Your Child's Checkup: 3 Years

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your child's weight and height, calculate body mass index (BMI), and plot the measurements on growth charts.

2. Check your child's blood pressure and vision, if your child is able to cooperate.

3. Ask questions, address concerns, and offer guidance about how your child is:

Eating. Growth is slow and steady during the preschool years. Offer three meals and two nutritious snacks a day. Even if your child is a picky eater, keep offering a variety of healthy foods.

Peeing and pooping. Your preschooler may be potty trained or using the potty during the day. Even so, it is common for kids this age to have an occasional accident during the day and still need a diaper at night. If your child has not yet shown the signs of being ready to potty train, tell your doctor. Also let the doctor know if your child is constipated, has diarrhea, seems to be "holding it," or was potty trained but is now having problems.

Sleeping. Preschoolers sleep about 10–13 hours a day. Most kids this age still take a nap during the day.

Developing. By 3 years, it's common for many kids to:

• string three or more words together to form short sentences
• be understood most of the time when they speak
• pedal a tricycle
• jump forward
• copy a circle
• dress and undress with a little help
• play make-believe
• take turns while playing

4. Do a physical exam with your child undressed while you are present. This will include an eye exam, teeth exam, listening to the heart and lungs, and paying attention to speech and language development.

5. Update immunizations. Immunizations can protect kids from serious childhood illnesses, so it's important that your child get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may assess your child's risk for anemia, lead exposure, and tuberculosis and order tests, if needed.

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Looking Ahead

Here are some things to keep in mind until your child's next checkup at 4 years:

Feeding

1. Preschoolers should get 2 cups (480 ml) of low-fat or nonfat milk (or equivalent low-fat dairy products) daily. You also can give a fortified milk alternative like soy or almond milk.
2. Limit juice to no more than 4 ounces (120 ml) a day. Avoid high-sugar and high-fat foods and drinks.
3. Let your child decide when he or she is hungry or full. If your child chooses not to eat, offer a healthy snack later.
4. Try to eat together as a family most nights of the week.

Routine Care

1. If your child gives up the afternoon nap, be sure to allow for some quiet "winding down" time during the day. You may also need to adjust bedtime to ensure your child gets enough sleep.
2. Nightmares and night awakenings are common at this age. If you haven't already, set up a regular bedtime routine to help your child fall asleep at night. Avoid scary or upsetting images or stories, especially before bed.
3. If you've enrolled your child in preschool, visit the classroom together a few times before school starts. If your child is not in preschool, look for opportunities to interact and play with other kids.
4. Limit screen time (TV shows, DVDs, smartphones, video games, tablets, and computers) to no more than 1 to 2 hours a day of quality children's programming. Keep screens out of your child's bedroom.
5. Read to your child every day.
6. Set reasonable and consistent rules. Praise good behavior and calmly redirect unwanted behavior.
7. Do not spank your child. Use time-outs instead.
8. Have your child brush teeth twice a day with a pea-sized amount of fluoride toothpaste. Schedule a dentist visit to have your child's teeth examined and cleaned.

Safety

1. Have a safe play area and allow plenty of time for exploring, make-believe, and active play.
2. Make sure playground equipment is well maintained and age-appropriate for your child. Surfaces should be soft to absorb falls (sand, rubber mats, or a deep layer of wood or rubber chips).
3. Always supervise your child around water and when playing near streets.
4. Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.
5. Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.
6. Make sure your child always wears a helmet when riding a tricycle or bicycle.
7. If your child is still in a rear-facing car seat, check the maximum weight and height limits recommended by the manufacturer. Turn the car seat around when your child is the right size. Kids should stay harnessed in the car seat until they reach the highest weight or height limit allowed by the seat's manufacturer.
8. Protect your child from gun injuries by not keeping a gun in the home. If you do have a gun, keep it unloaded and locked away. Ammunition should be locked up separately. Make sure kids cannot access the keys.
9. Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your child? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.