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 a growth chart.

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 3 meals and 2 healthy 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, most kids:

• can talk with another person and have at least 2 back-and-forth exchanges
• are understood by others most of the time when speaking
• give their first name when asked
• ask who, what, where, or why questions
• can identify what is happening in a picture, like running or playing
• notice other children and join them to play
• draw a circle when you show them how
• string some items together, like large beads
• put on some clothes by themselves
• use a fork

Talk to your doctor if your child is not meeting one or more milestones, or you notice that your child had skills but has lost them.

4. Do an 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 vaccines.Vaccines can protect kids from serious childhood illnesses, so it's important that your child get them on time. Vaccine schedules can vary from office to office, so talk to your doctor about what to expect.

6. Order tests. Your doctor may order tests to check for anemia, lead, and tuberculosis, if needed.

Looking Ahead

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

Feeding

• Preschoolers should get 2 cups (480 ml) of low-fat or nonfat milk or fortified soy milk. Offer other low-fat and nonfat dairy products, like yogurt.
• Limit 100% juice to no more than 4 ounces (120 ml) a day. Avoid high-sugar and high-fat foods and drinks.
• Let your child decide when they're hungry or full. If your child chooses not to eat, offer a healthy snack later.
• Try to eat together as a family most nights of the week.

Routine Care

• If your child no longer takes an afternoon nap, be sure to allow for some quiet time during the day. You may also need to adjust bedtime to ensure your child gets enough sleep.
• 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.
• 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 ways they can play and be with other kids.
• Limit screen time (time spent with TV, smartphones, tablets, and computers) to no more than 1 hour a day of high-quality children's programming. Watch with your child to boost learning. Keep TVs and other screens out of your child's bedroom.
• Read to your child every day.
• Set reasonable and consistent rules. Praise good behavior and calmly redirect unwanted behavior.
• Do not spank your child. Use time-outs instead.
• 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 checked and cleaned. To help prevent cavities, the doctor or dentist may brush fluoride varnish on your child’s teeth 2–4 times a year.

Safety

• Have a safe play area and allow plenty of time for exploring, make-believe, and active play.
• 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).
• Always supervise your child around water and when playing near streets.
• Apply sunscreen of SPF 30 or higher at least 15 minutes before your child goes outside to play and reapply about every 2 hours.
• Protect your child from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.
• Make sure your child always wears a helmet when riding a tricycle or bicycle.
• If your child has outgrown the rear-facing height or weight limit allowed by the seat’s manufacturer, turn the car seat forward-facing. Kids should stay harnessed in a forward-facing car seat in the back seat until they reach the highest weight or height limit. When your child has outgrown this seat, switch to a belt-positioning booster seat until your child is 4 feet 9 inches (150 cm) tall, usually when they're 8–12 years old.
• 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 can't get to the keys.
• 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.