “discussion” is usually not productive.

  • Temper tantrums often arise from frustration from the inability to communicate, inability to complete a task they are trying hard to achieve or because they are tired or hungry. Empathy goes a long way in these cases – often saying “I understand you are angry (sad, mad, frustrated) but it is not ok to scream (hit …); how can I help you?” Praise their tenacity if they are trying to build with blocks that keep falling down – they feel validated in their feelings and hopefully, will start to realize that they need a better way to express it. Be careful though, do not allow the ends to justify the means – there is a fine line between being frustrated and using negative behaviors to get your way – time-outs or physical removal from situations may have to occur when the tantrums are disruptive or physical in nature.
  • Teach your child how to be engaged – by 3 years of age, most children can entertain themselves for 1/2 the time they are with you – encourage them to use their imagination and creativity and you will often be amazed at the results
  • Be supportive and loving but do not rescue your child from normal life challenges – this will teach coping skills and self confidence that they are able to figure out “they have some of the answers too”

Language development is facilitated through plenty of opportunities to talk. Language maturation will go from speaking 2-3 word sentences and about 200 words at age 2 to fully intelligible complex sentences by 4 years of age. Some children start to assign sound to letters and begin reading by age 4. The best way to ensure strong language development is to spend as much time as possible communicating with your child – talk, sing, discuss everyday activities in simple sentences – this helps your child learn to communicate through language. Reading books is one of the most enjoyable ways to help your child’s language skills – pointing out pictures and acting out pages of a book helps create an interactive time that is invaluable to children’s language development. Please let us know if your child is not gesturing by 12 months of age, imitating sounds by 18 months of age or only imitates speech after 2 years of age – this could be a signal that language development is not progressing adequately and further testing may be warranted.


3 year old visit – children are generally up to date – any immunizations that are missing from the primary set may be given at this time

4 year old visit – booster doses of DtaP, IPV, Varivax and MMR are given