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How Your family is Doing
Take time for yourself and to be with your partner.
Stay connected to friends, your personal interests, and work.
Have regular playtimes and mealtimes together as a family.
Give your child hugs. Show your child how much you love them.
Show your child how to handle anger well, time alone, respectful talk, and how to be active.
Stop hitting, biting, and fighting right away.
Don’t smoke or use e-cigarettes. Keep your home and car smoke-free.
Don’t use alcohol or drugs.
If you are worried about your living or food situation, talk with us. Community agencies and programs such as WIC and SNAP can also provide information and assistance.
Your Growing and Changing Child
Children at this age often want to do things by themselves.
Give your child opportunities to make choices - what clothes to wear, books to read or places to go.
Patience and encouragement will help 3 year olds develop new skills and build self confidence.
At 3 years of age most children speak in 3 word sentences.
Caregivers can promote their child's language development by providing a language-rich environment such as talking aloud to your child as you are going through the day.
A stubborn toddler is normal- they are learning to say no.
The most powerful tool for effective discipline is attention - to reinforce good behavior and discourage others.
Don’t spank, hit, slap, threaten, insult, humiliate or shame to correct your child’s behavior.
Provide opportunities for your child to safely explore the world around them.
Teach good behavior. Have a few simple rules and consistently respond when your child follows or does not follow them.
CDC’s Milestone Tracker is a useful app (iOS and Android and on the web) to read about stages of your child’s development, for ages 2 months to 5 years.
FREE behavioral and developmental assessments are available.
San Diego County residents through the First 5 programs (888) 534-7785 or First5sandiego.org.
Southern Riverside residents through the Healthy Steps Programs (858) 966-8300 or Healthysteps.org.
Riverside and San Bernardino Counties are also served by Inland Regional Center (909) 890-4763.
Nutrition
Mealtimes should be a pleasant time for the family.
Eat together as a family.
Turn off the television during mealtimes.
Let your child decide how much to eat.
Think “5210” Every Day!
5 or more servings of fruits & vegetables
2 hours or less recreational screen time
1 hour or more of physical activity
0 sugary drinks, more water & low-fat milk
Important Vitamins and Nutrients
Calcium: Builds strong bones. Commonly found in dairy products, sardines, broccoli, kale, and enriched orange juice.
Vitamin D: Helps keep bones strong and supports many body functions. Most children’s multivitamins will contain the recommended 600 IU per day. Found in milk, yogurt, cheese, salmon, tuna, mushrooms, egg yolk, and fortified cereals.
Iron: Keeps blood healthy, helping with growth and development. Found in eggs, chicken, leafy greens, red meat, beans, and fortified grains like breads and cereals.
Food Assistance
2-1-1 is an organization that helps families connect with food assistance programs such as CalFresh, local and regional food banks, emergency food services, Women Infant Children (WIC) program and more. Contact them at 211sandiego.org/resources/food-assistance/ OR dial 2-1-1 from any phone.
Some families may qualify for assistance in purchasing food for children up to age 5. For more information on the WIC program please ask your doctor or contact WIC directly
WIC San Diego http://sandiegowic.org/ 1-800-500-6411
WIC Riverside 1-800-472-2321
Reading and Electronic Media
Read daily to your child.
Use books to talk together.
Ask your child questions about the story or pictures.
Let them “tell” the story.
Limit daily screen time to less than 2 hours total.
Turn off screens at least 1 hour before bedtime to help with better sleep.
Limit or reduce media exposure (including playing with electronic toys).
Playing with Others
Children at this age often play well with other children.
They may enjoy having “playdates”.
Encourage interactive games with peers and help them understand the importance of taking turns.
Toilet Training
Watch your child for clues that they are ready for toilet training - (staying dry, interest in potty, can pull pants up/down).
Praise success. Avoid punishment. Normalize accidents.
Physical Activity
Children younger than 6 years need 3 hours of activity every day.
Supervise all outdoor play, especially near streets and driveways.
Help your child build lifelong habits for staying active, enjoying recreation, and learning healthy ways to compete.
Support trying different activities instead of focusing on just one sport.
Sleep
3 year olds need between 10-13 hrs of sleep (including naps).
Set up a quiet routine before bedtime and be consistent.
If your child wakes up a lot at night or calls for you frequently, briefly reassure them and put them back in their bed.
You can also get additional information regarding sleep from the Pediatric Sleep Council at www.babysleep.com.
Healthy Teeth
Brush your child’s teeth twice per day with a soft bristled toothbrush and a small amount of fluoridated toothpaste.
Schedule regular visits with your child’s dentist.
Limit how much sweet and sugary foods and drinks your child gets.
Prevent baby bottle tooth decay by never putting your baby to bed with a bottle and don’t let them carry the bottle around with them.
The American Academy of Pediatrics recommends applying fluoride varnish to kids' teeth every 3-6 months, starting when they get their first tooth until they are 5 years old. Fluoride Varnish Information.
To find eligible Medi-Cal dental clinics near you: Call 1-800-322-6384 or visit http://www.denti-cal.ca.gov/
Safety
Childproof your home. Go through every room remove anything that is either valuable, dangerous, or messy.
Foods that may cause choking should be avoided until 5 years old. These include nuts, peanuts, popcorn, pretzels, chips, large chunks of meat, hard candy, gum, whole grapes, raisins, hot dogs, raw vegetables, and spoonfuls of peanut butter.
Cut their food into small pieces and make sure anything you give your child is soft, easy to swallow and cut into small pieces.
Never leave your child alone in the car, house, or yard.
Teach your child to ask if it is OK to pet a dog or another animal before touching it.
Continue to use a 5-point car safety seat (not a booster seat) in the back seat
Check your smoke detector to make sure it is working.
Keep a fire extinguisher in or near the kitchen.
Keep all electrical appliances out of the bathroom or out of reach, especially hair straightening and curling irons.
Turn your water heater down to 120°F (50°C).
Make sure windows are closed or have screens that cannot be pushed out.
Do not allow your child to climb on ladders, chairs, or cabinets.
Lock doors to dangerous areas like the basement or garage.
Make sure drawers, all furniture, televisions and lamps are anchored to the wall when possible and can't fall over.
Hold onto your child's hand when you are near traffic.
All family members should use a bicycle helmet, even when riding a tricycle.
Watch your child constantly when they are around the bathtub, jacuzzi, pool or any other body of water outside the house.
Protect your child from the sun with clothing, a hat, other covering, and sunscreen of 15 SPF or higher.
Keep all medicines, vitamins, cleaning fluids, and other chemicals locked away.
Keep the poison center number on all phones 1-800-222-1222 or 9-1-1.
Even small amounts of lead can hurt your child's health and brain development.
Take away toys and jewelry that could have lead.
Look up recalls on a website called Consumer Product Safety Commission.
Remove guns from the home.
If you do have a gun, store it unloaded and in a locked cabinet.
Store ammunition in a separate location
Immunizations
Immunizations protect your child against several serious, life-threatening diseases.
Before starting kindergarten your child will need vaccinations.
The recommended vaccines can be found at www.cdc.gov/vaccines/parents/childhood-vaccines and https://publications.aap.org/redbook/resources/15585/AAP-Immunization-Schedule.
During flu season (August through March), it is recommended your child receive a flu vaccine.
You may give acetaminophen (Tylenol) or Ibuprofen (Motrin or Advil) if your child develops irritability or a fever of 101 F or higher.
For swelling or soreness, put a wet, warm washcloth on the area of the vaccines as often and as long as needed for comfort.
Do not give cold and cough medicine to children at this age.
Acetaminophen(Tylenol) Dosing:
Give every 4-6 hours as needed for pain or fever (do not exceed more than 5 doses in 24 hours).
Pay attention to strength of medication.
Ibuprofen (Motrin, Advil) Dosing:
Give every 6-8 hours as needed for pain or fever.
Note that ibuprofen suspension comes in two different strengths.
What To Expect at Your Child’s 4 Year Visit
Bring your child’s immunization card to all visits.
We will discuss:
Caring for your child, your family, and yourself
Getting ready for school
Eating healthy
Promoting physical activity and limiting screen time
Keeping your child safe at home, outside, and in the car
📚 References
This content was adapted from HealthyChildren.org and Bright Futures.
Reviewed by SC MD, JW MD Patient Education Committee.