Nutrition Growing independence is a hallmark of this stage in your child’s life. It is easy to believe that your child can make good food and activity decisions independently. However, you still need to be in charge of your child’s nutrition and activity environment, providing food and activity choices for your child within the boundaries that you set. It is important for you to set the initial boundaries, such as what kinds of food will be in the house; when meal and snack times are; how much television time the family will have; and what kind of activities are available to the child. Within these boundaries parents should provide the child with choices, such as a variety of healthy snacks and options for what they will do during outside play. This not only prevents every decision from becoming a battle, but also encourages healthy decision making and avoids over-restriction. Busy families frequently eat out, often leaving the decision about what to eat up to the preschool child. It is important to limit eating out and to maintain oversight of your child’s food choices here as well. Meals and Snacks Set a schedule for meals and snacks for your child. This will provide structure and predictability. This should include 3 meals and 2-3 snacks per day as part of your child’s routine. With set meal and snack times, you can avoid your child eating (or grazing) throughout the day. Grazing can lead to an unhealthy eating pattern. Utilize the MyPlate visual diagram to include all 5 food groups in meals and snacks. For the 3 meals of the day make half of their plate fruits and vegetables. Remember: it can take up to 100 times of presenting a vegetable before a child will eat it. Never force a child to eat a vegetable—this will just create a battle and control issue-- and do not reward a child eating their vegetables with dessert. Remember: Parents provide and the child decides. Parents are responsible for what the family eats, when the family eats, and where the family eats. Your child’s job is to decide how much of the correct portion to eat. Children are responsible for whether they eat what is offered or wait until the next meal/snack. For more information and tips please visit ChooseMyPlate.gov. Picky eating, food refusal, and food jags—liking something one day and not the next -- are normal parts of your child’s development. As parents we need to avoid falling into a pattern of offering only what the child “likes” or offering less nutritious foods because your child refuses the healthy foods offered to them. Remember that small exceptions in portion sizes, treats, and snacks can add up to weight gain over time—as little as 150 kcal extra intake per day (such as an extra bowl of cereal before bed) can become a 15-lb (6.8-kg) weight gain over the next year. Is My Child Overweight/Obese? Childhood obesity is increasing at alarming rates in the United States. According to a 2011 report from the Institute of Medicine, slightly over 20 percent of children aged 2 -5 are overweight or obese. Contrary to the belief that young children will “grow out of it,” excess weight persists into later life and increases the risk for weight-related diseases in both childhood and adulthood. Body mass index (BMI) is widely used to help categorize weight. BMI compares height and weight, and norms vary by age and sex. In general a BMI between the 85th and 95th percentile is considered overweight, and a BMI above the 95th percentile is usually considered obese. BMI will be calculated at your child’s well visit. If your child’s BMI is in the overweight or obese zone, talk to your child’s doctor about developing a healthy weight plan. Good nutrition is a family affair. Parents are the most important role model for their children. Look down at your own plate and see what types of food you’re modeling for your child to eat. Try to have your own plate resemble the MyPlate diagram so that your child can see you eat and enjoy the foods that you are encouraging them to eat. Eating together promotes healthy nutritious habits, so sit down for family meals daily. Healthy Habits Tips Remember the message “7-5-2- 1-0” for what healthy habits are important for your child. 7: Eat breakfast 7 days a week. Eating breakfast prevents children from getting too hungry and overeating later in the day---habits that lead to excess weight. If serving cereal, provide a breakfast cereal with at least 2 grams of fiber and less than 9 grams of sugar per serving. 5: Eat at least 5 servings of fruits and vegetables per day. By making ½ your child’s plate fruits and vegetables at meals and including fruits and vegetables for snack, your child will get the needed amount of fruits and vegetables. Involve your preschooler in food preparation that is appropriate for their age. 2: Do not to let your child spend more than 1 to 2 hours on total screen time (TV, video games, recreational computer time, iPad, iPhones). 73% of 2 to 4 year olds watch TV every day; 39% of children at this age are using mobile devices; and 30% of 3 year olds have TVs in their bedrooms. The average age of first computer use is 3.5 years old. Increased TV time is associated with lower fruit and vegetable consumption. Preschoolers are a major target of advertising, and limited screen time will decrease your child’s unhealthy exposure to commercials and marketing that influence and result in cravings for unhealthy foods, including sugared-cereals, unhealthy snack foods, fast food, and sugar-sweetened beverages. o Parent’s number one reason for placing TVs in the bedroom is as a sleep aid, but ironically, TVs in bedrooms increase the risk for disordered sleep, decrease parent and child communication, and increase the risk of excessive screen time. Turn the TV off during meals and keep the TV and computer out of your child’s bedroom. If there already is a television in their bedroom, remove it. These steps will not only decrease screen time, but also help increase parent-child communication, and decrease disordered sleep. 1: Have your child participate in at least 1 hour of physical activity per day. Many children under 5 fail to meet physical activity guidelines. Playing outside at this age usually results in more physical activity than indoor play. Plan for unstructured, outdoor play time every day, if your child can play in a safe environment. 0: Encourage your child to drink almost no sugar sweetened beverages. Soda, sports drinks, lemonade, fruit drinks, and even 100% fruit juice (collectively called sugar-sweetened beverages) all contain a large amount of sugar which contributes greatly to excess weight, so try not to buy or bring these beverages into your home. Water and low-fat (1%) or nonfat (skim) milk are the best drinks for you to drink. Remember 2% milk is not considered low-fat. 27% of children at this age are still consuming whole milk, and 14% are consuming flavored milk. Whole milk and flavored milk add calories from fat and sugar that most children this age do not need. Many parents assume that child care, preschool, and other caregivers, including family members are providing good nutrition and activity options for their child. It is important for families to ask about these options and provide healthy alternatives if needed. For more information on how to encourage healthy habits for children 0-5 years of age, please visit: www.healthychildren.org/growinghealthy Feeding Guide for Children 2 to 3 Years of Age Food Portion Size Servings Comments Milk and dairy ½ cup (4 oz) 4-5 (16-20 oz total) The following may be substituted for ½ cup fluid milk: ½ -3/4 oz. cheese, ½ cup yogurt, 2 ½ tbsp. nonfat dry milk Meat, fish, poultry, or equivalent 1-2 oz (3 oz is about the size of a deck of cards) 2 (2-4 oz total) The following may be substituted for 1 oz. meat, fish, or poultry: 1 egg, 2 tbsp. peanut butter, 4-5 tbsp. cooked legumes 4-5 Include one green leafy or yellow vegetable for vitamin A, such as carrots, spinach, broccoli, winter squash or greens Vegetables and fruit Vegetables Cooked Raw 2-3 tbsp Few pieces Fruit Raw Canned (own juice) Juice Grain Products Whole grain or enriched bread Cooked cereal Dry cereal Include one vitamin C-rich fruit, vegetable, or juice, such as citrus juices, orange, grapefruit, strawberries, melon, tomato, or broccoli ½ - 1 small 2-4 tbsp 3-4 oz ½ - 1 slice ¼ - ½ cup ½ - 1 cup 3-4 **Aim to make ½ eaten grains, whole grains (example: brown rice, whole grain pasta, whole wheat bread) The following may be substituted for 1 slice of bread: ½ cup of spaghetti, macaroni, noodles, or rice, 5 saltines, ½ English muffin or bagel, 1 tortilla, corn grits Development Social/Emotional o A three year old’s world is full of fantasy and imagination. This is a magic time for children and for everyone around them. Your three year old’s vivid fantasy life helps her explore a wide range of emotions, from love and dependency to anger, protest and fear. She will take on several identities herself and may give living qualities and emotions to objects in her life. o Your child should be becoming more independent and responsive to other children. Self-help skills such as toilet training, dressing, tooth brushing, etc. are maturing. Also rapidly improving language skills keep your child expressing desires and feelings verbally rather than through physical actions such as whining and grabbing. Helping your child put all of her skills together so that she feels confident and capable is one of the most important ways that you can guide and encourage self-discipline during this age period. o At three your child will be less selfish than she was at age two. She will be less dependent on you and more secure. She will now play with other children, interacting instead of just playing side by side. You will see her drifting towards certain children and developing friendships. o A three year old is learning to become more aware of and sensitive to the feelings of others. This leads to more cooperation with both adults and other children. Play sessions should be calmer, and with less aggressive behavior. At times you will need to encourage cooperation. For instance, you might suggest to “use your words” as you see disagreements arise between children. You may need to remind children, who are sharing a toy, that each will have an equal turn. As the year progresses, your three year old should be able to learn to take turns and to share in a small group. Also she should be able to learn to ask politely much of the time, rather than grabbing, whining, or screaming for something. Tips: o Hug and cuddle your child often. Praise your child for positive behaviors, such as trying a new task, sharing with a friend or being cooperative. o Encourage and reward self-help skills. Encourage your child to use a fork and spoon at meals. Teach your child to use a washcloth or sponge to bathe. o Find a play group or nursery school where she can practice cooperation and learn to socialize. o Show your child, by your own example, how to peacefully deal with conflicts. If you have a bad temper, try to tone down your reactions in your child’s presence. Otherwise, she will mimic your behavior when she is under stress. Cognitive/Learning o Your three year old may spend much of his day questioning everything around him. He will love to ask “why”. Take these questions seriously but don’t feel obligated to give detailed explanations, especially to questions that have no real answers. Answers like: “because it is good for you” or “I don’t know; let’s find a book about the sun to read and see” are fine. A three year old’s reasoning skills are still very limited and one-sided. o Around age three your child will begin to develop a sense of time. He will know his daily routine and try to figure routines of other people. He will understand that holidays, and birthdays occur once in a while, but he’ll have no real sense of a year. Learning Milestones Between 3 -4 Years of Age o Correctly names some colors. o Understands the concept of counting and may know a few numbers. o Begins to have a clearer sense of time. o Understands the concept of same/ different. o Follows three part commands. o Recalls part of a story. Language/ Speech Development o By three years of age your child should have a vocabulary of 300-1000 words and be able to speak in sentences of five or six words. A stranger should be able to understand at least 75% of what your three year old says. o Most three year olds talk constantly. This may disturb parents at times, but relax this chatter is an important phase. Your child is learning new words and is gaining experience in using them and thinking with them. Tips to help Language and Speech Development: Read to your three year old at least 30 minutes a day. Ask your child questions about the story or the pictures. (How many?, What color?, Where did he go?, Is he up or is he down?) Use opposites. Let him tell part of the story. Sing songs and recite nursery rhymes with your child. Children at this age especially enjoy songs and stories that rhyme. Introduce ABC’s by drawing large capital letters and sing the alphabet song. Speech Sounds: By age three years most children are able to make the following sounds: b, p, m, h, d, g, k and vowel sounds (a, e, i, o, u). Between three and four the following sounds should develop: y, t, k, w. The following sounds may not develop more fully until after four years of age: l, f, s, r, v, z, ch, sh, th. Non-fluency/Stuttering o Children between ages two and five often have periods of “non-fluency” or stuttering. Non-fluency refers to difficulty in speaking that involves repeating syllables, (li-li-like this), words, or using fillers such as “uh-uh-uh”. Stuttering tends to last a month or two and then may come and go. Try not to correct your child’s non-fluencies; they will fade in time. If the syllable repetition is severe (li-li-li-li-like this), your child’s facial muscles look tense, or your child experiences a “block” (no voice or airflow for several seconds), then she may be having a significant problem with stuttering. Truly significant stuttering is not common at this age but can occur. Discuss your concerns and observations with your child’s provider. Gross Motor (Movement) Skills o At age three your preschooler should now be able to move about with great agility. She should be able to run, jump and even ride a tricycle with ease. However, her judgment and coordination are still developing, and she will need adult supervision at all times to prevent accidents and injuries. You should not leave her alone to play unless she is in her own child-proofed room. o Your preschooler may seem to be in constant motion. This is because she is using her body to convey thoughts and emotions. Their minds and bodies are very connected. All this movement is a sign that her mind is working and exploring the world. Moving her body helps her understand and explore new words and concepts. For example, if you start talking about an airplane, she may spread her wings and “fly” about the room. While all this activity may at times be annoying to you, it is a necessary part of her learning and her fun. Movement Milestones between 3 & 4 years: o Hops and stands on one foot for up to five seconds. o Goes up and down stairs without support. o Kicks ball forward o Throws ball overhead o Catches large bounced ball most of time Fine Motor (Hand and Finger) Skills o Three year olds are developing both the muscle control and the concentration needed to master more precise hand and finger movements. He should be able to hold his crayon more like an adult, with thumb on one side of the crayon and his fingers on the other. o Three year-olds also are becoming more aware of the relationship between objects in space. This increased awareness and his better fine muscle control will allow him to build a tower of nine or more blocks and to feed himself without spilling very much. o Three year-olds are interested in discovering what they can do with tools such as paper scissors, and with materials such as clay, paint and crayons. Activities to improve your child’s hand and finger skills: Build with blocks Simple jigsaw puzzles (4 or 5 large pieces) Pegboards String large beads Color with crayons or chalk Dressing and undressing dolls Encourage drawing circles and shapes Teach your child to use safety scissors. Cut out pictures from magazines and catalogs and help your child glue them to paper. Introduce ABCs by drawing large capital letters. Discipline A three year old is now capable of learning the basic rules of what is allowed and what is not allowed at home and in public. Parents have the right and responsibility to take charge and make rules for their child. Learning to follow rules and obey directions will help keep your child safe and will help your child become a pleasant, helpful and loving person. Telling your child “no” firmly and using “time-out” are most effective forms of discipline without anger. The AAP does not recommend corporal punishment (spanking). Make sure that your child understands the difference between important rules, that are not open to negotiation, and areas in which he does have choices. Important rules include staying in the car seat, not hitting other children, getting ready to leave on time in the morning and going to bed at night without problems. Try to keep important rules to no more than about 10 or 12 items and be prepared to stick to them. Examples of appropriate child decisions include things such as which cereal to eat, books to read and toys to take in the tub. All three year olds cry, whine and throw tantrums. If your child is crying because of pain, hunger or fear, respond immediately to this need. Make sure that your child receives sufficient sleep. Tired children are often irritable and poorly behaved. When your child is misbehaving because he wants something that is not allowed, ignore this behavior or use “time-out”. When your child shows good behavior, provide extra cuddling and enjoyable activities. Giving your child more attention for his good behavior will cause your child to behave better and have fewer tantrums. Safety Injuries are the leading cause of death in children younger than 4 years of age. Your child is at special risk for injuries from falls, drowning, poisons, burns, and car crashes. Your child doesn’t always understand dangers or remember “no” while playing and exploring. Falls o Your child will find an endless variety of dangerous situations at home and elsewhere. o Your child can fall off play equipment, out windows, down stairs, off a tricycle, or anything that can be climbed. Make sure the surface under play equipment is soft enough to absorb a fall. Use safety-tested mats or loose-fill materials, like shredded rubber, sand, wood chips, or bark, maintained to a depth of at least 9 inches and extending at least 6 feet (more for swings and slides) from play equipment. o Household items may pose a danger to your child. Children can have serious injuries from improperly secured television sets that topple on them. o Avoid the recreational use of trampolines at home. Children, especially those 5 years or younger, are at risk of serious trampoline-related injuries. o Lock doors to dangerous areas. Use gates on stairways and install operable window guards above the first floor. Fence in the play yard. Water Safety o Most drowning injuries occur in backyard pools. Water safety truly begins at home. Never leave a child alone in or near water, even for a moment. Constant adult supervision is essential. Children can even drown in wading pools or bathtubs in just a few inches of water. o Use Coast-Guard approved personal flotation devices (life jackets) if boating. o If you own a pool, be sure it is enclosed by a fence or wall with a self-closing, self-locking gate. Avoid fences, like chain-link, that can be climbed easily. Poisonings o Your child will be able to open any drawer and climb anywhere. Use only household products and medicines that are absolutely necessary and keep them safely capped and out of sight and reach. Keep all products in their original containers. o If your child does put something poisonous in his or her mouth, call the poison help line immediately and do not make your child vomit. Add the Universal Poison Control Number (1-800-222-1222) to your cell phone contacts and display the number prominently in your home. Burns o The kitchen is a dangerous place for your child, especially when you are cooking. Hot liquids, grease, and hot foods can spill and cause serious burns. Find something safe for your child to do while you are cooking. o Be careful with hot appliances. Irons, curling irons, ovens, heaters, and outdoor grills can burn your child long after you have finished using them. o To protect your child from hot water scalds, reduce the maximum temperature of your hot water heater to 120 degrees F. o Make sure that you have a working smoke alarm on every level of your home, especially in sleep areas. It is best to use smoke alarms that use long-life batteries, but if you do not, change batteries at least once a year. o If your child does get burned, immediately put cold (but not ice cold) water on the burned area. Keep the burned area in cold water for a few minutes to cool it off. Then cover the burn loosely with a dry bandage or clean cloth. Sun Exposure o Use sunscreen with SPF 30 or greater when your child is outside during the day. Avoid sun between the hours of 10 am and 4 pm. Sun exposure during childhood will increase your child’s chance of skin cancer and photo aging (wrinkles) later in life. Car Safety o Car crashes are the greatest danger to your child’s safety and health. To prevent serious injuries to your child use a forward facing 5 point harness car seat. Children 80 pounds AND up to 4 feet 9 inches (57 inches) need to be restrained in booster seat. For more information about car safety seats and for information about having your seat checked for proper installation call 1800-252- 8255 (safe riders program) or 1-866-SEATCHECK (www.seatcheck.org). o The safest spot for a car seat is in the middle of back seat. If your child must sit in the front seat, make sure that the seat is pushed back as far as possible to avoid air bag injury in the event of an accident. o Do not allow your child to play or ride a tricycle in the street. Driveways are also dangerous. Walk behind your car to check for little ones before you back up. You may not see your child in the rear view mirror. Children should play in a fenced areas, like a yard or playground Gun Safety o Children in homes where guns are present are in more danger of being shot by themselves, their friends, or family members than being injured by an intruder. It is best to keep all guns out of the home. If you choose to keep a gun, keep it unloaded and in a locked place separate from the ammunition. Handguns are especially dangerous. Ask if homes where your child visits or is cared for have guns and how they are stored. . Reading Suggestions and Resources The following are a few books and websites that we can recommend: Caring for Your Baby and Young Child: Birth to Age 5, The American Academy of Pediatrics. www.healthychildren.org, A parenting website sponsored by the American Academy of Pediatrics. www.choosemyplate.gov, USDA Dietary Guidelines. This website has child-friendly materials and practical information for parents.
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